Michael V.

Urrutia BSN-III SHOCK AND MULTISYSTEM FAILURE SHOCK:

September 3, 2012

Shock can be best defined as a condition in which widespread perfusion to the cells is inadequate to deliver oxygen and nutrients to support vital organs and cellular function. Adequate blood flow to the tissues and cells requires an adequate cardiac pump, effective vasculature or circulatory system, and sufficient blood volume. If one of these components is impaired, perfusion to the tissues is threatened or compromised. Classification of Shock: 1. Hypovolemic Shock: Shock state resulting in from decreased intravascular volume due to fluid loss. 2. Cardiogenic Shock: shock state resulting from impairment or failure of the myocardium occurs when he heart has an impaired pumping ability may be of coronary or non-coroary in origin 3. Distributive Shock: shck state resulting from displacement of blood volume creating a reative hypvolemia; also called vasogenic shock. Pathophysiology: Hypovolemic shock: - Can be caused by external fluid losses, as in traumatice blood loss, by internal fluid hifts, as in severe dehydration, edema or ascites. - Hypovlemic shock starts from the decrease in intravascuar volume causing decresed venous return of blood to the heart which leasds to subsequent decreased ventricular filing this causes decreased stroke volume (amount of blood being ejected from the heart) decreased cardiac output whe the CO drops, BP drops and tissues cannot be adequately perfuse death of cells occurs. Risk Factors for hypovolemic Shock: External Fluid Losses: Ineternal: Fluid Shifts: 1. Trauma 1. Hemorrhage 2. Surgery 2. Burns 3. Vomiting 3. Ascites 4. Diarrhea 4. Peritonitis 5. Diuresis 5. Dehydration 6. Diabetes insipidus Management: - Major goals of treatment is to restore intravascular volume to reverse the squence of vents leading to inadequate tissue perfusion, to redistribut fluid volume and to correct the underlying cause of the fluid loss as quickly as possible. Treatment of the underlying cause: - The goal is to stop whatever is causing indequate intravascular fluid within the body - In hemrrhage the main goal is to stop the bleeding by adding pressure on the area - In other complications that causes abnormal fluid exretion from the body like diarrhea or vomitting, medications should be administered respectively. Medical management:

Drugs such as inotropic agents like epinephrine is used in treating shock. This strengthens the myocardial contractility of the heart thus increasing cardiac rate and output so that more blood can flow through the system to provide adequate perfussion. Also to counteract one of the triad sign of shock which is hypotension - Oxygenation may be administered to prevent hypoxia Cardiogenic Shock: - Occurs when the hearts ability to contract and to pump blood is imparired and the supply of oxygen is inadequate for the heart and tissues. - Coronary cardiogenic shock is mre common and is seen most often in patients with acute myocardial infarctin resulting in damage to a singnificatnt portion f the left ventricular mycardiumwhich is the primary for pumping blood into the systemic circulation. Pathophyiology: Cardiac output compromsed SV and PR decrease BP falls impaired tissue perfussion blood, oxygen and nutrient supply is insufficient in the heart impairs ability to pump blood fluid accumulates in the lungs. Clinical Manifestation: - Patients with cardiogenic shck may experience angina pain and develop dysrhytmias Initiation of First-ine Treatment: Oxygenation: - Supplemental oxygenation should be given in the early stages of shock by nasal cannula at a rate of 2-6 L/mi to achieve oxygen saturation exceeding 90%. Pain Control: - Administer IV morphine if the patient experiences pain. Morphne also has a vasodilating effect which reduces work load of the heart