Types of Shock
Definition of Shock
Shock may be defined as state in which there is widespread, serious reduction of tissue perfusion, which if prolonged, leads to generalized impairment of cellular function.
Shock is a State or condition in which the cardiovascular and Circulatory system fails to perfuse tissues adequately
It is an impaired cardiac pumping circulatory system and or Fluid volume can lead to compromised blood flow to Organs and tissues
It is a physiologic state characterized by the systemic reduction in Tissue perfusion and resulting in decreased tissue oxygen delivery.
Types of Shock
Causes of hypovolemic shock:
- External fluid losses:
*Traumatic cause can result from penetrating and blunt trauma. Common traumatic injuries which can result in hemorrhagic shock include: myocardial laceration and rupture, major vessel laceration, pelvic and femur fractures, and scalp lacerations.
*Vascular disorder which can result in significant blood loss include: aneurysm rupture, dissection and bleeding from arteriovenous malformation.
*Examples of gastrointestinal disorders which can result in hemorrhagic shock include: bleeding oesophageal varices, bleeding peptic ulcers, Mallory – Weiss tears etc
*Pregnancy related disorders include ruptured ectopic pregnancy, placenta previa, and abruption of the placenta.
Gastrointestinal Causes For Shock
Renal Causes For Shock.
- Diabetes mellitus
- Diabetes insipidus
- Excessive use of diuretics
Cutaneous Causes For Shock.
- Exudative lesions
- Perspiration and insensible water loss without replacement,
Internal sequestration Causes For Shock.
- Ascites (peritonitis, pancreatitis, cirrhosis)
- Intestinal abruption
Types of Shock Nursing Management and First aid
- Place the patient in trendelenburg position, Start nasal oxygen
- Secure IV line using large bore IV cannula.
- Take blood samples for blood grouping and cross matching.
- Once IV access is obtained, initial fluid resuscitation is with isotonic crystalloid such as lactated ringer’s solution (RL) or normal saline (NS). An initial bolus of one to two liters is given for an adult or 20 ml/kg for a pedeatric patient, and then the patient responce os assessed. If vital sings returns to normal, the patient may be monitored to ensure stability, and blood shouled be send for type and cross match. If vital sings transiently improve, crystalloid infusion should continue, and type specific blood obtained.
- According to the types of shock, If there is no response within 30 minutes start a colloid like hemaccel. Plan for blood transfusion.
- catheterize the bladder and assess urine output
- monitor pulse rate, Blood Pressure, Respiration Rate continuously
- Replace the blood if the shock is because of blood loss
- If there is oliguria start dopamine infusion (2-4 micrograms/kg/mt)
- All female patients of child bearing years should have a pregnancy test done. if the patient is pregnant and shock. A pelvic Ultra Sonography S should be performed immediately in the emergency department. A culdocentesis may be performed, although in most places, ultrasound can be done in the ED, and yields more information on the source of bleeding
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