BSN Notes: Common Signs And Symptoms: Shock- Types of Shock,Hypovolemic shock

Types of Shock

1.       Cardiogenic

2.       Hypovolemic

3.       Distributive shock

·         Septic

·         Neurogenic

·         Anaphylactic

Type	Cause
Cardiogenic	Impaired ability of the heart to pump
Hypovolemic	Loss of circulating intravascular volume.
Distributive shock	Misdistribution of circulating blood volume.
·         Septic ·         Neurogenic ·         Anaphylactic	Result of microorganisms entering the body
	Result of loss of sympathetic tone
	Result of antigen antibody reaction

.

Hypovolemic shock

Result of intravascular blood volume depletion ie. Lack of circulating blood volume.

Common causes:  

·         Haemorrhage

·         GI ulcer

·         Vomiting

·         NG suction

·         Diarrhoea

·         Diuretic therapy

·         Diabetes insipidus

·         HyperGIycaemia

·         Liver diseases

·         Malnutrition

·         Blood coagulopathies

·         Bone marrow suppression

·         Haemophilia

·         Dehydration

·         Blood loss during major operations

 Pathophysiology:

Relative or absolute hypovolemia

↓

Decreased circulatory volume

↓

Decreased venous return to the heart

↓

↓in stroke volume and CO

↓

↓in tissue perfusion

↓

O2 and nutrients supply to peripheral tissue

↓

Impaired cellular metabolism

↓

Death

Clinical  features:

·         Initially diaphoresis

·         Anxiety , restlessness , altered mental state, hypotension , rapid , weak , thready pulse

·         Cool clammy skin, cyanosis

·         Rapid and shallow inspiration

·         Hypothermia         

·         Thirst and dry mouth

·         Fatigue

·         Cold and mottled skin

Management

·         Correct underlying cause

·         Redistribute the blood volume by use of devices as pneumatic antishock stockings

·         Crystalloids NaCI (0.9%) or lactated ringers

·         Colloids Hydroxyethyl Starch (Voluven, Hetastarch), Polysaccharides (dextran), Polygeline (Haemaccel).

·         Combination of crystalloid and colloid solution  

·         Blood transfusion.

·         Vasoactive medications to restore vasomotor tone and improve cardiac function

·         Nutritional support to meet the metabolic requirements

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