2. Definition of Shock
• A condition in which systemic blood pressure is
inadequate to deliver oxygen and nutrients to support
vital organs and cellular function (Mikhail, 1999).
• Inadequate oxygen delivery to meet metabolic demands.
• Shock is a physiologic state characterized by systemic
reduction in tissue perfusion, resulting in decreased
tissue oxygen delivery.
In short there is a DECREASE TISSUE PERFUSION!!!
3. Types of shock
• 68 yo M with hx of HTN and DM presents to the ER with
abrupt onset of diffuse abdominal pain with radiation to
his low back. The pt is hypotensive, tachycardic,
afebrile, with cool but dry skin.
WHAT TYPE OF SHOCK IS THIS?
HYPOVOLEMIC SHOCK!!!
5. Hypovolemic Shock
• A state of physical collapse and prostration caused by
massive blood loss.
• A particular form of shock in which the heart is unable to
supply enough blood to the body.
9. Treatment
A. Blood & fluid replacement
Highest Nursing Priority
• Initiate a least two intravenous lines for fluid
replacement.
Note: It should be a LARGE BORE/GAUGE!!!
10. Treatment
B. Control of bleeding
C. Redistribution of fluid
Priority Nsg. Intervention:
• Proper positioning (modified Trendelenburg) for the
patient who shows signs of shock. The lower extremities
are elevated to an angle of about 20 degrees; the knees
are straight, the trunk is horizontal, and the head is
slightly elevated.
13. Types of Shock
• A 55 yo M with hx of HTN, DM presents with “crushing”
substernal CP, diaphoresis, hypotension, tachycardia
and cool, clammy extremities
WHAT TYPE OF SHOCK IS THIS?
CARDIOGENIC SHOCK!!!
15. Cardiogenic Shock
• Occurs when the heart fails to pump adequately, thereby
reducing cardiac output and compromising tissue
perfusion.
16. Causes
•
•
•
•
•
•
Advanced heart block
Cardiomyopathy
Heart failure
MI
Myocarditis
Papillary muscle rupture
• Muscles located in the ventricles of the heart. They
attach to the cusps of the atrioventricular
valves (a.k.a. the mitral and tricuspid valves) via
the chorda tendinae and contract to prevent inversion
or prolapse of these valves.
17. Signs & Symptoms
•
•
•
•
Cold, clammy skin
Hypotension (systolic pressure below 90 mmHg)
Narrow pulse pressure
Oliguria (urine output of less than 30 mL/hour)
21. Types of Shock
• A 34 yo F presents to the ER after dining at a restaurant
where shortly after eating the first few bites of her meal,
became anxious, diaphoretic, began wheezing, noted
diffuse pruritic rash, nausea, and a sensation of her
“throat closing off”.
She is currently hypotensive,
tachycardic and ill appearing.
WHAT TYPE OF SHOCK IS THIS?
ANAPHYLACTIC SHOCK!!!
25. Causes
• Systemic exposure to or ingestion of sensitizing drugs or
other substances such as:
• Allergen extracts
• Diagnostic chemicals
• Insect venoms (honeybees, fire ants, mosquitoes, etc..)
• Vaccines
26. Signs & Symptoms
• First- Pruritus, flushing, urticaria appear
•Next- Throat fullness, anxiety, chest tightness,
shortness of breath and lightheadedness
•Finally- Altered mental status, respiratory
and circulatory collapse
distress
27. Signs & Symptoms
Note!!!
• A “lump in my throat” and “hoarseness” heralds lifethreatening laryngeal edema.
30. Drug Therapy
•
•
•
•
•
Epinephrine
• 0.3 mg IM of 1:1000 (epi-pen)
• Repeat every 5-10 min as needed
Corticosteroids
• Methylprednisolone 125 mg IV
• Prednisone 60 mg PO
Antihistamines
• H1 blocker- Diphenhydramine 25-50 mg IV
• H2 blocker- Ranitidine 50 mg IV
Bronchodilators
• Albuterol nebulizer
• Atrovent nebulizer
• Magnesium sulfate 2 g IV over 20 minutes
Glucagon
• For patients taking beta blockers and with refractory hypotension
• 1 mg IV q5 minutes until hypotension resolves
31. Types of Shock
• A 41 yo M presents to the ER after an MVC complaining
of decreased sensation below his waist and is now
hypotensive, bradycardic, with warm extremities
WHAT TYPE OF SHOCK IS THIS?
NUEROGENIC SHOCK!!!
33. Neurogenic Shock
• Occurs after acute spinal cord injury
• Sympathetic outflow is disrupted leaving unopposed
vagal tone
• Results in hypotension and bradycardia
• Spinal shock- temporary loss of spinal reflex activity
below a total or near total spinal cord injury (not the
same as neurogenic shock, the terms are not
interchangeable)
35. Snake Bite
Snake venom consists primarily of
proteins with a broad range of physiologic
effects. Multiple organ systems, especially
the neurologic, cardiovascular, and
respiratory systems, may be affected.
36. Common Victims;
Between 1 – 9 y.o
Common Site of Bite;
Upper Extremities
Biting Time;
Daylight hours into evening during
summer months.
WHY???
39. PERCENTAGE OF ENVENOMATION
20% to 25% results to envenomation due to snake
bite.
TYPES OF SNAKE BITE
1. DRY BITE – WITHOUT VENOM
2. WET BITE – WITH VENOM
40. TYPES OF TOXINS FROM A SNAKE BITE
1. Neurotoxins
- Directly affects the brain.
2. Hemotoxins
- Directly affects the blood thereby causing heart attack.
3. Cytotoxins
- Directly affects the nearby living cells from the bite
site.
41. TYPES OF TOXINS FROM A SNAKE BITE
4. Myotoxins (most common)
- Directly affecting the muscles which leads to
compartment syndrome.
NSG. INTERVENTION:
W.O.F – 4 P’s with S
1. PALLOR
2. PULSELESSNESS
3. PAIN
4. PARESTHESIA
5. SWELLING
TREATMENT: FASCIOTOMY
- To relieve the pressure!!!
42. Management
In the site;
Let the patient lie down
Instruct the patient to calm down
Remove all constrictive items
Providing warmth
Cleansing the wound (use soap if available)
Note: Do not suck the site of snake bite!!!
Immobilize the injured body part below the level of the
heart
“Ice or a tourniquet is not applied in the acute stage”
43. Management
D.O.C
ANTIVENIN (ANTITOXIN)
NSG. INTERVENTION:
• Best Time: (the golden time)
Within 12 hours after the incidence
• Dosage:
Depending on the type of snake & severity of bite
Note: Children needs more antivenin
44. • Skin and eye test to be perform before giving the
antivenin to determine antivenin allergy.
• Diphenhydramine & cimetidine are given prior to
antivenin administration.
• Best Route:
Intravenous
IM (can be used)
Note:
Antivenin should be diluted to 500 to 1000 mL of
PNSS.
45. • The antivenin should be infused within 4-6 hours.
Note:
It should be on a KVO rate for the first 10 mins. &
regulate @ desired flow rate after.
When symptoms is decreased the affected site
should be checked every 30 to 60 mins. for 2
days!!!
