Syndrome characterized by decreased tissue perfusion and impaired cellular metabolism
- Sudden and generalized ischemia to all body parts
- Demand for oxygen and nutrient is the same but the body is not able to provide
What is shock?
- Results from some type lead to a decrease in tissue perfusion which causes cell hypoxia
and eventually multiple organ destruction syndromes (MODS)... death.
- Types
- Septic (infection)
- Hypovolemic (fluid loss)
- Cardiogenic (weak heart)
- Anaphylactic (allergic)
- Neurogenic (neuro damage)
- Obstructive (impeding blood flow)
- Stages
- Initial
- Cell switch from aerobic to anaerobic.
- Metabolism = LACTIC ACID
- CO is LOW → Can’t support tissue perfusion and O2 demand
- S/S are subtle
- Lactic acid builds up in the blood (acid-base imbalance) damages cells
even more
- Normal serum lactate < 1mmol/L
- Lactic acidosis > 4mmol/L
- Compensatory (reversible)
- Biochemical, neural, and hormonal team (vasoconstriction) to fight effects
of anaerobic metabolism
- Tries to increase BP, CO → increase perfusion
- Baroreceptors: stimulates the SNS = release epinephrine and
norepinephrine = vasoconstriction (increase BP & HR)
- Increased perfusion to vital organs (brain and heart) shunted from
non-vital (GI, skin, lungs, kidneys)
- kidneys will activate RAAS → increases BLOOD VOLUME
- More blood return to the heart
- Due to aldosterone (kidneys keeping Na+ and water) urine will
have high osmolality
- GI System: risk for paralytic ileus
- Skin: cool, moist, pale
- EXCEPT! Septic shock: vasodilation, hot, flushed
- Lungs: increased RR, hyperventilation
- Decrease in arterial pressure = decrease in hydrostatic pressure
- Progressive
- Body systems are failing
- Progressing to MODS/ death
-
-
No more compensation → drop in CO → decreased O2 to cells →
HYPOXIC INJURY = increase capillary permeability = LOSE blood
volume and MASSIVE EDEMA
- Neuro: MAP < 60mmHg, slow speech, confused, agitated, decreased
reaction
- Lungs: ARDS, increased RR, decreased O2, resp failure
- Heart: muscle cells die, AMI, dysrhythmias
- Kidneys: acute tubular necrosis, renal failure, decreased UOP, increased
waste, increased creat & BUN
- Gut: GI bleeding and ulcers
- Liver: increased ammonia and bilirubin
- DIC: micro clots in vessels, wastes platelets and clotting factors,
bleeding everywhere
- Need fast dynamic treatment
Refractory (irreversible, not manageable)
- All organs will shut down
- Everything that happened in the previous stage is getting worse
Diagnostic studies
- Blood studies
- Lactate
- Base deficit
- 12 lead ECG, continuous ECG
- CXR
- Hemodynamic monitoring