FRANCIS JORDAN RAMOS CUSI, RN, RM

SHOCK AND ITS PHYSIOLOGY

ADEQUATE BLOOD FLOW TO TISSUES
AND CELLS REQUIRE ABC:
• A – dequacy of cardiac pump
• B – lood volume sufficiency
• C – irculatory system effectiveness
IMPAIRMENT IN ANY OF THE ABOVE
MAY LEAD TO SHOCK!
 SHOCK AND ITS PHYSIOLOGY
SHOCK
• a life-threatening condition that occurs when
HY
the body is not getting enough blood Pflow.
OT
EN
• CAUSES: SI
O N
Declining force of cardiac pump
Decreased blood volume
Altered peripheral resistance (vasodilation)

o do A – dequacy of cardiac
g t
e thin pump
So m ABC? B – lood volume sufficiency
h
wit
C – irculatory system
effectiveness
 SHOCK AND ITS PHYISOLOGY
Some other definitions of SHOCK:
• A condition in which systemic blood pressure
is inadequate to deliver oxygen and nutrients
to support vital organs and cellular functions
• Hypotension results from a decreased
circulating blood volume, leading to
decreased tissue perfusion and general
hypoxia.
NOTICED THE SAME PHYSIOLOGY?
 SHOCK AND ITS PHYSIOLOGY
Shock
▼
Body initially implements compensatory
mechanisms to counteracts effects (physiologic)
▼
Shock progresses
▼
Therapeutic measures are implemented
▼
If physiologic/therapeutic measures are inadequate
▼
Multi-organ damage
▼
death
 STAGES OF SHOCK
 COMPENSATORY STAGE
• Compensation mechanisms are initiated as soon
as blood pressure decreases.
 PROGRESSIVE STAGE
• Decompensation stage
• The mechanisms that regulate blood pressure
can no longer compensate
 IRREVERSBILE STAGE
• Refractory stage
• Organ damage is so severe
• Patient does not respond to treatment and
CANNOT survive
 STAGES OF SHOCK
Compensatory Stage
• COMPENSATION MECHANISMS
SNS and Adrenal Medulla: increased heart rate,
force of contractions, systemic vasoconstriction
Renin: activates angiotensin and aldosterone
Increased ADH: reabsorption of water,
vasoconstriction
Glucocorticoids: stabilizes vascular system –
decreasing capillary permeability and enhances
catecholamines
Acidosis: stimulates respirations
 STAGES OF SHOCK
Compensatory Stage
• BP normal
• Stimulation of SNS
Vasoconstriction
Increased heart rate
Increased heart contractility
• Shunting of blood to the brain and
heart
• Prognosis of patient is GOOD
 STAGES OF SHOCK
Compensatory Stage
• NURSING MANAGEMENT
Monitor tissue perfusion
Assess systematically patients at risk for
shock
Narrowing or decreasing pulse pressure
Vital signs
ALERT: decreased Bp - > cellular damage has
occurred
Recognize subtle signs of compensatory
stage
Reduce anxiety
Promote safety
 STAGES OF SHOCK
Progressive Stage
• Compensations and effects of shock
aggravates the problem
• OVERWORKED HEART becomes
DYSFUNCTIONAL
• AUTOREGULATORY FUNCTION of the
MICROCIRCULATION FAILS
• MAP falls below 80
• SBP <90 mmHg
• Prognosis WORSENS
MEAN ARTERIAL PRESSURE
 STAGES OF SHOCK
Progressive Stage
• ASSESSMENT AND DIAGNOSIS
Respi: rapid, shallow breathing, crackles,
decreased pulmonary blood flow, surfactant are
not produced, leaking of pulmonary capillaries
Cardio: dysrrhytmias, ischemia, chest pain,
cardiac enzymes rise
Neuro: mental status deteriorates
Renal: impaired glomerular filtration, acute renal
failure may develop
 STAGES OF SHOCK
Progressive Stage
• ASSESSMENT AND DIAGNOSIS
Hepa: impaired metabolic and
phagocytic functions
Gastro: ischemia can cause stress ulcers
Hema: hypotension, sluggish blood flow,
met acidosis, hypoxemia, DIC, bruises
 STAGES OF SHOCK
Progressive Stage
• MEDICAL MANAGEMENT
Optimizing intravascular volume
Supporting the pumping action of the
heart
Improving the competence of the
vascular system
 STAGES OF SHOCK
Progressive Stage
• NURSING MANAGEMENT
Prevent complications
Promote rest and comfort
Support family members
 STAGES OF SHOCK
Irreversible Stage
• Despite treatment, bp remains
low
• Complete renal and liver failure
• Progressing to complete organ
failure
• Death is imminent
 STAGES OF SHOCK
Irreversible Stage
• MEDICAL MANAGEMENT
Usually the same for the
progressive shock
Experimental strategies
may be tried
 STAGES OF SHOCK
Irreversible Stage
• NURSING MANAGEMENT
Carry out prescribed treatment
Monitor the patient
Prevent complication
Protect the client from injury
Provide comfort
 FIRST AID
 Check the person's airway, breathing, and
circulation. If necessary, begin rescue breathing
and CPR.
 Even if the person is able to breathe on his or her
own, continue to check rate of breathing at least
every 5 minutes until help arrives.
 If the person is conscious and DOES NOT have an
injury to the head, leg, neck, or spine, place the
person in the shock position. Lay the person on the
back and elevate the legs about 12 inches. DO NOT
elevate the head. If raising the legs will cause pain
or potential harm, leave the person lying flat.
 Give appropriate first aid for any wounds, injuries,
or illnesses.
 Keep the person warm and comfortable. Loosen
tight clothing.
FIRST AID…
 FIRST AID…
IFTHE PERSON VOMITS OR
DROOLS
• Turn the head to one side so he or
she will not choke. Do this as long as
there is NO suspicion of spinal injury.
• If a spinal injury is suspected, "log
roll" him or her instead. Keep the
person's head, neck and back in line
and roll him or her as a unit.
 FIRST AID…
DO NOT   
• DO NOT give the person anything by mouth,
including anything to eat or drink.
• DO NOT move the person with a known or
suspected spinal injury.
• DO NOT wait for milder shock symptoms to
worsen before calling for emergency medical
help.
End of First Part