CHAPTER 29: CARE OF PATIENTS WITH SHOCK
Overview:
Decreased blood flow to tissues—cellular dysfunction—organ failure
Decreased tissue perfusion is the hallmark of the shock state and is seen in all types of shock
PT is unable to maintain a normal MAP
Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to a
life-threatening emergency
All shock decreased blood flow to the tissues
Types of Shock:
1. Hypovolemic:
Inadequate total body fluid volume
Too little volume in the body due to blood loss or tissue fluid loss, and cannot maintain
circulating blood volume
Most common type of shock
Hemorrhage: trauma, GI bleeds, surgery, inadequate clotting (hemophilia, liver failure)
Dehydration: vomiting or diarrhea, diuretic therapy, NG suction, DI, hyperglycemia (due to peeing)
2. Cardiogenic:
Direct cardiac pump failure
Decreased CO and evidence of tissue hypoxia but there is sufficient blood volume. It cannot be propelled
forward to the cells that require the oxygen it carries.
Caused by: AMI, cardiac arrest, dysrhythmias, or severe cardiomyopathies
S/S: hypotension—systolic <90, decreased CO, decreased UOP, cool extremities, altered mentation (dec.
glucose and 02 to the brain), INCREASED PAWP
These patients will start out cool and clammy
FIX THE HEART by replacing function or assist with the poor function
3. Distributive: VASODILATES!!!
Due to changes in blood vessel tone that increase the size of vascular space without an increase in the
circulating volume
Tank is too big; change in blood vessel size and tone but there is not an increase in blood volume
All of these distributive shock patients start out WARM
Neural-induced – interference with SNS control of blood vessels with spinal cord injury (esp. spine),
spinal anesthesia or severe vasovagal reactions to pain or trauma (neurogenic shock)
Chemical-induced:
Anaphylaxis: severe hypersensitivity reaction resulting in massive vasodilation
Sepsis: infection with maldistribution of intravascular volume due to massive vasodilation
irritated by the body’s immune response to microorganism invasion
Gram negative and gram positive bacteria (toxins) trigger massive vasodilation
Capillary leak syndrome: burns, extensive trauma, liver impairment, hypoproteinuria
4. Obstructive:
Looks like cardiogenic, but the heart is not at fault; the environment it sits in is the cause
Cardiac function decreased by non-cardiac factors (indirect pump failure)
Cardiac tamponade, tension pneumothorax, constrictive pericarditis, pulmonary hypertension, pulmonary
embolus, thoracic tumors
1
, 2
Overview:
Decreased blood flow to tissues—cellular dysfunction—organ failure
Decreased tissue perfusion is the hallmark of the shock state and is seen in all types of shock
PT is unable to maintain a normal MAP
Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to a
life-threatening emergency
All shock decreased blood flow to the tissues
Types of Shock:
1. Hypovolemic:
Inadequate total body fluid volume
Too little volume in the body due to blood loss or tissue fluid loss, and cannot maintain
circulating blood volume
Most common type of shock
Hemorrhage: trauma, GI bleeds, surgery, inadequate clotting (hemophilia, liver failure)
Dehydration: vomiting or diarrhea, diuretic therapy, NG suction, DI, hyperglycemia (due to peeing)
2. Cardiogenic:
Direct cardiac pump failure
Decreased CO and evidence of tissue hypoxia but there is sufficient blood volume. It cannot be propelled
forward to the cells that require the oxygen it carries.
Caused by: AMI, cardiac arrest, dysrhythmias, or severe cardiomyopathies
S/S: hypotension—systolic <90, decreased CO, decreased UOP, cool extremities, altered mentation (dec.
glucose and 02 to the brain), INCREASED PAWP
These patients will start out cool and clammy
FIX THE HEART by replacing function or assist with the poor function
3. Distributive: VASODILATES!!!
Due to changes in blood vessel tone that increase the size of vascular space without an increase in the
circulating volume
Tank is too big; change in blood vessel size and tone but there is not an increase in blood volume
All of these distributive shock patients start out WARM
Neural-induced – interference with SNS control of blood vessels with spinal cord injury (esp. spine),
spinal anesthesia or severe vasovagal reactions to pain or trauma (neurogenic shock)
Chemical-induced:
Anaphylaxis: severe hypersensitivity reaction resulting in massive vasodilation
Sepsis: infection with maldistribution of intravascular volume due to massive vasodilation
irritated by the body’s immune response to microorganism invasion
Gram negative and gram positive bacteria (toxins) trigger massive vasodilation
Capillary leak syndrome: burns, extensive trauma, liver impairment, hypoproteinuria
4. Obstructive:
Looks like cardiogenic, but the heart is not at fault; the environment it sits in is the cause
Cardiac function decreased by non-cardiac factors (indirect pump failure)
Cardiac tamponade, tension pneumothorax, constrictive pericarditis, pulmonary hypertension, pulmonary
embolus, thoracic tumors
1
, 2
