SHOCK

Presented by: Samalagu

SHOCK

 A life-threatening condition that occurs when the body is not getting enough
blood flow.
 Lack of blood flow means that the cells and organs do not get enough oxygen
and nutrients to function properly. Many organs can be damaged as a result.
Types of Shocks

 Cardiogenic shock (due to heart problems)

 Hypovolemic shock (caused by too little blood volume)
 Anaphylactic shock (caused by allergic reaction)
 Septic shock (due to infections)
 Neurogenic shock (caused by damage to the nervous system)
 Cardiogenic shock
It’s when the heart has been damaged so much that it is unable to supply
enough blood to the organs of the body.
Complications

 A large section of heart muscle that no longer moves well or does not move at
all
 Breaking open (rupture) of the heart muscle due to damage from the heart
attack
 Pressure on the heart due to a buildup of fluid around it (pericardial
tamponade)
 Very slow heart rhythm (bradycardia) or problem with the electrical system of
the heart (heart block
Cardiogenic shock occurs when the heart is unable to pump as much blood as
the body needs. It can happen even if there has not been a heart attack if 1 of
these problems occurs and your heart function drops suddenly.
Symptoms

 Chest pain or pressure

 Coma
 Decreased urination
 Fast breathing
 Fast pulse
 Heavy sweating, moist skin
 Lightheadedness
 Loss of alertness and ability to concentrate
 Restlessness, agitation, confusion
 Shortness of breath
 Skin that feels cool to the touch
 Pale skin color or blotchy skin
 Weak (thready) pulse
Diagnose

 An exam will show:

 Low blood pressure (most often less than 90 systolic)
 Blood pressure that drops more than 10 points when you stand up after lying
down (orthostatic hypotension)
 Weak (thready) pulse
 Cardiac catheterization
 Chest x-ray
 Coronary angiography
 Echocardiogram
 Electrocardiogram
 Nuclear scan of the heart
 Arterial blood gas
 Blood chemistry (chem-7, chem-20, electrolytes)
 Cardiac enzymes (troponin, CKMB)
 Complete blood count (CBC)
 Thyroid stimulating hormone (TSH)
Treatment

 Cardiogenic shock is a medical emergency.

 You will need to stay in the hospital, most often in the Intensive Care Unit
(ICU).
 The goal of treatment is to find and treat the cause of shock to save your life.
medicines to increase blood pressure
and improve heart function, including:
 Dobutamine
 Dopamine
 Epinephrine
 Levosimendan
 Milrinone
 Norepinephrine
These medicines may help in the short-term. They are not often used for a long
time.
Complications

 Brain damage
 Kidney damage
 Liver damage
Prevention

You may reduce the risk of developing cardiogenic shock by:

 Quickly treating its cause (such as heart attack or heart valve problem)
 Preventing and treating the risk factors for heart disease, such as diabetes,
high blood pressure, high cholesterol and triglycerides, or tobacco use
Nursing Care Management

 Prevent recurrence of cardiogenic shock.

 Monitor hemodynamic status.
 Administer medications and intravenous fluids.
 Maintain intra-aortic balloon counter pulsation.
 Hypovolemic shock
An emergency condition in which severe blood or fluid loss makes the
heart unable to pump enough blood to the body.
This type of shock can cause many organs to stop working.
Causes

Blood loss can be due to:

 Bleeding from cuts
 Bleeding from other injuries
 Internal bleeding, such as in the gastrointestinal tract
The amount of circulating blood in your body may drop when you lose too many
other body fluids.
 Burns
 Diarrhea
 Excessive perspiration
 Vomiting
Symptoms

 Anxiety or agitation
 Cool, clammy skin
 Confusion
 Decreased or no urine output
 General weakness
 Pale skin color (pallor)
 Rapid breathing
 Sweating, moist skin
 Unconsciousness
The greater and more rapid the blood loss, the more severe the symptoms of shock.
Diagnose

A physical exam will show signs of shock, including:

 Low blood pressure
 Low body temperature
 Rapid pulse, often weak and thread
 Blood chemistry, including kidney function tests and those tests looking for
evidence of heart muscle damage
 Complete blood count (CBC)
 CT scan, ultrasound, or x-ray of suspected areas
 Echocardiogram: sound wave test of heart structure and function
 Endoscopy: tube placed in the mouth to the stomach (upper endoscopy) or
colonoscopy (tube placed through the anus to the large bowel)
 Right heart (Swan-Ganz) catheterization
 Urinary catheterization (tube placed into the bladder to measure urine
output)
Treatment

Get medical help right away. In the meantime, follow these steps:
 Keep the person comfortable and warm (to avoid hypothermia).
 Have the person lie flat with the feet lifted about 12 inches (30 centimeters)
to increase circulation. However, if the person has a head, neck, back, or leg
injury, do not change the person's position unless they are in immediate
danger
 Do not give fluids by mouth.
 If person is having an allergic reaction, treat the allergic reaction, if you
know how.
 If the person must be carried, try to keep them flat, with the head down and
feet lifted. Stabilize the head and neck before moving a person with a
suspected spinal injury
Medications

 Dopamine
 Dobutamine
 Epinephrine
 Norepinephrine
may be needed to increase blood pressure and the amount of blood pumped out
of the heart (cardiac output).
Complications

 Kidney damage
 Brain damage
 Gangrene of arms or legs, sometimes leading to amputation
 Heart attack
 Other organ damage
 Death
Nursing Management

 Maintain fluid volume at a functional level.

