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NEUROGENI C SHOCK By: ERVIN VICENTE

Neurogenic Shock

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Page 1: Neurogenic Shock

NEUROGENIC SHOCK

By: ERVIN VICENTE

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SHOCK Defined as a state of inadequate

perfusion, occurs when there is inadequate circulation

Tissues are deprived of oxygen Results in cellular metabolism

disturbance, waste accumulation 、 dysfunction

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STAGES of SHOCK 1st stage ( Initial Phase)

- the cardiac output insufficient to meet the metabolic needs of the body but now low enough to produce symptoms

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STAGES of SHOCK 2nd stage ( Compensatory Phase)- due to catecholamine being

released - an increase in HR. increase in CO. Vasoconstriction

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STAGES of SHOCK 3rd stage (Progressive Stage) - unfavorable signs and

symptoms become more apparent:- decrease blood pressure- increased heart rate- oliguria- system dysfunction begins

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STAGES of SHOCK 4th stage (Irreversible Stage)

- myocardial depression- massive capillary dilation- blood remains pooled in the extremities- death may occur

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PATHOPHYSIOLOGYINITIAL INSULT

LEADING TOSHOCK

DECREASE TISSSUEPERFUSION, DECREASE

OXYGENATION

ACTIAVATION OF HEMOSTATICRESPONCE

INCREASE CATECHOLAMINES AND CORTISOL

INCREASE SYMPATHETIC RESPONSE,

DECREASE RR TO INCREASE SATURATION AND DELIVERY

INCREASE RENIN-ANGIOTENSIN ACTIVAQTION

RESTORATION OF TISSUEPERFUSSION AND OXYGENATION

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compensatory progressive irreversible

Blood pressure normal Sys: <80 – 90 mmHg Requires mechanical and pharmacological support

Heart rate > 100 bpm > 150 bpm Erratic/ asystolic

Respiratory status > 20 bpm PaCO2 <30 mm Hg

Rapid, shallow, craklesPaCO2 > 45 mmHg

Requires intubations and mechanical ventilation and oxygenation

Urinary output decreased 0.5 mL/kg/h Anuric, requires dialysis

Mentation confusion lethargy unconsciousness

Acid-base balance RespiratoryAlkalosis

MetabolicAcidosis

Profuse acidosis

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Shock

HYPOVOLEMIC CARDIOGENICCIRCULATORY

INTERNALFLUID LOSS

EXTERNALFLUID LOSS

LOSS OF CARDIAC PUMPING

ACTION

NEUROGENICSEPTIC ANAPHYLACTIC

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HYPOVOLEMIC SHOCK

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SEPTIC SHOCK

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CARDIOGENIC SHOCK

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NEUROGENIC SHOCK

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Hypovolemic Shock Decreased intravascular volume

15%- 30% of volume reduction

Example:750 -1500 ml of blood loss in 70kg patient

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PathophysiologyDec. blood volume

Dec. venous return

Dec. stroke volume

Dec. cardiac output

Dec. tissue perfusion

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Risk FactorExternal (fluid losses) Trauma Surgery Vomiting Diarrhea Diuresis Diabetes insipidus

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Risk FactorExternal (fluid losses)

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Risk FactorInternal (fluid losses) Hemorrhage Burns Ascites Peritonitis Dehydration

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Risk FactorInternal (fluid losses)

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Medical management Fluid and blood replacement Pharmacologic theraphy

>anti-emetic>anti-diarrheal>desmopressin

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Nursing managementFOCUS: Primary Prevention of SHOCK

>proper positioning>monitor V/s>monitor I & O>oxygenation

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Cardiogenic Shock Inability of the heart to contract and to

pump

Inadequate supply of oxygen to the heart and tissue

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Causes Coronary

Most common Ex. Acute MI

Non- Coronary Stresses the myocardium

Hypoglycemia Hypocalcaemia Tension pneumothorax

Ineffective myocardial function Cardiomyopathies Cardiac tamponade Dysrhythmias Vulvular damage

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PathophysiologyDecreased cardiac

contraction

Decreased Stroke Volume and CO

Pulmonary congestionDecreased systemic

PerfusionDecreased coronary

Artery perfusion

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Medical management Coronary

PCI CABG Intra aortic balloon pump

therapy

Non-coronary Faulty cardiac valve

replacement Correction of

dysrhytmias Correction of acidosis Treatment of tension

pneumothorax

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Medical management

Oxygenation Pain control Hemodynamic monitoring Fluid replacement Pharmacologic therapy

Dobutamine Nitroglycerine

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Medical management Pharmacologic therapy

Dobutamine Nitroglycerine Dopamine Antiarhytmic

Mechanical assistive devices Intra-aortic balloon counter pulsation VAD’s Total temporary artificial heart

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Nursing management ECG monitoring Maintaining IABC Enhancing safety and comfort

Prevent infection Protect the skin Proper positioning Adm. Medication for pain

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Circulatory shock

Blood volumes pools in peripheral blood vessels

Types: Septic Anaphylactic neurogenic