Shock

1
Shock

• Chapter 15

2
Shock

• Pathologic condition
• Initiated by abnormal cellular metabolism in the
  presence of hypoxia (anaerobic)
• Classified by specific functional impairment
  caused
• Occurs in stages

3
Shock States

• Classifications
• Hypovolemic
• Cardiogenic
• Circulatory
• Septic
• Neurogenic
• Anaphylactic

4
Common Physiologic Responses

• Hypoperfusion of tissues
• Hypermetabolism
• Activation of inflammatory response

5
Cellular
6
Compensatory Mechanisms
7
Stages of Shock

• Compensatory stage
• Progressive stage
• Irreversible stage
• Basis of stages
• How well compensatory mechanisms work
• Severity of clinical manifestations
• Whether tissue damage is reversible

8
Compensatory Stage of Shock

• Discuss the role of the SNS in this stage.
• Describe shunting and associated manifestations.
• Discuss the adequacy of tissue perfusion.
• Identify the expected acid-base imbalance.
• Discuss the associated respiratory changes.
• Identify a patient behavior that may indicate
  this stage of shock.

9
Progressive Stage of Shock

• Why does this stage occur?
• Describe the affect on
• Brain
• Lungs
• Heart
• Kidneys
• Identify other organ systems affected?
• DIC may be a cause or complication.

10
Irreversible Stage of Shock

• Discuss the criteria for this designation.
• When can this designation be made?
• BP remains low
• Liver and kidneys fail
• Acidosis worsens
• Multiple organ dysfunction progresses to complete
  organ failure

11
Common Shock Treatment

• Identify two treatment approaches common to all
  types of shock.
• The sequence of events for the different types of
  shock will vary. Therefore, the management and
  care of the patient will vary.

12
Hypovolemic Shock
13
Cardiogenic Shock
14
Circulatory Shock
15
Management of All Types of Shock

• Describe the rationale for
• Fluid replacement
• Vasoactive medications
• Nutritional support

16
Fluid Replacement

• Identify common Crystaloids
• Identify common Colloids
• Blood components
• Why should dextran be avoid when hemorrage is the
  underlying cause?
• Identify two serious complications associated
  with fluid replacement.

17
Vasoactive Medications

• When will they be used and why?
• Frequent VS
• Administer through central line
• Titrate doses

18
Nutritional Support

• Discuss the reasons for nutritional support.
• Identify two nutritional support modalities.
• Discuss the rationale for using the GI system for
  nutritional support.
• Explain the role of glutamine.
• Identify the pharmacologic drug class most
  effective in prevention of sress ulcers.

19
Psychological Support

• Discuss who needs to be supported with
  psychological support and why?
• Identify problems/issues that must be addressed.

20
Multiple Organ Dysfunction Syndrome

• Sequence of cell damage cause by the massive
  release of toxic metabolites and enzymes, once
  the damage starts the sequence becomes a vicious
  cycle
• Metabolites cause clots to form which block
  tissue oxygenation and damage more cells,
  perpetuating the cycle.
• MODS occurs first in the liver, heart, brain and
  kidney. Most profound change is deterioration of
  the heart muscle.
• Release of myocardial depressant factor (MDF)
  from the ischemic pancreas is a contributing
  factor