Chi Sherry的部落格

Shock 休克

休克指的是一急性的綜合症 (acute syndrome)。在這種狀態下，全身有效血流量減少，微循環出現障礙，導致重要的生命器官缺血缺氧(shortage of systemic blood supply to a vital organ)。

即是身體器官需氧量與得氧量失調

3 main parts maintaining circulation: 

1. Heart = can pump enough blood for the body's need
2. Blood = enough blood to pump 
3. Blood vessel = remain elasticity

3 Stages of shocks

• first stage (compensatory of shock) = compensate by heartbeat (↑HR), vasoconstriction, sympathetic excitement 
• second stage (decompensatory of shock) = body compensatory disorders begin e.g.  ↓ BP, cold extremities 
• third stage (irreversible shock) = prolonged perfusion leads to cell damage

Major s/s for early detection:  ↓ BP, ↑ HR, ↓UO

ref: NEJS - the New England Journal of Stupid

https://www.facebook.com/nejsblog/photos/a.169812586422013/951733698229894/?type=1&theater

5 types of shock:

a. hypovolemic shock 血容積過少性休克  

when blood volume ↓15-25% (i.e. 500-1500ml)

e.g. acute blood loss more than 20% (800ml)/ severe diarrhea/ vomiting 

** if blood loss >40% = risk of death**

b. Cardiogenic shock心因性休克

心臟罷工了=due to acute cardiac ejection failure e.g. MI

c.Septic shock  敗血性休克 

shock by sepsis (mainly due to bacterial infection, but also mold, viral, yeast)

infection changed vessel permeability >> even with IV BP still low and organ dysfunction 

d. Anaphylactic shock 過敏性休克

allergic reaction>>vasodilatation e.g. food/ drug allergy 

can save by steroid 

e. Neurologic shock 神經性休克

severe pain stimulation through nerve reflex>> peripheral blood vessel dilated >> ↓ BP + ↓ cerebral perfusion >> short-term LoC

shock index=pulse rate / dBP

0.5 normal 

1 mild shock (20-30%)

>1 shock

>1.5 severe shock ( blood loss 30-50%)

Shock management, Nx: 

1. 頭高腳低> blood easily return to brain/ heart 
2. O2 supply + keep airway 
3. maintain body tight
4. lose tight clothing 
5. NPO