Lecture 7
Shock
Definition of Shock
It is a condition in which systemic blood
pressure is inadequate to provide
perfusion to the vital organs.
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1.
2.
3.
4.
5.
Hypovolemic: inadequate blood volume
Cardiogenic: failure of the heart as a pump
Neurogenic: neural alterations of vascular
smooth muscle tone
Anaphylactic: immunologic processes or
allergic reactions
Septic: systemic inflammatory response to
microorganisms and/or damaged
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Hypovolemic
Caused
1. loss of whole blood (hemorrhage),
2. plasma (burns)
3. diaphoresis,
4. DM/hyperglycemia,
5. DI,
6. emesis
7. diuresis
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 LOC
 Skin: cool, moist, pale
skin
 Resp rate: rate and depth are increased
and pt c/o dyspnea
 Heart rate: pulse is weak and thready,
 Blood pressure: decreases
 Urine output: decreased ( oligurea )
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Note
Hypovolmic shock is most common
type of shock
problem associated with hypovolmic
shock is
1.
2.
•
•
•
Altered tissue perfusion
Impaired gases exchange
Decrease cardiac out put ( dec.Bp)
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Treatment of Hypovolemia
 Early
detection and minimizing the loss
are key
 Restoration of fluids and plasma volume
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Causes of Cardiogenic Shock
1.
2.
3.
4.
MI (>40% of muscle loss)
Valve dysfunction
Severe dysrhythmias
Pulmonary embolism
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Treatment of Cardiogenic Shock
1.
2.
Increase oxygen supply to the heart
Decrease heart work
Goal of treatment
1.
2.
Restore and maintain tissue perfusion
Correct physiologic abnormality
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Neurogenic Shock

Also called vasogenic shock
 Causes:
• Develops with spinal anesthesia,
• spinal cord injury,
• altered function of the vasomotor center in
response to
 low blood sugar
 drugs, including sedatives, barbiturates, and
narcotics
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Anaphylactic Shock
1.Result of a severe allergic or antigenantibody reaction
2.Reaction causes a release of histamine,
causing vasodilation
3.bronchoconstriction
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Causes of Anaphylactic Shock
1. Substances that act as antigens:
1. Drugs (ex: PCN)
2. Contrast media
3. Transfused blood
4. Insect venoms
5. Foods (ex: shellfish)
6. Pollens
7. Latex allergies
2.
Once in the body, the antigen causes an
extensive immune and inflammatory
response causing vasodilation
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Symptoms of Anaphylactic Shock
Onset of symptoms is within seconds and progression
can lead to death in minutes
• Allergic reaction sx:
 Edema
 Uticaria (hives)
 Burning, itching skin
 Difficulty breathing
 Anxiety
 Enlarged tongue
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First Aid
 Check the person's airway, breathing, and
circulation. If necessary, begin rescue
breathing and CPR.
 Even if the person is able to breathe on his
or her own, continue to check rate of
breathing at least every 5 minutes until
help arrives.
 If the person is conscious and DOES NOT
have an injury to the head, leg, neck, or
spine, place the person in the shock
position.
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4. Lay the person on the back and
elevate the legs about 12 inches.
5. DO NOT elevate the head. If raising
the legs will cause pain or potential
harm, leave the person lying flat.
6. Give appropriate first aid for any
wounds, injuries, or illnesses.
7. Keep the person warm and
comfortable. Loosen tight clothing
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1.
Turn the head to one side so he or she will
not choke. Do this as long as there is NO
suspicion of spinal injury.
2.
If a spinal injury is suspected, "log roll" him
or her instead. Keep the person's head, neck
and back in line and roll him or her as a unit.
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