Shock and its Management

Shock

Shock is an abnormal physiological state where there is an imbalance between the amount of blood that is flowing and the size of the vascular bed, which leads to circulatory failure and tissue starvation of oxygen and nutrients. It is a potentially fatal condition caused by circulatory failure that severely dysfunctions life-supporting organs. Shock causes reversible effects at first, but they quickly become irreversible, leading to multi-organ failure and death.

Classification of Shock

• Hypovolemic: Loss of blood, body fluids, or water; decreased circulatory blood volume; and inadequate cardiac output hypotension and shock (such as hemorrhage, severe diarrhoea or vomiting)
• Cardiogenic: Failure of the heart to pump effectively, characterized by diminished cardiac function brought on by either mechanical irregularity causing a drop in cardiac output and blood pressure, such as MI, CHF, arrhythmias, etc.
• Distributive: In cases of neurogenic, anaphylactic, or septic shock, vasodilatation causes a decrease in preload, which results in hypotension with a normal or increased cardiac output.
• Neurogenic: Collapse of the arteriolar walls, causing a significant vasodilation and blood pooling The stoppage of sympathetic impulses brought on by unpleasant situations, excruciating pain, spinal cord injuries, head injuries, etc.
• Anaphylactic: Severe vasodilatation brought on by an allergic reaction caused by the production of histamine and other associated chemicals, such as an allergy to drugs, insect venom, etc.
• Septic: Gram negative septicemia is characterized by the production of bacterial toxins that directly affect the blood arteries, causing severe vasodilation and blood pooling.
• Extra cardiac obstructive: Results secondary to a cardiovascular circuit obstruction, such as a tension pneumothorax or cardiac tamponade.

Body Response to Shock

• Hyperventilation: It causes respiratory alkalosis.
• Vasoconstriction: Pumps blood to the brain and heart. 
• Tachycardia: To supply tissues and organs as needed
• Fluid shifts: Maintaining circulating blood volume by converting intracellular to extracellular
• Impaired metabolism: Metabolic acidosis results from tissue anoxia's anaerobic metabolism, which builds up lactic acid.
• Impaired organ function: For instance, shock lung, reduced kidney perfusion, and renal failure (ARDS)

Signs and Symptoms of Shock

• Warm, dry, and pink skin against cool, pale, and wet skin (in hypovolemic and cardiogenic shock) (in septic and neurogenic shock).
• tachycardia with a thready, feeble pulse.
• Due to compensatory processes, BP may be normal in the early stages and fall in the latter stages.
• decreased urine production
• breathing that is quick and shallow because of tissue hypoxia.
• Changed LOC: agitation and anxiety, eventually leading to coma.
• Lower temperature.

Nursing Interventions

• Keep an open airway and sufficient ventilation:
  • Create and maintain an airway.
  • As directed, give oxygen to patients.
  • Watch your breathing and ABGS.
  • Start resuscitation techniques as necessary.
• Encourage the restoration of blood volume and deliver fluids (RL, NS for crystalloid solutions and albumin, dextran, and plasmanate for colloid solutions) and blood products as directed.
• administering medications as directed
• Limit shock-causing factors as much as possible:
  • Elevate the lower body by 45 degrees to encourage venous return to the heart and boost cardiac output.
  • Trendelenburg's position should be avoided since it worsens respiratory impairment.
  • Utilize energy-saving techniques to encourage rest, and try to keep the surrounding area as quiet as possible.
  • Utilize narcotics with caution to relieve pain.
• Drugs that cause vasoconstriction should only be administered intravenously and in very modest doses.
• Vasoconstriction may result in insufficient absorption whether administered IM or SC; when circulation returns to normal, the patient may experience an overdose.
• Warm the sufferer up.
• Continue assessment of the patient:
  • Regular monitoring of vital indicators
  • Monitor your urine output, CVP, and ECG and report any significant changes, such as a decrease in urine production of less than 30 ml/hour.
  • Examine laboratory results: Blood gases, electrolytes, BUN, creatinine, and CBC
• Support the patient's and family's mental well-being; comfort the patient to allay anxiety

Cardiac Arrest

It is a state in which the heart is pumping blood through the body adequately and breathing abruptly and unexpectedly stops. Cardiac arrest, also referred to as cardiopulmonary arrest or circulatory arrest, is the cessation of regular blood flow as a result of the heart's inability to contract efficiently.

Causes Maybe

• Airway problems:
  • Obstruction brought on by: laryngospasm, CNS depression, blood, vomit, foreign bodies, trauma, infection, and inflammation
• Circulatory problems may be primary or secondary:
  • Primary: Acute coronary syndromes, dysrhythmias, hypertensive heart disease, valve disease, drugs, electrolyte / acid base abnormalities. 
  • Secondary: Hypoxemia, blood loss, hypothermia, septic shock
• Breathing problems: Decreased respiratory effort due to muscular weakness, nerve injury, a restricted chest defect, and pain from rib fractures. decreased respiratory drive due to CNS depression. (3) Conditions affecting the lungs, such as acute ARDS, pneumothorax, hemothorax, infection, exacerbation of COPD, asthma, and pulmonary embolism.

Signs and Symptoms

• Unresponsiveness and a halt to breathing cyanosis and pallor.
• Heartbeats, blood pressure, and tactile pulses are absent.
• enlarging of the pupils
• Ventricular fibrillation or cardiac arrest (if the patient is being monitored).

Management

• Cardiopulmonary resuscitation
• Drug therapy:
  • Verapamil, lidocaine, and procainamide
  • Norepinephrine, isuprel (isoproterenol), and dopamine (levophed)
  • Enhancing myocardial automaticity, excitability, conductivity, and contractility with epinephrine
  • Atropine sulfate increases heart rate by lessening the vagus nerve's control over the heart.
  • Bicarbonate is used to treat respiratory and metabolic acidosis during the initial moments of a cardiac arrest.
  • Calcium chloride: Calcium ions improve the contractile force of the myocardium, which makes the heart beat more efficiently.
  • Defibrillation

Nursing Management

• Caused by ventricular fibrillation, monitor arrest
• Start the precordial thump, and if it works, give lidocaine.
• If that fails, defibrillation
• When defibrillation fails, start performing CPR right away.
• Assist with the administration of further emergency medications and keep an eye on their effects