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SHOCK, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS),& MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)
JOAN M. PINO-TALBOT
FALL 2005
SHOCK
A condition that occurs when the cardiovascular system fails to adequately perfuse the body’s tissues.
Inadequate tissue perfusion occurs when there is an imbalance between O2 supply and the demand
BEST TREATMENT OF SHOCK IS PREVENTION
SHOCK SYNDROME
Best defined as a generalized systemic response to inadequate tissue perfusion. Cyclic, self-perpetuating
Regardless of the cause and clinical manifestations…all types of shock result in ineffective tissue perfusion acute circulatory failure or shock syndrome:
Cellular hypoxia Impaired cellular metabolism= tissue damage—Organ
failure-- Death
Shock Syndrome
Etiology 4 Classifications
Hypovolemic Cardiogenic Distributive
Septic, Anaphylactic or Neurogenic
Shock Syndrome
Pathophysiology Initial Stage Compensatory Stage Progressive Stage Refractory Stage
COMPENSATORY STAGE
The body’s attempt to increase O2to tissues. initiate three types of responses:
Neural: increased: HR, contractutility,and venous vasconstriction
Chemical: hyperventilation toneutralized lactic acid Hormonal: vasconstriction,Na &H2O retention
increased blood glucose levels
PROGRESSIVE STAGE
Compensatory mechanism begin to fail. Energy from anaerobic metabolism not
sufficient to maintain cellular functioning & irreversible damage begins: Na/K pump begins to fail---cell & organelles swell Mitochondria the “powerhouse” of the cells
ruptures…cellular energy production ceases: O2 delivery is futile-no longer able to utilize Destructive enzymes leak into cell leading to auto-
digestion leading to cell death
REFACTORY STAGE
Shock now is irreversible at this stage. Unresponsive to medical thearpies… organ systems
fails
MODS occurs MODS is defined as the failure of two or more
interrelated organ systems. Death is imminent !!!! Death as a result of the original problem: ineffective
tissue perfusion---inability to meet cellular O2 demands
Shock Syndrome
Assessment and DiagnosisSBP below 90 mm HgTachycardia or bradycardiaAltered mental statusVaries with specific shock
syndromes
Shock Syndrome
Medical Management Improvement of tissue perfusion Adequate pulmonary gas exchange Adequate cardiac output Optimal metabolic environment Nutritional support
Shock Syndrome
Understanding of pathophysiologyFamily support
Hypovolemic Shock
Hypovolemic Shock Description Etiology
Absolute Relative
Pathophysiology Loss of circulating blood volume
Hypovolemic Shock
Hypovolemic Shock Assessment and Diagnosis
Initial stage Compensatory stage Progressive stage Refractory stage
Hemodynamic Assessment
Hypovolemic Shock
Hypovolemic Shock Medical Management
Correct hypovolemia Restore tissue perfusion
Management Prevention of hypovolemic shock Minimize fluid losses Enhance volume replacement
Cardiogenic Shock
Cardiogenic Shock Description
Failure of heart to pump blood effectively Etiology
Primary ventricular ischemia Structural problems Dysrythmias
Cardiogenic Shock
Cardiogenic Shock Pathophysiology
Impaired ability of ventricle to pump blood
Caused by a “heart” problem Assessment and Diagnosis
Low CO and low BP Compensatory mechanisms develop
Hemodynamic Assessment
Cardiogenic Shock
Card Cardiogenic Shock iogenic Shock Medical Management
Correct underlying cause of pump failure
Increase myocardial oxygen supplyDecrease myocardial demandRestore tissue perfusion
Cardiogenic Shock
Cardiogenic Shock Management
Prevention of cardiogenic shock Limit myocardial oxygen consumption Enhance oxygen supply Knowledge of side effects of interventions
Inotropes, Vasodilators,
Anaphylactic Shock
Anaphylactic Shock Description
Distributive shock Etiology
Antigen-antibody reaction Pathophysiology
Immunologic stimulation Peripheral vasodilation
Anaphylactic Shock
Anaphylactic Shock Assessment and Diagnosis
CV Respiratory Cutaneous Neurologic GI Subjective Hemodynamic
Anaphylactic Shock
Anaphylactic Shock Medical Management
Remove antigen Reverse effects of biochemical mediators Fluid replacement Oxygen Epinephrine
Anaphylactic Shock
Anaphylactic Shock Management
Prevention of anaphylactic shock Note all allergies Facilitate ventilation Enhance volume replacement Promote comfort Hemodynamic monitoring
Neurogenic Shock
Neurogenic Shock Description
Distributive shock Etiology
Disruption of SNS Pathophysiology
Lack of sympathetic tone
Neurogenic Shock
Neurogenic Shock Assessment and Diagnosis
Hypotension Bradycardia Hypothermia Warm dry skin
Hemodynamic Assessment
Neurogenic Shock
Neurogenic Shock Medical Management
Remove cause of neurogenic shock Restore tissue oxygenation and perfusion
Management Prevention of neurogenic shock Immobilization of spinal cord injuries DVT prevention
Septic Shock
Septic Shock Description
Distributive shock Etiology
Septic originIntrinsic factorsExtrinsic factors
Septic Shock
Septic Shock Pathophysiology
Stimulation of immune / inflammatory system
Systemic response
Septic Shock
Septic Shock Assessment and Diagnosis
Initial stage: Massive vasodilation HR: Increases to compensate for
hypotension Lungs: Ventilation / perfusion mismatch
ABG Neuro: LOC decreases WBC: Elevates
Septic Shock
Septic Shock Medical Management
Control and eliminate infection
Reverse pathophysiologic responses
Support CV system
Fluid administration
Provide oxygenation and ventilation
Initiate nutrition
Pharmacologic therapy
Septic Shock
Septic Shock Management
Prevention of septic shockSupport all body systemsProvide comfortPrevent secondary complications
Septic Shock
Septic Shock Pathophysiology
Stimulation of immune / inflammatory system
Systemic response
SIRS & MODS
Multiple Organ Dysfunction Syndrome Nursing Management
Multidisciplinary collaboration Infection (prevention, detection,
treatment) Tissue oxygenation Nutritional / metabolic support
SIRS & MODS
Multiple Organ Dysfunction Syndrome Pathophysiologic Mechanisms
Platelet Activating Factor (PAF) Arachidonic Acid Metabolites (AA) Proteases Complement
SIRS & MODS
Multiple Organ Dysfunction Syndrome Organ-Specific Manifestations
GI Dysfunction
Hepatobiliary Dysfunction
Renal Dysfunction
CV Dysfunction
Coagulation Dysfunction Thrombotic Hemorrhagic