 Report understanding of the causative factors of fluid volume deficit.
 Maintain normal blood pressure, temperature, and pulse.
 Maintain elastic skin turgor, most tongue and mucous membranes, and
orientation to person, place, and time.
Anaphylaxis Shock

 Is a life-threatening type of allergic reaction.

 Anaphylaxis is a severe, whole-body allergic reaction to a chemical that has
become an allergen.
 An allergen is a substance that can cause an allergic reaction.
 Tissues in different parts of the body release histamine and other substances.
This causes the airways to tighten and leads to other symptoms.
Anaphylaxis can occur in response to any allergen. Common causes include:
 Drug allergies
 Food allergies
 Insect bites/stings
 Pollen and other inhaled allergens rarely cause anaphylaxis. Some people
have an anaphylactic reaction with no known cause.
 Anaphylaxis is life-threatening and can occur at any time. Risks include a
history of any type of allergic reaction.
Symtoms

 Abdominal pain
 Feeling anxious
 Chest discomfort or tightness
 Diarrhea
 Difficulty breathing, coughing, wheezing, or high-pitched breathing sounds
 Difficulty swallowing
 Dizziness or lightheadedness
 Hives, itchiness, redness of the skin
 Nasal congestion
 Nausea or vomiting
 Palpitations
 Slurred speech
 Swelling of the face, eyes, or tongue
 Unconsciousness
Diagnose

 The health care provider will examine the person and ask about what might
have caused the condition.
 Tests for the allergen that caused anaphylaxis (if the cause is not obvious)
may be done after treatment.
Teatment

 Anaphylaxis is an emergency condition that needs medical attention right

away. Call 911 immediately.
 Check the person's airway, breathing, and circulation, which are known as the
ABC's of Basic Life Support. A warning sign of dangerous throat swelling is a
very hoarse or whispered voice, or coarse sounds when the person is
breathing in air. If necessary, begin rescue breathing and CPR.
 Call 911.
 Calm and reassure the person.
 If the allergic reaction is from a bee sting, scrape the stinger off the skin with
something firm (such as a fingernail or plastic credit card). Do not use
tweezers. Squeezing the stinger will release more venom.
 If the person has emergency allergy medicine on hand, help the person take
or inject it. Do not give medicine through the mouth if the person is having
difficulty breathing.
 Take steps to prevent shock. Have the person lie flat, raise the person's feet
about 12 inches (30 centimeters), and cover the person with a coat or
blanket. Do not place the person in this position if a head, neck, back, or leg
injury is suspected, or if it causes discomfort.
 DO NOT:
 Do not assume that any allergy shots the person has already received will
provide complete protection.
 Do not place a pillow under the person's head if they are having trouble
breathing. This can block the airways.
 Do not give the person anything by mouth if they are having trouble
breathing.
 Paramedics or other providers may place a tube through the nose or
mouth into the airways. Or emergency surgery will be done to place a tube
directly into the trachea.
Complications

Without prompt treatment, anaphylaxis may result in:

 Blocked airway
 Cardiac arrest (no effective heartbeat)
 Respiratory arrest (no breathing)
 Shock
Preventions

 Avoid triggers such as foods and medicines that have caused an allergic
reaction in the past. Ask detailed questions about ingredients when you are
eating away from home. Also carefully examine ingredient labels.
 If you have a child who is allergic to certain foods, introduce one new food at
a time in small amounts so you can recognize an allergic reaction.
 People who know that they have had serious allergic reactions should wear a
medical ID tag.
 If you have a history of serious allergic reactions, carry emergency medicines
(such as a chewable antihistamine and injectable epinephrine or a bee sting
kit) according to your provider's instructions.
 Do not use your injectable epinephrine on anyone else. They may have a
condition (such as a heart problem) that could be worsened by this drug.
 Client will maintain an effective breathing pattern
 Client will demonstrate improved ventilation
 Client will display hemodynamic stability
 Client and significant others will verbalize understanding of allergic reaction,
its prevention, and management.
 Client and significant others will verbalize understanding of need to carry
emergency components for intervention, need to inform health care providers
of allergies, need to wear medical alert bracelet/necklace, and the
importance of seeking emergency care.
 Septic shock
Septic shock is a serious condition that occurs when a body-wide
infection leads to dangerously low blood pressure.
Causes

