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Questions and Answers
Which condition is primarily associated with high venous pressure leading to fluid extravasation and edema?
Which condition is primarily associated with high venous pressure leading to fluid extravasation and edema?
What effect does moderate dosage of dopamine (5 mcg/kg/min) have on cardiac function?
What effect does moderate dosage of dopamine (5 mcg/kg/min) have on cardiac function?
Which treatment is indicated specifically for cardiac tamponade?
Which treatment is indicated specifically for cardiac tamponade?
Which of the following is NOT a characteristic of septic shock?
Which of the following is NOT a characteristic of septic shock?
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What is the most common cause of death in non-cardiac ICUs?
What is the most common cause of death in non-cardiac ICUs?
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Which medication is used to stabilize mast cells during anaphylactic shock?
Which medication is used to stabilize mast cells during anaphylactic shock?
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Which of the following statements about distributive shock is TRUE?
Which of the following statements about distributive shock is TRUE?
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What is a key intervention for patients experiencing severe sepsis?
What is a key intervention for patients experiencing severe sepsis?
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Which of the following is a potential result of severe sepsis?
Which of the following is a potential result of severe sepsis?
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When using beta-adrenergic agonists for treatment, which drug is used to decrease the workload of the heart?
When using beta-adrenergic agonists for treatment, which drug is used to decrease the workload of the heart?
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What characterizes the initial stage of shock?
What characterizes the initial stage of shock?
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During which stage of shock are vital organs primarily affected by hypoxia?
During which stage of shock are vital organs primarily affected by hypoxia?
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Which of the following is NOT a feature of hypovolemic shock?
Which of the following is NOT a feature of hypovolemic shock?
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What is a common cause of cardiogenic shock?
What is a common cause of cardiogenic shock?
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What occurs during the nonprogressive stage of shock?
What occurs during the nonprogressive stage of shock?
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What treatment is used to replace blood volume in a patient with hypovolemic shock?
What treatment is used to replace blood volume in a patient with hypovolemic shock?
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What signifies the refractory stage of shock?
What signifies the refractory stage of shock?
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Which of the following is a characteristic of multiple organ dysfunction syndrome (MODS)?
Which of the following is a characteristic of multiple organ dysfunction syndrome (MODS)?
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Study Notes
Types of Shock
- Hypovolemic shock
- Cardiogenic shock
- Obstructive shock
- Distributive shock
Stages of Shock
- Initial stage: MAP decreased less than 10 mm Hg from baseline, slight increase in heart and respiratory rate, adaptive responses like vascular constriction and increased heart rate
- Nonprogressive stage: Compensatory phase, MAP decreases by 10-15 mm Hg, kidney and hormonal adaptive mechanisms activated, tissue hypoxia in nonvital organs, acidosis
- Progressive stage: Sustained decrease in MAP greater than 20 mm Hg from baseline, vital organs develop hypoxia, life-threatening, immediate intervention needed within 1 hour of onset
- Refractory stage: Too much cell death and tissue damage due to low oxygen reaching tissues, body can no longer respond to interventions, irreversible cell and tissue death
Multiple Organ Dysfunction Syndrome (MODS)
- Metabolites released from dead cells
- Microthrombi formation throughout the body, location depends on specific circumstances of infection and individual's health
- MODS occurs first in liver, heart, brain, and kidneys
Hypovolemic Shock
- Intravascular volume decreased
- MAP stimulates baroreceptors
- SNS stimulation leading to tachycardia and increased contractility, temporarily increasing cardiac output
- Coronary arteries dilate, decreasing blood pressure
- Reduced tissue perfusion
Causes of Hypovolemic Shock
- Hemorrhage
- Dehydration
- Fluid shifts (trauma, burns)
Treatment for Hypovolemic Shock
- Control source of blood loss
- Replenish lost volume
- Colloids (Albumin, Dextran, Hetastarch) to increase serum osmotic pressure
- Crystalloids (Normal Saline, Lactated Ringers) to increase blood pressure
- Blood products (Packed RBCs, Whole Blood) to replace lost blood
Cardiogenic Shock
- Actual heart muscle is unhealthy and pumping is directly impaired.
- Myocardial infarction is the most common cause
Clinical Manifestations of Cardiogenic Shock
- Tachycardia
- Decreased cardiac output
- Low blood pressure
- Narrowing pulse pressure
- Vasoconstriction
- Crackles
Treatment of Cardiogenic Shock
- Beta-adrenergic agonists (Norepinephrine, Dobutamine, Dopamine)
- Dopamine (low dose): dilates renal and mesenteric arteries, increases renal perfusion
- Moderate doses of dopamine: increases heart rate, contractility, and cardiac output.
- High doses: increases vasoconstriction
- Vasodilators: decrease workload, preload, and afterload of the heart (e.g., Nitroprusside, Nitroglycerin)
Mechanical Assist Devices
- Intra-aortic balloon pump (IABP)
- Mobility restricted, pedal pulses
Obstructive Shock
- Caused by problems that impair the ability of the heart muscle to pump effectively
- Caused by: Pulmonary embolism, Cardiac tamponade
Treatment for Obstructive Shock
- Pulmonary Embolism: Heparin, Fibrinolytic therapy (Streptokinase, Alteplase)
- Cardiac Tamponade: Pericardiocenthesis, Pericardial window, drain
Distributive Shock
- Pathogenesis of Septic Shock:
- Local infection → Systemic infection → SIRS → Sepsis → Organ Failure → Septic Shock → Death
Severe Sepsis
- All tissues have some degree of hypoxia
- Microthrombi formation is extensive
- Amplified systemic inflammatory response
- Anaerobic metabolism continues
Septic Shock
- Most common cause of death in non-cardiac ICUs in the US
- Nosocomial infections are common
- Increased risk with advanced invasive technology, especially in the elderly
- Mortality rate: 40%-85%
Septic Shock: Interventions
- Blood cultures
- Antibiotic therapy (Vancomycin, Aminoglycosides, Penicillins, Cephalosporins)
- Oxygen therapy
Anaphylactic Shock
- Allergic/Antigen-Antibody reaction
- Histamines, Leukotrienes released
- Bronchoconstriction
- Peripheral vasodilation
Treatment for Anaphylactic Shock
- Airway management (bronchodilators, e.g., Albuterol)
- Epinephrine to stabilize mast cells and increase BP
- IV therapy with Normal Saline to increase vascular volume
- Steroids (e.g., Methylprednisolone) to decrease inflammation
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Description
Test your knowledge on the various types and stages of shock, including hypovolemic, cardiogenic, obstructive, and distributive shock. Learn about the physiological changes occurring in each stage, from the initial adaptive responses to the critical effects of Multiple Organ Dysfunction Syndrome (MODS).
