Neurogenic

Septic

Anaphylactic

Vasodilation is key in these shocks

Coronary -  LAD, CX, RCA

Noncoronary - cariomyopathy, myocarditis

Relative hypovolemia from vasodilation

-increased size of vascular space

-altered distribution of blood volume

SCI, spinal anesthesia, medulla damage

Massive vaso dilation from ANS

-hypotension & bradycardia

-Warm & dry skin

Venous pooling ->drop preload -> drop CO -> drop perfusion

-all pressures are low

Also known as: septicemia, sepsis, septic shock, SIRS, MODS

Sources: infection (foley, IV caths), chronic-disease, immunoseppresion (decreased resistance) , malnutrition

-gram neg bacteria (Ecoli)

Septicemia -> release of endotoxins -> trigger cascaed of inflammation & release of mediators -> vasodilations & ^ cap permeability -> drop SVR

Endotoxins bind to monocytes & macrophages

Hyperdynamic phase (inital)

-U/o ok, skin warm/flushed/dry, fever, WBC

-drop: BP, SVR, CVP, PAWP

Hypodynamic phase (late -> MODS)

-Death imminent

-cold, clammy, mottled

IgE antibodies produced in response to allergen

-Bronchial vasoconstriction

-excess secretion of mucous

-systemic vasodilation ^ cap permeability

Causes: beestings, food, latex, pcillin, animal serum

Manifestations: ^ pulse(weak)

-drop BP, CO, SVR, CVP

External loss of fluids

-hemorrhage

-plasma

-body fluids

* ANYTHING THAT ELIMINATES FLUIDS

Internal shifting of fluids

-ascities, peritonitis, bowel obstruction, pancreatitis

- internal bleeding: trauma, long bone fx

Class I: <15% - 750ml ^BP & P, little anxious

Class II: 15-30% - 750-1000ml ^BP & P, anxious, low u/o

Class III: 30-40% - 1500-2000ml BP drop, P^^, RR^, anxious/confused, u/o low

Class IV: BP LOW!, P^^, RR^^, lethargic(hypoxic)

fluid loss -> drop PL -> drop SV -> drop CO -> poor perfusion

Relative: blood=thickened=sludging=clots

Manifestations: ^^P, high SVR, low CVP, CO

BP is perserved until late: systolic gets closer to diastolic

Heart cannot pump and CO suffers, vascular system tires to compensate

Sources:

Coronary - MI

Noncoronary - structural or obstructive

Manifestations

HF!

HIGH - P, SVR, PVR, PAWP

LOW - BP, CO, Ejection fraction

Early

Compenstated

Progressive

Refractory

Drop MAP 10-15mmHg ->stimulates chemo/baro receptors -> release of catacholamines -> A&B stimulation

Manifestations: Narrowing pulse pressure, tachycardia, increased respirations, drop in u/o, thirst, increased BS, cool and pale

Sustained drop in MAP

Compensatory mechanisms ineffective

CO not maintain -> drop in BP

Pulmonary bed ->ARDS

Manifestations: stuporuos to unresponsive, BP less than 80 systolic, ARF, cold, cyanosis, low temp

Irrevesible from cellular necrosis

Tx=futile

Patho: sympathetic system fails -> drop Co -> acidosis

Pooling & sludging of blood

Oliguria, cerbral anoxia

Manifestations: unresponsive, little BP, pulmonary edema, organ ischemia

Monitor VS, PA readings, I&O. LOC, peripheral pulses, color , EKG, JVD

Positioning: Modified Trendelenburg

Vasopressor drug therapy: choices - dopamine, dobutamine(B), norepi(A&B), blood(low hgb) , colloids (Albumin) , corticosteriods