neurogenic shock
DESCRIPTION
shockTRANSCRIPT
NEUROGENIC SHOCK
By: ERVIN VICENTE
SHOCK Defined as a state of inadequate
perfusion, occurs when there is inadequate circulation
Tissues are deprived of oxygen Results in cellular metabolism
disturbance, waste accumulation 、 dysfunction
STAGES of SHOCK 1st stage ( Initial Phase)
- the cardiac output insufficient to meet the metabolic needs of the body but now low enough to produce symptoms
STAGES of SHOCK 2nd stage ( Compensatory Phase)- due to catecholamine being
released - an increase in HR. increase in CO. Vasoconstriction
STAGES of SHOCK 3rd stage (Progressive Stage) - unfavorable signs and
symptoms become more apparent:- decrease blood pressure- increased heart rate- oliguria- system dysfunction begins
STAGES of SHOCK 4th stage (Irreversible Stage)
- myocardial depression- massive capillary dilation- blood remains pooled in the extremities- death may occur
PATHOPHYSIOLOGYINITIAL INSULT
LEADING TOSHOCK
DECREASE TISSSUEPERFUSION, DECREASE
OXYGENATION
ACTIAVATION OF HEMOSTATICRESPONCE
INCREASE CATECHOLAMINES AND CORTISOL
INCREASE SYMPATHETIC RESPONSE,
DECREASE RR TO INCREASE SATURATION AND DELIVERY
INCREASE RENIN-ANGIOTENSIN ACTIVAQTION
RESTORATION OF TISSUEPERFUSSION AND OXYGENATION
compensatory progressive irreversible
Blood pressure normal Sys: <80 – 90 mmHg Requires mechanical and pharmacological support
Heart rate > 100 bpm > 150 bpm Erratic/ asystolic
Respiratory status > 20 bpm PaCO2 <30 mm Hg
Rapid, shallow, craklesPaCO2 > 45 mmHg
Requires intubations and mechanical ventilation and oxygenation
Urinary output decreased 0.5 mL/kg/h Anuric, requires dialysis
Mentation confusion lethargy unconsciousness
Acid-base balance RespiratoryAlkalosis
MetabolicAcidosis
Profuse acidosis
Shock
HYPOVOLEMIC CARDIOGENICCIRCULATORY
INTERNALFLUID LOSS
EXTERNALFLUID LOSS
LOSS OF CARDIAC PUMPING
ACTION
NEUROGENICSEPTIC ANAPHYLACTIC
HYPOVOLEMIC SHOCK
SEPTIC SHOCK
CARDIOGENIC SHOCK
NEUROGENIC SHOCK
Hypovolemic Shock Decreased intravascular volume
15%- 30% of volume reduction
Example:750 -1500 ml of blood loss in 70kg patient
PathophysiologyDec. blood volume
Dec. venous return
Dec. stroke volume
Dec. cardiac output
Dec. tissue perfusion
Risk FactorExternal (fluid losses) Trauma Surgery Vomiting Diarrhea Diuresis Diabetes insipidus
Risk FactorExternal (fluid losses)
Risk FactorInternal (fluid losses) Hemorrhage Burns Ascites Peritonitis Dehydration
Risk FactorInternal (fluid losses)
Medical management Fluid and blood replacement Pharmacologic theraphy
>anti-emetic>anti-diarrheal>desmopressin
Nursing managementFOCUS: Primary Prevention of SHOCK
>proper positioning>monitor V/s>monitor I & O>oxygenation
Cardiogenic Shock Inability of the heart to contract and to
pump
Inadequate supply of oxygen to the heart and tissue
Causes Coronary
Most common Ex. Acute MI
Non- Coronary Stresses the myocardium
Hypoglycemia Hypocalcaemia Tension pneumothorax
Ineffective myocardial function Cardiomyopathies Cardiac tamponade Dysrhythmias Vulvular damage
PathophysiologyDecreased cardiac
contraction
Decreased Stroke Volume and CO
Pulmonary congestionDecreased systemic
PerfusionDecreased coronary
Artery perfusion
Medical management Coronary
PCI CABG Intra aortic balloon pump
therapy
Non-coronary Faulty cardiac valve
replacement Correction of
dysrhytmias Correction of acidosis Treatment of tension
pneumothorax
Medical management
Oxygenation Pain control Hemodynamic monitoring Fluid replacement Pharmacologic therapy
Dobutamine Nitroglycerine
Medical management Pharmacologic therapy
Dobutamine Nitroglycerine Dopamine Antiarhytmic
Mechanical assistive devices Intra-aortic balloon counter pulsation VAD’s Total temporary artificial heart
Nursing management ECG monitoring Maintaining IABC Enhancing safety and comfort
Prevent infection Protect the skin Proper positioning Adm. Medication for pain
Circulatory shock
Blood volumes pools in peripheral blood vessels
Types: Septic Anaphylactic neurogenic