SHOCK DISORDERS/SIRS
MAJOR PROBLEM OF SHOCK- DEC TISS. PERF....NOT GETTING O2 TO TISSUE---DUH!!
IF NOT TREATED...PT WILL GO INTO ACIDEMIA!!
ALL SHOCK-----SYSTOLIC BP < 90....DUH, but just in case you didn't know :)
Types of Shock: cardiogenic, hypovolemic, distributive, obstructive
OBSTRUCTIVE:- physical obstruction to bld flow w/dec CO
-restriction of diastolic filling to RV 2ndary to compression
-S/S: JVD, PULSA PARADOXUS-norm is 10mmHG, but will rise. Have person take
breathe in and listen to systolic BP....NOT REALLY SURE WHAT THE HELL THIS IS SO ANYONE
THAT KNOWS LET ME KNOW!
-EMERGENT TX!!!
HYPOVOLEMIC:- Loss of intravascular volume
-absolute---external loss of bld or fluids---surg, hemorrhage, etc
pt. comes in ....BUN 45....Cr 1....BP 80/40....whats up??? DEHYDRATED!! GIVE FLUIDS!!!
TX: you got to replace in the pipes what's needed....example: Walker gets stabbed in
the aorta and is bleeding out....what does she need?? Not fluids.....SHE NEEDS BLOOD!!!
-relative----fluid moves out intravascular----3rd spacing, SEPSIS, burns, etc
-Dec venous return/preload/SV/CO
-dec. tissue perfusion impaired cellular metabolism
DISTRIBUTIVE:- maldistribution of CO to body bc alterations in blood vessel diameter and
capillary wall.....SIMPLE WAY TO SAY THAT ALL THE PIPES ARE DILATED AND EVERYTHING IS
LEAKING OUT!
3 types: neurogenic-spinal cord injury
anaphylactic- allergic to something---give EPI!
, Septic.....you know this!!
PHASES OF SHOCK
Compensatory-beginning of HICC
-try to compensate....SNS COMES IN----VASOCONSTRICTS----SHUNTS BLOD TO
ORGANS
Progressive- compensatory mech. failing....CV greatly dec 1st....CO dec....Alt. cap.
permeability....fluid leak...anasarca....interstitial lung
edema...AKI....etc....
-AGGRESSIVE INTERVENTION TO PREVENT MODS!!!
Irreversible-Starts with a "D"......ends in an "H"....so grab your purse, go to subway grab
ya some food and head on home cause you're in trouble!!....DOWNEY ISM! LOL
FIRST SIGN OF GETTING ILLER ON THE HICC IS........DEC LOC!!!!!!!!!!!!
SEPTIC SHOCK:
* begins as a response to inflammation that DOES NOT STAY LOCAL BUT GOES SYSTEMIC!!!
CAUSE-----SIRS----SEPSIS---SEVERE SEPSIS---SEPTIC SHOCK----MODS.
"am I drawing? am I drawing?? Walkerism for ya! lol
* OKAY SO PG. 3...LAST SLIDE....THIS IS MY SIMPLE WAY TO BREAK DOWN ALL THE CRAP THAT
WALKER WAS TRYING TO SAY ON THE LAST SLIDE...MY WAY IS SIMPLE......
-What happens is your ass gets hurt.....your body starts an inflammatory
response....your body releases a shit ton of chemical mediators to fix the problem.....these
mediators are called cytokines....those are all the things she listed on the slide, but just know
that they are called CYTOKINES....ANYWAY....normally these chemical mediators (CYTOKINES)
go away on their own.....THE PROBLEM IS THAT THEY DON'T GO AWAY....SOOOOOO...."septic
cascade" happens....which is what causes the endothelial damage....which leads to SEPSIS/SIRS
and then more of the damn cytokines get releases...etc...etc...etc.....The body is unable to
MAJOR PROBLEM OF SHOCK- DEC TISS. PERF....NOT GETTING O2 TO TISSUE---DUH!!
IF NOT TREATED...PT WILL GO INTO ACIDEMIA!!
ALL SHOCK-----SYSTOLIC BP < 90....DUH, but just in case you didn't know :)
Types of Shock: cardiogenic, hypovolemic, distributive, obstructive
OBSTRUCTIVE:- physical obstruction to bld flow w/dec CO
-restriction of diastolic filling to RV 2ndary to compression
-S/S: JVD, PULSA PARADOXUS-norm is 10mmHG, but will rise. Have person take
breathe in and listen to systolic BP....NOT REALLY SURE WHAT THE HELL THIS IS SO ANYONE
THAT KNOWS LET ME KNOW!
-EMERGENT TX!!!
HYPOVOLEMIC:- Loss of intravascular volume
-absolute---external loss of bld or fluids---surg, hemorrhage, etc
pt. comes in ....BUN 45....Cr 1....BP 80/40....whats up??? DEHYDRATED!! GIVE FLUIDS!!!
TX: you got to replace in the pipes what's needed....example: Walker gets stabbed in
the aorta and is bleeding out....what does she need?? Not fluids.....SHE NEEDS BLOOD!!!
-relative----fluid moves out intravascular----3rd spacing, SEPSIS, burns, etc
-Dec venous return/preload/SV/CO
-dec. tissue perfusion impaired cellular metabolism
DISTRIBUTIVE:- maldistribution of CO to body bc alterations in blood vessel diameter and
capillary wall.....SIMPLE WAY TO SAY THAT ALL THE PIPES ARE DILATED AND EVERYTHING IS
LEAKING OUT!
3 types: neurogenic-spinal cord injury
anaphylactic- allergic to something---give EPI!
, Septic.....you know this!!
PHASES OF SHOCK
Compensatory-beginning of HICC
-try to compensate....SNS COMES IN----VASOCONSTRICTS----SHUNTS BLOD TO
ORGANS
Progressive- compensatory mech. failing....CV greatly dec 1st....CO dec....Alt. cap.
permeability....fluid leak...anasarca....interstitial lung
edema...AKI....etc....
-AGGRESSIVE INTERVENTION TO PREVENT MODS!!!
Irreversible-Starts with a "D"......ends in an "H"....so grab your purse, go to subway grab
ya some food and head on home cause you're in trouble!!....DOWNEY ISM! LOL
FIRST SIGN OF GETTING ILLER ON THE HICC IS........DEC LOC!!!!!!!!!!!!
SEPTIC SHOCK:
* begins as a response to inflammation that DOES NOT STAY LOCAL BUT GOES SYSTEMIC!!!
CAUSE-----SIRS----SEPSIS---SEVERE SEPSIS---SEPTIC SHOCK----MODS.
"am I drawing? am I drawing?? Walkerism for ya! lol
* OKAY SO PG. 3...LAST SLIDE....THIS IS MY SIMPLE WAY TO BREAK DOWN ALL THE CRAP THAT
WALKER WAS TRYING TO SAY ON THE LAST SLIDE...MY WAY IS SIMPLE......
-What happens is your ass gets hurt.....your body starts an inflammatory
response....your body releases a shit ton of chemical mediators to fix the problem.....these
mediators are called cytokines....those are all the things she listed on the slide, but just know
that they are called CYTOKINES....ANYWAY....normally these chemical mediators (CYTOKINES)
go away on their own.....THE PROBLEM IS THAT THEY DON'T GO AWAY....SOOOOOO...."septic
cascade" happens....which is what causes the endothelial damage....which leads to SEPSIS/SIRS
and then more of the damn cytokines get releases...etc...etc...etc.....The body is unable to
