SHOCK

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DEPARTMENT OF NURSING DONE BY: RN, BSc.N ABDULLA K NGWALI SECOND YEAR, SEMISTER ; 1LECTURE; RAHMA JARUFE

TOPIC

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TOPIC: CARDIOVASCULAR SYSTEMSUB TOPIC: SHOCK


Learning objectives’-


At the end of this session every leaner should be able to understand the following:-

Define shock List the stage of shock Describe types of shock with its causes, sign and symptoms. Explain the path physiology of shock List sign & symptoms of the shock in general. Mention the complication of shock. Describe Management & treatment of shock

Definition Shock is a serious medical condition where

the tissue perfusion is insufficient to meet demand for oxygen and nutrition because the body is not getting enough blood flow.

Shock often accompanies severe injury / illness.

OR Is a life threatening condition that occurs

when the body is not getting enough blood flow.

Zanzibar university

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OR

Is a sudden fall in the blood passing through the tissues of the vital organ.

STAGE OF SHOCK


The following stage increase your chances of developing shock:

(a) “PRE- SHOCK” (b) SHOCK (c) “END ORGAN DYSFUNCTION”

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(a) “PRE- SHOCK” Body is able to compensate for decrease perfusion up to 10% reduction n blood volume.

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(b) “SHOCK” Compensatory mechanism overwhelmed see

signs (symptoms of organ dysfunction) 20-25% reduction in blood volume.

(c) “END ORGAN DYSFUNCTION” Learning to irreversible organ damage or death.

Types of shock

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Shock can be divided into: A. Hypovolemic shock B. Cardiogenic shock C. Obstructive shock D. Distributive shock They are;- ( !) Sepsis

(2) Neurogenic (spinal shock) (3) Anaphylaxis (4) Electricity

(A). Hypovolemic shock


Hypovolemic shock (caused by inadequate blood volume)

Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart

unable to pump enough blood to the body. This type of shock can cause many organs to stop

working.


Its primary cause is hemorrhage due to trauma (internal and/or external), or loss of fluid from the

circulation and vomiting and diarrhea are the most common cause in children.

With other causes including burns.

Cause of hypovolemic shock

SIGN AND SYMPTOMS

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A rapid, weak, thread pulse due to decreased blood flow combined with tachycardia.

Cool, clammy skin due to stimulation of vasoconstriction.

Rapid and shallow breathing due to sympathetic nervous system stimulation and acidosis

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Hypothermia due to decreased perfusion and evaporation of sweat.

Thirst and dry mouth, due to fluid depletion.

{B} Cardiogenic shock


Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body.

Sign and symptoms


Distended jugular veins due to increased jugular venous pressure. Weak or absent pulse. Arrhythmia often Tachycardia.

CAUSES OF CARDIOGENIC SHOCK


Cardiogenic shock is caused by the failure of the heart to pump effectively.

This can be due to damage to the heart muscle, most often from a large myocardial infarction.

Cardiomyopathy /myocarditis Congestive heart failure (CHF) Cardiac valve problems.

OBSTUCTIVE SHOCK Is due to obstruction of blood flow outside of

the heart. Several conditions can result in this form of

shock.


Causes of obstructive shock Cardiac tamponade in which fluid in the pericardium prevents inflow of blood into the heart (venous return).

Constrictive pericarditis in which the pericardium shrinks and hardens, is similar in presentation.

Tension pneumothorax Through increased intrathoracic pressure, blood flow to the heart is prevented (venous return).


continue Pulmonary embolism is the result of a

thromboembolic incident in the blood vessels of the lungs and hinders the return of blood to the heart.

Aortic stenosis hinders circulation by obstructing the ventricular outflow tract.


Sign and symptoms of obstructive

Low blood pressure

Lack of oxygen to body tissue

Clammy skin

Cool skin.


{C} DISTRIBUTIVE SHOCK


Is due to impaired utilization of oxygen and thus production of energy by the cell.

Distributive shock include the following;- Septic Anaphylactic, Neurogenic, Electricity

Causes of distributive shock It can be caused by;-

Systematic Inflammatory Response Syndrome (SIRS)

Due to conditions other than infection such as pancreatitis ,burns, or trauma.


continue Toxic Shock Syndrome (TSS) Anaphylaxis (A sudden ,severe allergic reaction) Reactions to drug or toxins. Hepatic (Liver) insufficiency and damage to the(

CNS)


Sign and symptoms of distributiveTemperature <36 OR > 38

Heart rate >90 beats per minutes

Respiratory Rate >20bmin


{a} SEPTIC SHOCK


Septic shock ( associated with infections)

Septic shock is a serious condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow.

The brain, heart, kidneys, and liver may not work properly or may fail.

