SHOCK, SYSTEMIC INFLAMMATORY

RESPONSE SYNDROME (SIRS),&

MULTIPLE ORGAN DYSFUNCTION
SYNDROME (MODS)
JOAN M. PINO-TALBOT
FALL 2005

SHOCK
A condition that occurs when the
cardiovascular system fails to
adequately perfuse the bodys
tissues.

Inadequate tissue perfusion occurs when there is an

imbalance between O2 supply and the demand

BEST TREATMENT OF SHOCK IS PREVENTION

SHOCK SYNDROME
Best defined as a generalized systemic
response to inadequate tissue perfusion.

Cyclic, self-perpetuating
Regardless of the cause and clinical manifestationsall

types of shock result in ineffective tissue perfusion

acute circulatory failure or shock syndrome:

Cellular hypoxia
Impaired cellular metabolism= tissue damageOrgan
failure-- Death

Shock Syndrome

Etiology
4 Classifications

Hypovolemic
Cardiogenic
Distributive

Septic, Anaphylactic or
Neurogenic

Shock Syndrome
Pathophysiology

Initial Stage
Compensatory Stage
Progressive Stage
Refractory Stage

COMPENSATORY STAGE
The bodys attempt to increase O2to tissues.
initiate three types of responses:

Neural: increased: HR, contractutility,and venous

vasconstriction
Chemical: hyperventilation toneutralized lactic acid
Hormonal: vasconstriction,Na &H2O retention

increased blood glucose levels

PROGRESSIVE STAGE
Compensatory mechanism begin to
fail.

Energy from anaerobic metabolism not

sufficient to maintain cellular functioning &
irreversible damage begins:
Na/K pump begins to fail---cell & organelles swell
Mitochondria the powerhouse of the cells

rupturescellular energy production ceases:

O2 delivery is futile-no longer able to utilize

Destructive enzymes leak into cell leading to autodigestion leading to cell death

REFACTORY STAGE
Shock now is irreversible at this stage.

Unresponsive to medical thearpies organ systems

fails

MODS occurs
MODS is defined as the failure of two or more

interrelated organ systems.

Death is imminent !!!!
Death as a result of the original problem: ineffective
tissue perfusion---inability to meet cellular O2
demands

Shock Syndrome

Assessment and Diagnosis

SBP below 90 mm Hg
Tachycardia or bradycardia
Altered mental status
Varies with specific shock
syndromes

Shock Syndrome

Medical Management

Improvement of tissue perfusion

Adequate pulmonary gas exchange
Adequate cardiac output
Optimal metabolic environment
Nutritional support

Shock Syndrome

Understanding of pathophysiology
Family support

Hypovolemic Shock
Hypovolemic Shock

Description
Etiology
Absolute
Relative

Pathophysiology
Loss of circulating blood volume

Hypovolemic Shock
Hypovolemic Shock

Assessment and Diagnosis

Initial stage
Compensatory stage
Progressive stage
Refractory stage

Hemodynamic Assessment

Hypovolemic Shock
Hypovolemic Shock

Medical Management
Correct hypovolemia
Restore tissue perfusion

Management
Prevention of hypovolemic shock
Minimize fluid losses
Enhance volume replacement

Cardiogenic Shock
Cardiogenic Shock

Description
Failure of heart to pump blood effectively

Etiology
Primary ventricular ischemia
Structural problems
Dysrythmias

Cardiogenic Shock
Cardiogenic Shock

Pathophysiology
Impaired ability of ventricle to pump blood
Caused by a heart problem

Assessment and Diagnosis

Low CO and low BP
Compensatory mechanisms develop

Hemodynamic Assessment

Cardiogenic Shock
Card Cardiogenic Shock iogenic
Shock

Medical Management
Correct underlying cause of pump
failure
Increase myocardial oxygen supply
Decrease myocardial demand
Restore tissue perfusion

Cardiogenic Shock
Cardiogenic Shock

Management
Prevention of cardiogenic shock
Limit myocardial oxygen consumption
Enhance oxygen supply
Knowledge of side effects of interventions

Inotropes, Vasodilators,

Anaphylactic Shock
Anaphylactic Shock

Description
Distributive shock

Etiology
Antigen-antibody reaction

Pathophysiology
Immunologic stimulation
Peripheral vasodilation

Anaphylactic Shock
Anaphylactic Shock

Assessment and Diagnosis

CV
Respiratory
Cutaneous
Neurologic
GI
Subjective
Hemodynamic

Anaphylactic Shock
Anaphylactic Shock

Medical Management
Remove antigen
Reverse effects of biochemical mediators
Fluid replacement
Oxygen
Epinephrine

Anaphylactic Shock
Anaphylactic Shock

Management
Prevention of anaphylactic shock
Note all allergies
Facilitate ventilation
Enhance volume replacement
Promote comfort
Hemodynamic monitoring

Neurogenic Shock
Neurogenic Shock

Description
Distributive shock

Etiology
Disruption of SNS

Pathophysiology
Lack of sympathetic tone

Neurogenic Shock
Neurogenic Shock

Assessment and Diagnosis

Hypotension
Bradycardia
Hypothermia
Warm dry skin

Hemodynamic Assessment

Neurogenic Shock
Neurogenic Shock

Medical Management
Remove cause of neurogenic shock
Restore tissue oxygenation and perfusion

Management
Prevention of neurogenic shock
Immobilization of spinal cord injuries
DVT prevention

Septic Shock
Septic Shock

Description
Distributive shock
Etiology
Septic origin
Intrinsic factors
Extrinsic factors

Septic Shock
Septic Shock

Pathophysiology
Stimulation of immune /
inflammatory system
Systemic response

Septic Shock
Septic Shock

Assessment and Diagnosis

Initial stage: Massive vasodilation
HR: Increases to compensate for

hypotension
Lungs: Ventilation / perfusion mismatch
ABG

Neuro: LOC decreases

WBC: Elevates

Septic Shock
Septic Shock

Medical Management
Control and eliminate infection
Reverse pathophysiologic responses
Support CV system
Fluid administration
Provide oxygenation and ventilation
Initiate nutrition
Pharmacologic therapy

Septic Shock
Septic Shock

Management
Prevention of septic shock
Support all body systems
Provide comfort
Prevent secondary complications

Septic Shock
Septic Shock

Pathophysiology
Stimulation of immune /
inflammatory system
Systemic response

SIRS & MODS

Multiple Organ Dysfunction
Syndrome

Nursing Management
Multidisciplinary collaboration
Infection (prevention, detection,

treatment)
Tissue oxygenation
Nutritional / metabolic support

SIRS & MODS

Multiple Organ Dysfunction
Syndrome

Pathophysiologic Mechanisms
Platelet Activating Factor (PAF)
Arachidonic Acid Metabolites (AA)
Proteases
Complement

SIRS & MODS

Multiple Organ Dysfunction Syndrome

Organ-Specific Manifestations
GI Dysfunction
Hepatobiliary Dysfunction
Renal Dysfunction
CV Dysfunction
Coagulation Dysfunction

Thrombotic

Hemorrhagic