Shock[1] - Shock Regardless of the CAUSE of shock- in the...

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Shock Regardless of the CAUSE of shock- in the end you will have Decreased Perfusion. This causes decreased cell nutrition which causes tissue death! Definition A condition in which systemic blood pressure is inadequate to deliver oxygen and nutrients to support vital organs and cellular organs. Pathophysiology Shock begins with abnormal cellular metabolism (due to decreased oxygen to tissues), which occurs when too little oxygen is delivered to the tissues (anaerobic metabolism). Body begins to compensate to maintain or restore tissue perfusion and oxygenation even while the causes of shock are still present. Review of Tissue Perfusion Tissue oxygenation depends on how much oxygen from arterial blood perfuse the tissues. Organ perfusion is related to mean arterial pressure (MAP) which is directly related to : Total blood volume Cardiac output Size of vascular bed-depends on whether arteries are vasodilated or vasocostricted. Normal MAP 70-105 The MAP is calculated: Systolic + (Diastolic + Diastolic) 3 Which Organs can Tolerate Reduction in Blood for hours? Skin and skeletal muscles. Which cannot? Brain, Liver, Heart and Kidney’s (Note: Decreased oxygen perfusion to the kidneys will immediately cause decreased urine output) 1
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Stages of Shock Initial Stage Anaerobic metabolism has started. MAP 5-10 mmHg Mild vasoconstriction Heart rate Compensatory Stage (See Chart Below) C o m p e n s a t o r y S t a g e f o r S h o c k i n c r e a s e s f o r c e o f c o n t r a c t i o n s i n c r e a s e s O 2 r o h r t . m u s c l e r e l a x e s b r o n c i l m u s c l e s r e l e a s e c a t e c h o l a m i n e s m e d u l l a A C T r e l e a s e g l u c o c o r t i c o i d s g l o c o s e p r o d u c e d a l d o s t e r o n e S t i m u l a t e s P i t u i t a r y e n d o c r i n e d e c r e a s e s p u l m . b l d f l o w V / Q i m b a l a n c e i n c r e a s e d R R a l k a l o s i s C O 2 D e c r e a s e d c h e m i c a l H y p o t e n s i o n Progressive Stage vasoconstriction blood shunted to major organs prolonged vasoconstriction leads to low capillary flow = cellular hypoxia metabolic acidosis Lack of ATP & Na & K+ pump failure = cells swelling 2
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Immune and inflammatory response happens and then blood flows to capillary bed due to lactic acidosis. The patient will look like they are in fluid overload when really it is 3 rd spacing that is taking place. hydrostatic pressure rises so fluid is pushed out of capillaries to interstitial space decreased perfusion to the coronary areteries=MI Irreversible Stage Time for psychosocial support Occurs when too much cell death and tissue damage results from too little oxygen reaching the tissues. Body is unable to respond effectively to interventions, and shock continues Cellular ischemia Necrosis of organs Death from Multiple Organ Dysfunction Syndrome (MODS) o Cell damage & death causes massive release of toxic metabolites and enzymes o Metabolites trigger small clots o Clots block tissue oxygenation o More damage o Cycle continues DIC 3
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Classifications of Shock Hypovolemic shock
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Shock[1] - Shock Regardless of the CAUSE of shock- in the...

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