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widespread abnormal cellular metabolism that occurs when oxygenation and tissue perfusion needs are not met to the level necessary to maintain cell function
factors that influence MAP
- total blood volume
- cardiac output
- size of the vascular bed
Overall cause of hypovolemic shock
total body fluid decreased (when too little circulating blood volume causes a MAP decrease, resulting in inadequate total body oxygenation)
Specific causes of risk factors for hypovolemic shock
overall cause of Cardiogenic shock
direct pump failure
specific cause of risk factors for cardiogenic shock
- Cardiac arrest
- Ventricular dysrythmias
- cardiac amyloidosis
- myocardial degeneration
overall cause of distributive shock
fluid shifted from central vascular space (blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot circulate and deliver oxygen)
specific cause or risk factors for distributive shock
- Neural-induced (pain, anesthesia, stress, spinal cord injury)
- chemical induced (anaphylaxis, sepsis, capillary leak (burns))
overall cause of Obstructive shock
cardian function decreased by noncardiac factor
specific cause or risk factors of obstructive shock
pulmonary embolus, pulmonary hypertension, thoracic tumors, tension pneumothorax
4 stages of shock
- initial stage
- nonprogressive stage
- progressive stage
- refractory stage
Cardiac output = ______ x _______
- Heart rate x stroke volume
- normal= 4-7 L/min
how to calculate MAP
- (Systolic - Diastolic) / 3 = X
- X + Diastolic = MAP
Initial Stage of shock is present when the patient's baseline MAP is decreased by less than ___ mm Hg. Total loss of ___ mL of circulating volume.
10 mm Hg. total loss of 750 mL.
Nonprogressive (compensatory) stage of shock is present occurs when MAP decreases by ___ to ___ mm Hg from baseline. Total loss of ___ mL to ____ mL of circulating volume.
10-15 mm Hg. total loss of 750-1500 mL.
what happens in the nonprogressive state of shock
- Kidneys and baroreceptors react- trigger the release of renin, ADH, aldosterone, epinephrine, and norepinephrine to start kidney compensation.
- acidosis occurs (low blood pH)
- hyperkalemia (k+ increases)
what does renin do?
causes decreased urine output, increased sodium reabsorption, and widespread blood vessel constriction.
what does ADH do?
increases water reabsorption in the kidney, further reducing urine output and also causes blood vessel constriction in the skin and other less vital tissue areas
Clinical manifestations for nonprogressive state of shock
- increased respirations
- decreased urine output
- decreased systolic, increased diastolic
- 2%-5% decrease in O2 saturation
Progressive (intermediate) state of shock occurs when there is a sustained decrease in MAP of more than ___ mm Hg from baseline. Total loss of ___ mL to ____ mL of circulating volume.
20 mm Hg. total loss of 1500-2000 mL.
what happens in progressive stage of shock
- vital organs develop hypoxia
- less vital organs become anoxic and ischemic
- low blood pH
- rising lactic acid and potassium levels
clinical manifestations for progressive stage of shock
- restlessness and anxiety
- feeling of impending doom
- pale, cool moist skin
- rapid pulse
refractory (irreversible) stage of shock occurs when ________.
too much cell death and tissue damage result from too little oxygen reaching the tissues.
clinical manifestations for refractory stage of shock
- rapid loss of conciousness
- nonpalpable pulse
- cold, dusky extremities
- slow, shallow respirations
- unmeasurable oxygen saturation
- increase BP
- dopamine (intropin, revimine)
- non-epinephrine (levophed)
- improve contractility of heart
- Dobutamine (Dobutrex)
- Milrinone (primacor)