 Septic shock occurs most often in the very old and the very young. It may also
occur in people with weakened immune systems.
 Any type of bacteria can cause septic shock.
 Fungi and (rarely) viruses may also cause the condition. Toxins released by
the bacteria or fungi may cause tissue damage.
 This may lead to low blood pressure and poor organ function. Some
researchers think that blood clots in small arteries cause the lack of blood
flow and poor organ function.
Risk Factors

 Diabetes
 Diseases of the genitourinary system, biliary system, or intestinal system
 Diseases that weaken the immune system, such as AIDS
 Indwelling catheters (those that remain in place for extended periods,
especially intravenous lines and urinary catheters, and plastic and metal
stents used for drainage)
 Leukemia
 Long-term use of antibiotics
 Lymphoma
 Recent infection
 Recent surgery or medical procedure
 Recent use of steroid medicines
 Solid organ or bone marrow transplantation
Symptoms

Septic shock can affect any part of the body, including the heart, brain, kidneys,
liver, and intestines.
 Cool, pale arms and legs
 High or very low temperature, chills
 Light headedness
 Little or no urine
 Low blood pressure, especially when standing
 Palpitations
 Rapid heart rate
 Restlessness, agitation, lethargy, or confusion
 Shortness of breath
 Skin rash or discoloration
 Decreased mental status
Diagnose

 Blood tests may be done to check for:

 Infection around the body
 Complete blood count (CBC) and blood chemistry
 Presence of bacteria or other organisms
 Low blood oxygen level
 Disturbances in the body's acid-base balance
 Poor organ function or organ failure
 A chest x-ray to look for pneumonia or fluid in the lungs (pulmonary edema)
 A urine sample to look for infection
Treatment

Septic shock is a medical emergency. In most cases, people are admitted to the
intensive care unit of the hospital.
Treatment may include:
 Breathing machine (mechanical ventilation)
 Dialysis
 Drugs to treat low blood pressure, infection, or blood clotting
 Fluids given directly into a vein (intravenously)
 Oxygen
 Sedatives
 Surgery to drain infected areas, if needed
 Antibiotics
Complications
 Respiratory failure, cardiac failure, or any other organ failure can occur.
Gangrene may occur, possibly leading to amputation.

Prevention
 Prompt treatment of bacterial infections is helpful. However, many cases of
septic shock cannot be prevented.
 Neurogenic Shock
Vasodilation occurs as a result of a loss of balance between parasympathetic and sympathetic stimulation
It is a type of shock (a life-threatening medical condition in which there is insufficient blood flow throughout the body)
that is caused by the sudden loss of signals from the sympathetic nervous system that maintain the normal muscle tone
in blood vessel walls.
Causes

 Spinal cord injury – Is recognised to cause hypotension and bradycardia

(neurogenic shock).
 Spinal anesthesia —injection of an anesthetic into the space surrounding
the spinal cord —or severance of the spinal cord results in a fall in blood
pressure because of dilation of the blood vessels in the lower portion of the
body and a resultant diminution of venous return to the heart.
 Depressant action of medications. Depressant action of medications and lack
of glucose could also cause neurogenic shock.
Symptoms

 Dry, warm skin. Instead of cool, moist skin, the patient experiences dry,
warm skin due to vasodilation and inability to vasoconstrict.
 Hypotension - occurs due to sudden, massive dilation.
 Bradycardia. Instead of getting tachycardic, the patient experience
bradycardia.
 Diaphragmatic breathing. If the injury is below the 5th cervical vertebra, the
patient will exhibit diaphragmatic breathing due to loss of nervous control of
the intercostal muscles (which are required for thoracic breathing).
 Respiratory arrest. If the injury is above the 3rd cervical vertebra, the
patient will go into respiratory arrest immediately following the injury, due to
loss of nervous control of the diaphragm.
Diagnose

 Computerized tomography (CT) scan. A CT scan may provide a better look at

abnormalities seen on an X-ray.
 Xrays. Medical personnel typically order these tests on people who are
suspected of having a spinal cord injury after trauma.
 Magnetic resonance imaging (MRI). MRI uses a strong magnetic field and
radio waves to produce computer-generated images.
Medications

 Inotropic agents. Inotropic agents such as dopamine may be infused for fluid
resuscitation.
 Atropine is given intravenously to manage severe bradycardia.
 Steroids Patient with obvious neurological deficit can be given I.V. steroids,
such as methylprednisolone in high dose, within 8 hours of commencement
of neurogenic shock.
 Heparin. Administration of heparin or low molecular-weight heparin as
prescribed may prevent thrombus formation.