Shock

Local infection ⬇️, Systemic infection (early sepsis) ⬇️, SIRS (systemic inflammatory response syndrome) ⬇️, Organ failure (Severe sepsis) ⬇️, Multiple organs system failure (MODS) (Septic shock) ⬇️, 💀Death💀

Perfusion, Infection

Clotting, Gas exchange, Immunity

Widespread abnormal cellular metabolism, Occurs when gas exchange with oxygenation and tissue perfusion needs are not sufficiently met to maintain cell function, **Is a condition- NOT A disease!**, All body organs affected

Hypovolemic, Cardiogenic, Distributive, Obstructive

Is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body.

A life-threatening condition in which your heart suddenly can't pump enough blood to meet your body's needs.

Occurs when the body’s blood vessels dilate, or relax, to an extreme degree (hot or cold temperatures)

Occurs when blood flow to the heart is blocked, preventing oxygen and nutrients from reaching the body's organs and tissues.

Pump failure, Volume loss, Loss of vascular tone, Loss of vascular volume resulting in decreased mean arterial pressure, More than one may occur at the same time

Average arterial pressure, Normal 65-100 mmHg, Less than 60mmHg = organ ischemia, 1 way to calculate: diastolic+1/3 pulse pressure, 2nd way: 2diastolic + systolic divided by 3 I feel like this is easiest

117 mmHg

44

152 mmHg

Intial, Compensatory, Progressive, Refractory

Decreased O2 delivery=, Rbcs carry less O2=, Eventually cell death

Restlessness, Anxiety, Confusion, Lethargy

⬆️HR, Thready pulse, ⬆️BP, ⬆️CO

⬆️RR, Shallow breaths

⬇️Temperature, Thirst, Acidosis, ⬇️Urine output

Pale, Clammy, Cool

911 or rapid response, O2, IV: fluids, vasopressors to increase managing MAP ≥ 65, Identify cause

Baseline MAP decrease by <10mmHg, Compensation responses include vascular construction and increased HR, Difficult to detect indicators of shock at this stage, Adequate organ perfusion

MAP decreases by 10-15 mmHg, Kidney and normal hormal compensatory mechanisms activated, Urine output ⬇️ blood vessel constriction increases, Tissue hypoxia occurs, Thirst and anxiety are subject changes, Compare these changes with what was previously identified

Sustained decrease in MAP pf more thank 20 mmHg from baseline, Vital organs develop hypoxia, Some tissues die, Rapid respirations, low pulse, low BP, pallor, cool, moist skin; anuria, decrease in O2 sat, *Life threatening emergency*, Conditions causing shock must be corrected within 1 hour or less of progressive stage onset

Too little oxygen reaches tissues; cell death and tissue damage result, MODS- sequence of cell damage causes by massive release of toxic metabolites and enzymes, Rapid loss of consciousness, no palpable pulse, cold, dusky extremities, slow,shallow respirations, unmeasurable O2 sat, eventual death

Impaired tissue perfusion, Impaired gas exchange, Decrease cardiac output

Too little blood volume causes MAP decrease that prevents total body perfusion and gas exchange, Hypovolemic shock incidence and prevalence is unknown, as it is a response rather than a disease

Recognition of signs, Continue assessment and compare to baseline, Teach patient about signs and symptoms of shock

History – Risk factors – Illness, trauma, procedures, chronic health problems – Urine output, Physical Assessment/ Signs & Symptoms -Cardiovascular, respiratory, kidney and urinary, skin, CNS, and skeletal muscle changes, Psychosocial Assesmsent -Determine if behavior and cognition are the or different from baseline

Decreased ph, Decreased PaO2, Incrased PaCO2, Increased lactic acid, Increased or decreased hematocrit, Increased or decreased hemoglobin, Increased potassium

Hold pressure, Find cause and treat, Give O2, Give fluids, Give blood

Prevention:, Closely monitor IVsite, If subcutaneous inject phentolamine (regitine) to surrounding tissue, IV cannula before removal, Check clock wise to all tissue see if it’s getting worse, Think big open wounds, Can go into septic shock fast

Pump failure:, -MI, -Dysryhtmias (VT/VF), -Cardiomyopathies

⬆️O2 delivery-CPAP, ⬇️Preload, Enhance contractility -milrinone (primacor) -Dobutamine, Dilate coronary vessels to enhance perfusion -Nitro -Nitroprusside (Nipride)

Heart cannot pump effectively due to outside conditions, Cardiac tamponade, PE, Tension pneumothorax, Tumors

Remove cause, Supportive -airway -fluids -drugs

Patho- loss of sympathetic tone, Patho- blood vessel dilation, Patho- vascular leakage, Causes-Neurological, Causes- Chemically induced -anaphylaxis -capillary leak -Sepsis

Aiway-O2, intubate, Epi, Benadryl

1 million patients/yr in US, Mortality rate 28-50%

Dilate arteries and constrict veins to increase blood flow, Neutrophils, monocytes, and macrophages attack, Local swelling dilutes micrograms and toxins

Uncontrolled inflammation, Uncontrolled coagulation, Uncontrolled fibrinolysis, #1 mortality in ICU

Life threatening organ dysfunction due to dysregulated host response to infection, Clinical significance qSOFA score of 2 or more, Mortality 10%

Sequential or Sepsis related Organ Failure Assessment (SOFA), Used on pts with suspected or confirmed infections, 3 warning sings/criteria, FYI-SOFA another tool for ICU only (Know for exam)