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CAUSES OF SEPTIC


Septic shock can be caused by ;-1) Gram negative Bacteria such as (among others) Escherichia

co li, Proteus species, kle bsie la , pneumo niae which release an endotoxin which produces adverse biochemical,

Immunological and occasionally neurological effects which are harmful to the body.

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2) Gram-positive Cocci such as pneumococci and

Streptococci and certain fungi as well as Gram-positive

bacterial toxins.

Septic shock also includes some elements of cardiogenic shock.

Symptoms of septic shock Symptoms are :

similar to hypovolaemic shock except in the first stages:Pyrexia and fever, or hyperthermia, due to

overwhelming bacterial infection.

Vasodilation and increased cardiac output due to sepsis.


(b) Anaphylactic shock


Is a type of severe hypersensitivity or allergic reaction.

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causes


Causes include;- Allergy to insect stings, medicines, or foods

(nuts, and seafood), etc.

Sign and symptoms of anaphylactic Polyuria, Respiratory distress, hypotension (low blood

pressure), Encephalitis, fainting, unconsciousness, Urticaria (hives), Angioedema (swelling of the lips, face, neck

and throat), Tears (due to angioedema and stress), Vomiting, itching, Anxiety,

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(d) Electrical Shock

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Is the physiological reaction or injury caused by electric

current passing through the human body. OR An electric current that passes through the body is

also called a shock. And it can be so dangerous but electrical

shock is different from the medical shock discussed .

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In electric shock Oxygen is routinely given, to the victim and some people need to be put on a ventilator (a breathing machine) to increase the amount of oxygen getting to their cells.

Causes Electrical cause can cause injuries including

burns and disturbances to heart rhythm (heart failure) that could be fatal.

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Sign and symptoms Unconsciousness.

Burns, particulary entrance and exit burns ( where the electricity entered and left the body.)

Difficult in beathing or n breathing at all.

Sudden onset of cardiac arrest.


PATHOPHYSIOLOGY OF SHOCK Cells switch from aerobic to anaerobic metabolism Lactic acid production Cell function ceases and swells Membrane becomes more permeable Electrolytes and fluids seeps in &out of cell.


continue Na and K pump impaired


Mitochondria damage cells death


Sign and symptoms in general types ) Rapid respiration 2) Cold and clammy skin,3) A weak but rapid pulse, 4) Fall in blood pressure, due to reduction of blood

volume 5) Weakness all over the body. 6) Dizzy, confused, and may become unconscious. Intensive thirsty due to loss of water

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GENERAL COMPLICATION OF SHOCK


Kidney disease

Liver disease

Intestinal ischemia

Stroke

Disseminated intravascular coagulation (DIC)

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Respiratory failure

Heart failure

Death

Managements and Treatments shock


Airway breathing Circulation Treatments of shock always should be aimed to

correct the cause of shock and helping physiological compensatory mechanism to restore the tissue perfusion.

continue The main goals of the treatment of cardiogenic

shock are the re-establishment of circulation to the myocardium, minimising heart muscle damage and improving the heart’s effectiveness as a pump.

Oxygen (O2) therapy to reduces the workload of the heart by reducing tissue demands for blood flow. Administration of cardiac drugs


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Increase heart’s pumping action and decrease work load of the heart through medication such as Dopamine, dobutamine, epinephrine, norepinephrine.

Nitroglycerine useful only if cardiogenic shock accompanied by appropriate

Dosage 10mg-min 6ml-hr increase by 10mg –min every 5-10min to achieve optimal effect.


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So due to this reason shock is treated due to under lying causes of it if whether is hemorrhagic, or Hypovolemic or anaphylactic

In all types of shock restoration of arterial pressure is essential to maintain perfusion and blood flow to the brain.

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People in shock should be taken by ambulance to a hospital as quickly as possible. then, they should be kept lying down on their back with their feet raised about a foot higher than their head.

Administer counter-mediators such as anti-histamine.

GENERAL PREVENTION OF SHOCK


Elevate the foot of the bed to maintain a good blood supply to the vital organ eg;- brain cells

Replacement of lost fluids by infusion or transfusion.

Administer oxygen if cyanosis is marked.

In case of trauma, give analgesic for pain.

CONTINUEIdentify and control source of infectionAdminister antibiotic

Remove risk factor for infection



References


Silverman, Adam (Oct 2005). "Shock: A Common Pathway For Life-Threatening Pediatric Illnesses And Injuries". Pediatric Emergency Medicine Practice 2 (10).

Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 165–172. ISBN 0-07-148480-9. Marino, Paul L. (September 2006). The ICU Book. Lippincott Williams & Wilkins, Philadelphia & London. ISBN 0-7817-4802-X.

Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 174–175. ISBN 0-07-148480-9.

Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. ISBN 0-07-148480-9.

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