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What are the classifications of shock?
hypovolemic-decreased body fluid (hemorrhage, dehydration)
cardiovascular-direct pump failure (MI)
distributive- Fluid shift from central vascular space; increase in fluid (pain, anesthesia, sepsis)
Obstructive-indirect pump failure; cardiac function decreased (pulmonary embolus)
- decreased cardiac output
- increased pulse; thready
- decreased BP
- slow cap. refill
- diminshed peripheral pulse
- Icreased resp. rate; shallow depth
- Cyanosis, around lips and nail beds
- increased Paco2
- decreased Pao2
- increased thirst
- muscle weakness
- absent deep tendo reflex
- sluggish pupillary response to light
- decreased urine output
- increased specific gravity
- sugar present in urine
- pale, mottled to cyanotic
- moist, clammy
- mouth dry
- decreased motility
- diminished bowel sounds
What are some risk factors for hypovolemic Shock?
- Diuretic therapy
- Diminished thirst reflex
- use of aspirin
- use of compilmentary therapies
- anticoagulant therapy
What factors influence Mean Arterial Pressure(MAP)?
- Total blood volume
- Cardiac Output
- Size of vascular bed
*these are related to oxygenation and tissue perfusion
How is total blood volume and cardiac output diresctly related to MAP?
How is the vascular bed indirectly related to MAP?
*Increases in total blood volume or cardiac output raise MAP. Decreases lower MAP.
*Increase in bed size lower MAP and decreases raise MAP
What is anaphylaxis?
*allergic reaction, happens in seconds to minutes
*loss of blood vessel tone; decreased cardiac output
What is sepsis?
*widespread infection that triggers a whole body inflammatory response (distributive shock); infection in blood
What is Capillary Leak Syndrome?
- response of capillaries that change blood vessel intergrity and allow fluid to shift from te blood vessels into interstitial tissue. Once in tissue can no longer supply O2 or remove waste
- (burns, peritonitis, large wounds, malnutrition)
what is hypovolemic shock?
loss of blood volume from vascular space, resulting in decreased MAP, and a loss of O2 carrying capacity from the loss of curculating RBC's
What are the stages of hypovolemic shock?
Initial stage of hypovolemic shock (Early)
*patients baseline MAP is 5-10mm Hg less
*compensatory mechanisms are so effective at returning systolic pressure to normal that O2 blood flow to vital organs is maintained
*may notice an increase in pt's heart and RR from baseline or slight increase in diastolic bp
Nonprogressive Stage of hypovolemic shock (compensatory)
*MAP decreases 10-15mm Hg
*this activates kidney and hormonal compensatory mechanisms b/c cardiovascular are no longer to maitain supply of O2 to organs on own
*kidneys release renin (ADH) which maintains fluid volume by fluid constriction; ie decreased urine output and blood vessel constriction in skin
*pt will be thirsty and anxious, restless, tachycardia, increased RR, decreased urine output, decreased systolic, increased dystolic, 2-5% decrease in O2, pt cold
Progressive Stage of Shock (intermediate)
*sustained decrease in MAP of more than 20 mm Hg
*O2 not being delivered to vital organs, severe cell damage and death
*pt feels impending doom, confused, rapid weak pulse, low bp, cyanosis, anuria, rising latic acid and postassium level
*this needs to be corrected in less than 1 hour for pt to survive
Refractory stage of hypovolemic shock
*too much cell deat has occurred, therapy no longer effective
What is MODS?
Multiple Organ Dysfunction Syndrome- one organ dies and contiues to the next
Risk factors for shock
- GI ulcers
- liver diorders
- vomiting and diarrhea
- asparin, diuretics and NSAIDS
Lab Values: Ph, Latic Acid, Hematocrit, Hemoglobin, Potassium
PH < 7.35 = decreased tissue O2
Latic acid > 7= decreased tissue O2, buildup metabolites
- Hematocrit > 47% (F), 52% (M)=
- < 37% (F), 42% (M)=
- Hemoglobin > 16 (F), 18(M)= dehydration
- < 12 (F), 14(M)= hemorrhage
Potassium> 5= dehydration
what does normal saline and ringers lactate do for pt in hypovolemic shock?
*fluid replacement, increase plasma volume
*cotains sodium, chlorde, calcium, potassium, and lactate dissolved in water-expands vlume, and buffers acidosis
what is best practice to maintain pt safety and quality of care during hypovolemic shock
- ensure airway
- start IV
- administer O2
- Elevate feet, head flat <30 degrees
- examinefor overt bleedng (apply pressure if necessary)
- administer drugs
- icrease iv flow
- do not leave pt
what vitals should be monitored in hypovolemic shock
pulse, BP, Pulse pressure, Central Venous pressure (monitors rt atrium), RR, skin and mucosal color, O2 saturation, mental status, urine output
*every 15 minutes
what vasoconstricting drugs are used to increase MAP?
what inotropic drugs are used to help improve heart muscle contraction?
Which drugs improve myocardial perfusion?
what are some treatment goals?
- maintain tissue perfusion
- replace loss fluid
- control fluid loss
- treat cause of hypovolemia
- support compensatory mechaisms