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Shock Definition: Inadequate tissue perfusion. (Cant get O2 out)! General Shock- Applies to all types. Cause 1.

Loss of blood volume 2. Massive vasodilation 3. Heart failure (to pump the blood) *with any type of shock: decreased Cardiac Output , blood, and O2 to tissues and organs. FYI: *Shock is based on the individuals V/S and symptoms. *Always obtain baseline V/S!example: Pt. has a B/P of 80/40... Are they in shock? It depends. A low B/P may be normal. Compare it to the baseline to be sure. *A drop in blood pressure decreases urinary outputcharacteristics of all types of shock. 4 Types of Shock 1. Hypovolemic Shock D/t low circulating blood volume (most common) Causes: 1. Anything that depletes blood volume 2. Trauma (gunshot, Stabbing, ect.) 3. Anticoagulants

(Heparin, Coumadin (can bleed internally)) 4. Diuretics 5. Dehydration 6. Third spacing (fluid into tissues) 7. Draining wounds and burns 8. Diabetes Insipidus (Deals with a decreased amt. of ADH in the body.) Signs and Symptoms of Hypovolemic Shock 1. Decreased Loss of Consciousness 2. Tachycardia (pulse: weak and thready) 3. Decreased B/P 4. Decreased Cardiac Output (CO= SV x HR) 5. Decreased Urinary Output6. Cool, Clammy Skin 2. Cardiogenic Shock Deals with the heart itself. Cause 1. Myocardial Infarction (MI/ heart attack) Decreased O2 to an area (Ischemia)Death of tissue (necrosis) 2. Decreased Cardiac Output3. Decreased B/P *Because heart cant pump the blood. 3. Obstructive Shock -occurs when the heart or vessels are obstructed/compressed.

Example:Cardiac Tamponade: occurs with fluid buildup within the pericardial sac that surrounds the heart. The fluid compresses on the heart and prevents the heart from pumping adequately. Example:Tension Pneumothorax: occurs when the lung is compressing on the heart. Prevents the heart from pumping adequately. 4. Distributive/Normovol emic Shock Classic characteristic is massive vasodilationQuick refresh (Medulla controls the heart)Example: B/P medication overdose: there would be no fluid loss, however peripheral resistance is decreased. (vasodilation) therefore, blood is redistributed throughout the body.

Three types of Distributive Shock A. Neurogenic Shock Causes 1. Damage to vasomotor center of the brain (medulla)

Vessels lose peripheral resistance. 2. Spinal cord injuries 3. Overdose of opoids, tranquilizers, and anesthetics *Depresses the CNS and lowers the respiratory rate *Refresher (Narcan is the antidote for opoid overdose) Signs/Symptoms of Neurogenic shock 1. Decreased LOC 2. Bradycardia 3. Hypotension 4. Warm, Dry Skin Vessels are closer to surface due to massive vasodilation 5. Decreased Respiratory Rate6. Decreased Urinary Output B. Septic/Toxic Shock Characteristics: Bacterial infection that spreads to the blood. The most common infection is Gramnegative bacteria (ex: Ecoli) FYI: Septicemia/bacteremiabacteria in the blood. Cause 1. Tampon Misuse 2. Soft-tissue injuries*
Bacteria releases endotoxins that cause vasodilation of the blood vessels. Endotoxins stimulate cystokines that increase capillary

permeability and allows fluid to seep into tissues.

causing hives, itching, and rash.* Treatments for Anaphylactic Shock Medications 1. Epinephrine (adrenaline): dilates airway and increases B/P 2. Benadryl (antihistamine) 3. SoluMedrol (steroid): reduces inflammatory response

Signs/Symptoms of Septic/Toxic Shock 1. Decreased LOC 2. Tachycardia 3. Fever 4. Skin: dry and warm 5. Increased WBC count due to infection 6. Rash 7. Desquamation (peeling of the palms) (reddened) 8. Decreased Urinary Output 9. Decreased B/P 10. Decreased Cardiac Output * FYI: staph and strep are two types of grampositive bacteria* C. Anaphylactic Shock -caused by allergy (hypersensitivity caused by the antigen/antibody reaction) Example: Peanuts, Penicillin (Pt. should wait 30 min. post injection before leaving the office/hospital)Antidote: epinephrine (Epi-pen) * Mast cells release histamine (produces inflammation and causes massive vasodilation of the vessels, increases permeability which causes fluid to seep into tissues. Causes bronchi constriction (airway swells) )