Shock in Surgery Complications

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Questions and Answers

What is necessary for the body to maintain adequate blood pressure?

Effective vasculature or circulatory system

Adequate cardiac pump

Sufficient blood volume

All of the above (correct)

What is the primary response of the body during the compensatory stage of shock?

Vasoconstriction (correct)

Bradycardia

Vasodilation

Tachycardia

What is a clinical sign of the compensatory stage of shock?

Cold, clammy skin (correct)

Hypertension

Increased urine output

Tachypnea

What occurs during the progressive stage of shock?

Blood pressure falls below normal limits Signup and view all the answers

What is a characteristic of the progressive stage of shock?

Hypotension Signup and view all the answers

What occurs in the microcirculation during the progressive stage of shock?

Increased capillary permeability Signup and view all the answers

What is the initial response of the body to shock?

A compensatory response to changes in the delivery of O2 to tissues Signup and view all the answers

What is the result of anaerobic metabolism in the progressive stage of shock?

Buildup of lactic acid Signup and view all the answers

What is the characteristic of the irreversible stage of shock?

BP remains low despite treatment Signup and view all the answers

What is the result of poor delivery of oxygen and nutrients to cells in shock?

Cell death and organ dysfunction Signup and view all the answers

What is the primary goal of treating shock?

Reverse the underlying cause of shock Signup and view all the answers

What is the impact of anaerobic metabolism on energy production?

Low energy yields Signup and view all the answers

What is the role of catecholamines, cortisol, glucagon, and cytokines in shock?

To promote gluconeogenesis and mobilize glucose for cellular metabolism Signup and view all the answers

What is the consequence of untreated shock?

Multi-system organ failure and death Signup and view all the answers

What is the consequence of continued activation of the stress response in shock?

Depletion of glycogen stores, resulting in proteolysis and eventual organ failure Signup and view all the answers

What is the result of the clotting cascade becoming overproductive in shock?

Small clots lodging in microcirculation, further hampering cellular perfusion Signup and view all the answers

What is the consequence of the build-up of metabolic wastes in cells and interstitial spaces in shock?

Cellular dysfunction and eventual organ failure Signup and view all the answers

What are the three components required for adequate blood flow to tissues?

Oxygen, nutrients, and blood pressure Signup and view all the answers

What is the most common type of distributive shock?

Septic shock Signup and view all the answers

What is the primary risk factor for septic shock?

Immunosuppression Signup and view all the answers

What is the primary causative agent of septic shock?

Gram-negative bacteria Signup and view all the answers

What is the result of a clinical insult that initiates an inflammatory response that is systemic?

SIRS Signup and view all the answers

What is the primary criterion for diagnosing SIRS?

Temperature > 38.3°C Signup and view all the answers

What is the primary cause of hypovolemic shock?

Decreased intravascular volume Signup and view all the answers

What is the most common type of shock?

Hypovolemic shock Signup and view all the answers

What is the primary cause of cardiogenic shock?

Impaired heart's ability to contract and pump blood Signup and view all the answers

What is the result of inadequate tissue perfusion in distributive shock?

Relative hypovolemia Signup and view all the answers

What is the primary cause of metabolic acidosis in shock?

Anaerobic metabolism Signup and view all the answers

What is the primary goal of interventions in hypovolemic shock?

Control bleeding Signup and view all the answers

What is the result of a decrease in intravascular volume in hypovolemic shock?

Decreased stroke volume Signup and view all the answers

What is the primary cause of anaphylactic shock?

Specific antigen Signup and view all the answers

What is the clinical manifestation of cardiogenic shock?

All of the above Signup and view all the answers

What is the primary cause of distributive shock?

Loss of sympathetic tone Signup and view all the answers

Study Notes

Shock

Shock is a complex syndrome of decreased blood flow to body tissues, resulting in cellular dysfunction and eventual multi-system organ failure.

Pathophysiology of Shock

Cells lack adequate blood supply, leading to cell death, organ dysfunction, and anaerobic metabolism.
The cell swells, and the cell membrane becomes more permeable, leading to electrolyte imbalance and cell death.
In stress states, the body releases catecholamines, cortisol, glucagon, and cytokines, causing hyperglycemia and insulin resistance, which promotes gluconeogenesis.
Continued activation of the stress response causes depletion of glycogen stores, resulting in proteolysis and eventual organ failure.
The clotting cascade becomes activated, leading to small clots lodging in microcirculation and further hampering cellular perfusion.

