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Hypovolemic Shock

Occurs when too little circulating blood volume causes a decrease in Mean Artirial Pressure, which causes a need for oxygen

Causes of Hypovolemic Shock

Acute blood loss (internal or external), or dehydration

Sign and Symptoms of Hypovolemic Shock

Increased Respirations, Heart Rate, Potassium, Creatnine, BUN, lactic Acid and SVR (could be normal)
Decreased CVP, PAP (could be normal), PAWP, Cardiac Output/Index, Pulse pressure, Unrinary Output, hemaglobin, Hematocrit, Blood pressure, pH,

Treatment for Hypovolemic Shock

Oxygen therapy, Fluid replacement and Drug therapy: Drugs that increase venous return, increase cardiac contractility, and perfusion by dialating coronary artiers

Drug Choices for Hypovolemic Shock

Dopamine, norepinephrine, phenylephrine: vasoconstrictors, they increase the workload of the heart and oxygen consumption but increase peripheral resistence and increase venus return to the heart and its contractility
Dobutamine/milarone: increase muscle cell contraction and stimulates beta 1 receptors
nitroprusside: increases blood flow by dialating the coronary arteries

Cardiogenic Shock

The heart muscle is unhealthy and pumping is directly impaired, so oxygenated blood cannot circulate.

Signs and symptoms of Cardiogenic shock

Inceased heart rate, respiratory rate, PAP, PAWP.
Decreased systolic BP, urinary output, pulse pressure, cardiac output/index, oxygen saturation

Causes of Cardiogenic Shock

from any condition that causes left ventricle dysfunction and decreases cardiac output. Most common cause is MI

Treatment of Cardiogenic Shock

Diuretics to keep the patient "dry"
doputamine/milarone: to increase contractility of the heart
Digoxin- decreases blood pressure, and makes the heart pump more effectively
phenalnephrine or neosnephrine: use for MI's
Nitroglycerine: vasodialator that decreases venus return and decrease the workload of the heart.
Intra Aortic Baloon pump: let the heart rest and decrease the oxygen consumption
Do not use dopamine in Cardiogenic shock because it increases the workload and uses more oxygen

Obstructive Shock

Casued by problems that impair the ablility of a normal heart muscle to pump effectively, the heart remains normal but outside conditions prevent either adequate filling or adequate contraction

Causes of Obstructive Shock

pulmonary hypertension, tension pneumothorax, pericarditis, cardiac tamponade, Pumonary embolis

Distributive Shock

Occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot circulate

Casues of Distributive Shock

nerual induced loss of vascular tone due to trauma to head or spine, chemical induced loss of vascular tone due to sepsis, anyphylaxsis, capillary leak, opiods and sedatives.

Initial/early shock

-decrease MAP of 10 mmHg
- Compensatory mechanisms do a good job at maintaining oxygenated blood to vital organs: vasoconstriction and increased heart rate keep MAP and Cadiac Output up

Nonprogressive/compensatory shock

- Decrease in MAP of 10-15 mmHg
- Kidney Compensatory mechanisms kick in and release Renin, Aldosterone, ADH, epinephrine, Norepinephrine
-tissue hypoxia occurs in non vital organs and kidneys
-no permanet damange yet

Symptoms of Eary/Initual Shock

Increased Heart rate, lactic Acid, blood pressure

Symptoms of Nonprogressive Shock

increased thirst, anxiety, restlessness, tachycardia, increased respirations, decreaed urine output, decreased systolic blood pressure and increased diastolic (narrowing pulse pressure), cool extremities, 2-5% decrease in pulse ox,

Progressive/intermediate shock

-decrease MAP of 20 mmHg
-compensatory mechanisms are functioning but cannot deliver enough oxygen to vital organs
- vital organs become hypoxic and less vital organs become anoxic and ischemic

Symptoms of Progressive/intermediate shock

severe thirst, deeper anxiety, confusion, rapid weak pulse, low BP, pallow to cyanosis of mucous membranes and nailbeds, cool, moist skin.
pulse ox decreased 5-20%, decreased pH, and increased lactic acid and potassium

Refactory/ irreversable Shock

To much death and tissue damage has occured. Vital organs have had overwhelming amount of damage. The body cannot respond effectivly to intervensions and shock continues

Symptoms of Refactory/Irreversable Shock

Rapid loss of concousness, non palpable pulses, cold mottled and dusky extremities, slow shallow resps, and unmeasureable oxygen saturation

ADH

increases water reabsorption and urine concentration

Aldosterone

Affects reabsorption by regulating sodium retention and helps control potassium secretion

Renin

regulates Blood pressure when there is a decline in extracellular fluid volume

CVP

represents preload, so if CVP is low that means the tank needs to be filled. decreased fluid volume.

PAWP

gets the pressure on the left side of the heart

SVR

systemic vascular resistence. and increase indicates that the left ventricle is not pumping all the blood out

PAP

right ventricle afterload

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