Chapter 10 SHOCK

Problems with any part of cardiovascular system can cause...

Decreased blood flow--> cellular hypoxia --> shock!

What are the classic signs of hypovolemic shock?

Hypovolemia is insufficient amounts of intravascular fluid. Symptoms can be: tachycardia, tachypnea, low blood pressure, poor perfusion, slow cap refill, signs of dehydration

What are the 4 kinds of shock ?

Obstructive Cardiogenic Distributive hypovolemic

Shock occurs when...

One or more components of the cardiovascular system fails. Shock is a result of inadequate tissue perfusion and inadequate oxygenation.

What can happen when sepsis is not properly controlled?

Pathogens will multiply beyond control cause profound vasodilation and cellular hypoxia

Resistance blood vessels

Permit the body to control where blood is directed based on metabolic need

In non-hemorrhagic hypovolemic shock water is drawn away from the plasma and directed where?

The space between the cells. This shift in fluid removes water from the bloodstream resulting in a decrease in circulating blood volume and a lowered blood pressure

Cardiac output

The volume of blood pumped in one minute

What is the role of hemoglobin?

To carry O2 in the blood

Tension pneumothorax is most commonly caused by?

Trauma that compromises either chest wall or lung

What are the factors affecting Shock

age, illness, injury, medical conditions, mind altering drugs, including prescription meds

what type of prescription medicine can exacerbate shock by limiting or preventing the clotting of blood?

anticoagulant

what type of medication can mask the signs of the shock by limiting the body's ability to increase heart rate?

beta blockers

The "liquid of life" is ...

blood

Signs of decompensated shock?

body unable to restore blood perfusion to the tissues, cellar hypoxia worsens and capillary refill markedly delayed. -respirations become shallow, bP drops below 90 mmHg and heart rate increases. -skin is gray or pale, cool and moist to touch - treated early decompensated shock can be corrected but serious complications can result.

A tension pneumothorax can effect the _____ and the _____?

heart and lungs - because it collapses the lung which can put pressure on the heart

Factors that adversely affect the _______ or the _____ can lead to shock

heart rate; stroke volume

hypovolemic shock is caused by?

loss of circulating blood or loss of internal body water/fluid

The most common cause of distributive shock is

sepsis

what should an OEC do if suspecting patient is going into shock during an assessment?

shift gears - curtail the assessment - manage patient ABCD's and transport immediately!

what position do you put shock patients in if spinal cord injury is NOT suspected?

supine position with feet elevated 8 to 12 inches above the level of the heart

Diaphoresis

sweating

What are some signs that a person may be going into shock?

tachycardia over 100/bpm Tachypnea - respirations over 20/rpm cool skin AMS ( A on AVPU; GCS >15) normal BP

A Pneumothorax is?

A Pneumothorax is a collapsed lung. Major symptoms include: -respiratory distress, -tracheal deviation, -unequal breath sounds -unequal chest rise -chest pain -tachycardia

Define obstructive shock?

A blockage that prevents oxygenated blood from reaching vital organs

Hypovolemic shock is what kind of problem?

A blood volume- related problem

What kind of problem is distributive shock?

A container related problem

what is the most common cause of cardiogenic shock?

A heart attack

Irreversible Shock is not survivable, death is imminent because body systems fail, organ systems shut down and it cannot be reversed

...

What are the 3 most common causes of Obstructive Shock?

1. Tension Pneumothorax - Air seepage into plural space. Pump related disorder 2. Pericardial tamponade - fluid accumulating in the pericardium - sac surrounding the heart. The Right side of heart more vulnerable because walls are thinner than the left side. 3. Pulmonary embolism - Condition caused when blood clot becomes stuck in and blocks a pulmonary artery. Blood clot from leg or pelvis travels to heart and prevents gas exchange in lungs. Condition can be rapidly fatal.

An "early indicator" of hemorrhage is?

A relative tachycardia

The normal heart pumps _____ mL of blood / per contraction?

60-100mL

Shock requires what type of life support system?

ALS

if you must transport a patient in injury down position, it's important to do what?

Access the airway and breathing status frequently

Neurogenic shock results from a disruption in what?

Central nervous system

What are the (4)categories of the American College of surgeons for blood loss

Class I to Class IV. Category class I blood loss is 1 mL lesson or 15% of total volume for 1.5 units. Class IV is extremely life-threatening for loss of 40% of total volume or greater

What causes Neurogenic Shock?

Disruptions in CNS most often result of spinal cord injury

Beta blockers work on heart by...

Limiting the hearts ability to beat faster

Hypotension following a recent post spinal injury can lead to what 2 types of shock?

Neurogenic shock "or" the most likely cause of post trauma shock => hemorrhagic shock due to large volume of blood lost.

What are the 3 types of Distributive shock

Septic (most common) Anaphylactic Neurogenic

non-hemorrhagic hypovolemia shock can occur as a result of?

Severe burns, dehydration, excessive vomiting or diarrhea, sweating, and the use of diuretic medications

What is the standard treatment for pneumothorax?

Support the patient with fluids and oxygen

The Classic signs of shock are?

Tachycardia hypotension (later in shock) tachypnea pale, cool diaphoretic skin, altered mental state restless or combative thirst, weakness, and nausea * Frequent reassessment is important!

What are the three causes of obstructive shock?

The 3 conditions are: 1. tension pneumothorax, 2. pulmonary embolism 3. pericardia tamponade

Define stroke volume?

The amount of blood pumped by left ventricle (heart) with each contraction

What us the parietal plura

The fibrous membrane around the chest wall

Define oxygen saturation?

the degree to which oxygen has bound to hemoglobin

True or False. Neurogenic shock is a "slow" process usually occurring over a period of "hours or days" in the aftermath of spinal trauma injury?

true

in neurogenic shock, the normal neurological input of the blood vessels is disrupted causing what?

vessel dilation

Whats the difference in skin presentation in neurogenic shock that is different from other types?

warm, dry skin