Overview of Shock

Adequate blood flow to tissues requires adequate cardiac pump, effective vasculature, and sufficient blood volume.
Shock becomes a life-threatening condition if not treated, leading to multi-system organ failure and death.
Shock can occur even in the absence of hypotension.

Stages of Shock

Compensatory Stage: The body responds to shock by increasing heart rate, contractility, and vasoconstriction to maintain blood pressure.
Progressive Stage: The body's compensatory mechanisms fail, leading to hypotension, decreased tissue perfusion, and organ dysfunction.
Irreversible Stage: The patient does not respond to treatment, and organ damage is severe, leading to complete organ failure and death.

Clinical Signs of Shock

Compensatory Stage: normal blood pressure, tachycardia, tachypnea, cool and clammy skin, decreased urine output, and confusion.
Progressive Stage: hypotension, tachypnea, crackles, mottled skin, decreased urine output, and lethargy.
Irreversible Stage: low blood pressure despite treatment, erratic heart rate, intubation and mechanical ventilation, jaundiced skin, anuric, and unconscious.

Classifications of Shock

Low Blood Flow
Maldistribution of Blood Flow
Hypovolemic: caused by low circulating volume due to hemorrhage, burns, dehydration, or third spacing.
Septic: caused by septicemia secondary to endotoxin release, commonly from gram-negative bacteria.
Cardiogenic: caused by pump failure secondary to acute MI, PE, or ventricular aneurysm.
Neurogenic: caused by spinal cord injury or anesthesia.
Anaphylactic: caused by acute, life-threatening allergic reaction to a specific antigen.

Hypovolemic Shock

Also known as hemorrhagic shock, the most common type of shock.
Caused by a decrease in intravascular volume due to external fluid losses (e.g., traumatic blood loss, surgery, vomiting, diarrhea, diuresis, diabetes insipidus) or internal fluid shifts (e.g., hemorrhage, burns, peritonitis, ascites, necrotizing pancreatitis).
Decreased intravascular volume leads to decreased venous return, decreased stroke volume, decreased cardiac output, and decreased tissue perfusion.

Clinical Manifestations of Hypovolemic Shock

Hypotension
Weak, thready pulse
Delayed capillary refill
Cyanosis
Dysrhythmias
Altered LOC
Clammy, pale skin

Interventions for Hypovolemic Shock

Oxygen
Control bleeding
Fluid/blood replacement with crystalloid, blood products, or FFP
Pharmacologic therapy with vasoactive medications to prevent cardiac failure

Cardiogenic Shock

Occurs when the heart's ability to contract and pump blood is impaired, leading to inadequate oxygen supply to the heart and tissues.
Caused by coronary or non-coronary conditions, such as acute MI, cardiomyopathies, valvular damage, or cardiac tamponade.

Clinical Manifestations of Cardiogenic Shock

Pain (angina-type)
Fatigue
Hypotension
Weak pulse
Tachycardia
Dysrhythmias
Altered LOC
Cool, clammy, cyanotic skin

Interventions for Cardiogenic Shock

Oxygen
Pain control
Fluid therapy
Vasopressors
Inotropic agents
Antiarrhythmic medications

Distributive Shock

Occurs when blood volume pools in the peripheral blood vessels, causing a relative hypovolemia.
Caused by a loss of sympathetic tone or release of biochemical mediators from cells that cause vasodilation.

Septic Shock

The most common type of distributive shock.
Systemic response to widespread infection or sepsis.
Risk factors include immunosuppression, extremes of age, malnourishment, chronic illness, and invasive procedures.
SIRS (systemic inflammatory response syndrome) criteria include temperature, heart rate, respiratory rate, and WBC count.

Clinical Manifestations of Septic Shock

SIRS criteria
Hypotension
Tachycardia
Tachypnea
Altered LOC
Decreased urine output
Cyanosis

Interventions for Septic Shock

Oxygen
Fluid therapy
Vasopressors
Antibiotics
Supportive care for organ dysfunction

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Description

Learn about the concept of shock, a complex syndrome resulting from decreased blood flow to body tissues, leading to cellular dysfunction and multi-system organ failure. Understand the pathophysiology of shock and its effects on the body.