Shock: Blood and Fluid Resuscitation

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Shock is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism. This results in an imbalance between the supply of and demand for oxygen and nutrients. The exchange of oxygen and nutrients at the cellular level is essential to life. When a cell experiences a state of hypoperfusion, the demand for oxygen and nutrients exceeds the supply at the microcirculatory level. Classification of Shock

The four main categories of shock are
* cardiogenic,:
* hypovolemic,
* absolute hypovolemia
* relative hypovolemia
* distributive:
* neurogenic shock
* anaphylactic shock
* septic shock
* obstructive

multiple organ dysfunction syndrome (MODS) target organs
* cardiovascular dysfunction
* lung dysfunction
* gastrointestinal dysfunction
* liver dysfunction
* CNS dysfunction
* Renal dysfunction
* Skin dysfunction
Although the cause, initial presentation, and management strategies vary for each type of shock, the physiologic responses of the cells to hypoperfusion are similar. Relationship of shock, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. CNS, Central nervous system.

cardiogenic shock shock occurring when either systolic or diastolic dysfunction of the myocardium results in compromised cardiac output either systolic or diastolic dysfunction of the pumping action of the heart results in reduced cardiac output (CO). Decreased filling of the ventricle will result in decreased stroke volume

the heart's inability to pump the blood forward is classified as systolic dysfunction. Systolic dysfunction primarily affects the left ventricle, because systolic pressure and tension are greater on the left side of the heart. When systolic dysfunction affects the right side of the heart, blood flow through the pulmonary circulation is reduced. The most common precipitating cause of systolic dysfunction is acute myocardial infarction (AMI). Cardiogenic shock is the leading cause of death from AMI patient experiences impaired tissue perfusion and impaired cellular metabolism because of cardiogenic shock. patient's response may include tachycardia, hypotension, and a narrowed pulse pressure. An increase in systemic vascular resistance (SVR) increases the workload of the heart, thus increasing the myocardial oxygen consumption. The heart's inability to pump blood forward will result in a low CO (less than 4 L/min) and cardiac index (less than 2.5 L/min/m2). On examination, the patient will be tachypneic and have crackles on auscultation of breath sounds due to pulmonary congestion. Signs of peripheral hypoperfusion (e.g., cyanosis, pallor, diaphoresis, weak peripheral pulses, cool and clammy skin, delayed capillary refill) will be apparent. Decreased renal blood flow will result in sodium and water retention and decreased urine output. Anxiety, confusion, and agitation may develop as cerebral perfusion is impaired. Studies that are helpful in diagnosing cardiogenic shock include laboratory studies (e.g., cardiac enzymes, troponin levels, b-type natriuretic peptide [BNP]), electrocardiogram (ECG), chest x-ray, and echocardiogram. Hypovolemic shock occurs when there is a loss of intravascular fluid volume the volume is inadequate to fill the vascular space. The volume loss may be either an absolute or a relative volume loss. . * Absolute hypovolemia results when fluid is lost through hemorrhage, gastrointestinal (GI) loss (e.g., vomiting, diarrhea), fistula drainage, diabetes insipidus, or diuresis. * In relative hypovolemia, fluid volume moves out of the vascular space into the extravascular space (e.g., interstitial or intracavitary space). This type of fluid shift is called third spacing. One example of relative volume loss is leakage of fluid from the vascular space to the interstitial space from increased capillary permeability, as seen in sepsis and burns A reduction in...
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