• Christie Holt, 14yrs old..
• Went to see her GP Flu-like symptoms,sore
throat,head ache.
• But shortly after being sent home she developed a
rash and her family dialled 999 for an ambulance.
• Miss Holt was admitted at 7.15am and died 14 hours
later .
• Septic shock
Shocked???
Drugs for Shock
Shock
• Condition in which vital tissue and organs are not
receiving enough blood to function properly
• Without adequate oxygen and other nutrients, cells
cannot carry out the normal metabolic processes.
• Medical Emergency
• Failure to reverse the causes and symptoms may lead
to irreversible organ damage and death
Signs and Symptoms
• Many are nonspecific
– Pale
– “feel sick”, weak with no specific complaint
– Behavioral changes
– Pain
– Thirsty
– Cold or clammy
– Without immediate treatment, multiple body systems will be
affected and respiratory or renal failure may result.
Shock
• Central problem in most types of shock is the inability of
the cardiovascular system to send sufficient blood to vital
organs, with the heart and brain being affected early in the
progression of the disease
– Blood pressure
– Cardiac output diminished
– Heart rate , rapid weak thready pulse
– Respiratory Rate ,rapid and shallow
Types of Shock
•
•
•
•
•
Hypovolemic shock
Neurogenic shock
Cardiogenic shock
Septic shock
Anaphylactic shock
Hypovolaemic Shock
• Low Volume
• Causes:
haemorrhage
vomiting
sweating
burns
diuresis
diarrhoea
Cardiogenic Shock
• Pump Failure
• Causes:
acute MI
obstruction
CHF
arrhythmias
9
Neurogenic Shock
• Loss of tone of blood vessels
• Causes:
spinal cord damage, anaesthesia, hypoglycaemia
Anaphylactic
• Mass release of histamine due to allergic hypersensitivity
reaction (foods, insect bites, blood transfusion, drugs)
• Increased capillary permeability with vasodilatation reduces
venous return and BP
10
Septic
•Systemic infection
•Bacterial toxins
•Associated with pyrexia, marked generalised vasodilatation
and intravascular micro-clotting
Immunocompromised patients at risk
11
Treatment Priorities for Shock
• ABC’s of life support
– Airway
– Breathing
– Circulation
• Identify underlying cause; then start more specific
treatment
• Keep client warm and quiet
• Offer psychological support
Hypovolemic Shock
•
•
•
•
Restore blood volume by suitable fluids IV
Administer electrolytes & oxygen
Morphine IV
Dopamine IV
Cardiogenic shock
•
•
•
•
•
•
Elevate the limbs
Nitroglycerine SC
Morphine / Pethidine IV
Oxygen
Aspirin – oral
Dopamine IV
Type I allergic reaction
( Anaphylactic reaction)
drug ( antigen)
↓
Penicillin
antibody ( IgE)
↓
Streptokinase
attached to mast cells
heparin
Second exposure
↓
AG:AB reaction
↓
release of mediators( histamine,LTs)
↓
Urticaria
Itching
Angioedema
Asthma
hypotension
Anaphylaxis Treatment
•
•
•
•
•
Put the patient in reclining position
Administer Oxygen
Inject Adrenaline 0.5mg IM
Administer Chlorpheniramine 10-20mg IM
Inject Hydrocortisone 100-200 mg IV
Drugs for Shock – Fluid
Replacement
• Blood or blood products
– May be administered to restore fluid volume
– Whole blood for acute, massive blood loss (more
than 30% of total volume)
– Replace plasma volume and supply red blood cells
– Components
• Whole blood, plasma protein fraction
• Fresh-frozen plasma, packed red blood cells
Whole Blood
• Indicated for treatment of acute, massive
blood loss
– 30% or more of total volume
• Supply depends on donor
• Requires careful cross-matching
• Can transmit infections such as hepatitis or
HIV
Colloids
• Expand plasma volume and maintain blood pressure
• Used when up to one-third of adult client’s blood
volume lost
• Stay suspended in blood
• Draw molecules from body’s cells and tissues into
blood vessels
– Oncotic pressure
– Examples: normal human serum albumin, plasma protein
fraction, dextran, hetastarch
Colloid Agents
• Mechanism of action: to maintain plasma osmotic
pressure; transport substances through blood
• Primary use: restoration of plasma volume and blood
proteins
• Examples of blood colloids: normal human serum albumin,
plasma protein fraction, serum globulins
• Examples of nonblood-product colloids: dextan (40,
70, and high-molecular weight)and hetstarch
(Hespan)
Crystalloids
• Intravenous solutions that contain electrolytes
• Concentration resembling those of plasma
• Mechanism of action: can readily leave blood and
enter cells
• Primary use: to replace fluids that have been lost and
to promote urine output
• Examples: normal saline, lactated Ringer’s,
Plasmalyte, and hypertonic saline