What is the main objective of managing obstructive shock?-Correct the cause of cardiac output obstruction-Restore tissue perfusion. Why is it important to immediately identify obstructive shock? Obstructive shock can rapidly progress to cardiopulmonary failure and then cardiac arrest.
What is obstructive shock and how is it treated?
Obstructive shock is a condition that prevents blood and oxygen from getting to your organs. You need immediate treatment of the problem that caused this emergency, such as a blood clot or collapsed lung. Survival rates for this rare type of shock are better than survival rates for more common types of shock.
What is the goal of treatment for shock?
The true goal of treatment for shock is to correct the underlying cause, but except for some causes of shock (STEMI, hypovolemia) that's not usually immediately possible. Interim goals for treatment for shock are to augment perfusion and oxygen delivery and minimize organ damage until the body's natural homeostatic mechanisms return.
What is the pathophysiology of obstructive shock?
Obstructive shock occurs when the heart endures insufficient diastolic filling (when the heart is supplied with a fresh stream of blood). Without regular diastolic filling, the heart can’t adequately perform its cardiac functions, which means that fresh supplies of blood won’t be pumped to the other organs in the body.
What is an example of obstructive shock?
Examples of obstructive shock include acute pericardial tamponade, tension pneumothorax, pulmonary or systemic hypertension, and congenital or acquired outflow obstructions. How do I manage hemodynamic decompensation in a critically ill patient? Allison Dalton, Michael F. O’Connor, in Evidence-Based Practice of Critical Care (Third Edition), 2020
What is obstructive shock in nursing?
Obstructive shock refers to the anatomical blockage of the great vessels of the heart, leading to decreased venous return, increased afterload, and decreased cardiac output.
What type of shock is obstructive shock?
Obstructive shock is one of the four types of shock, caused by a physical obstruction in the flow of blood. Obstruction can occur at the level of the great vessels or the heart itself. Causes include pulmonary embolism, cardiac tamponade, and tension pneumothorax. These are all life-threatening.
What is the pathophysiology of obstructive shock?
Etiology and Pathophysiology Obstructive shock is caused by the inability to produce adequate cardiac output despite normal intravascular volume and myocardial function. Causative factors may be located within the pulmonary or systemic circulation or associated with the heart itself.
What are signs of obstructive shock?
Obstructive ShockLow blood pressure can happen quickly, but the body will be trying to compensate (unlike neurogenic shock)Rapid pulse.Unequal breath sounds (if caused by a pneumothorax)Trouble breathing.
What medications are used for obstructive shock?
Obstructive shock - the judicious use of IV crystalloids. If shock persists, early initiation of vasopressors-norepinephrine is the first choice and add vasopressin if refractory. Continue IV fluids but monitor very closely. If acute massive pulmonary embolism -thrombolysis.
What is obstructive shock EMT?
Obstructive shock occurs when there is a physical obstruction in the heart or blood flow that causes a decrease in cardiac output. A common cause of obstructive shock is cardiac tamponade.
What is obstructive and distributive shock?
Hypovolemic shock relates to the blood and fluids compartment while distributive shock relates to the vascular system; cardiogenic shock arises from primary cardiac dysfunction; and obstructive shock arises from a blockage of the circulation.
What's the difference between cardiogenic and obstructive shock?
In cardiogenic shock, the contractility is impaired; but in obstructive shock, the heart is prevented from contracting appropriately. Common causes of obstructive shock are cardiac tamponade, tension pneumothorax, congenital heart malformations, and pulmonary embolism.
What is obstructive shock?
Obstructive shock refers to the anatomical obstruction of the great vessels of the heart (e.g., superior vena cava, inferior vena cava, and pulmona...
What causes obstructive shock?
There are two major causes of obstructive shock: a blockage of the pulmonary vascular system, thereby affecting the blood flow from the right-sided...
What are the signs and symptoms of obstructive shock?
Individuals with obstructive shock typically experience respiratory distress and may present with tachycardia, hypotension, tachypnea, air hunger (...
How is obstructive shock diagnosed and treated?
Obstructive shock can be diagnosed based on a thorough review of the individual’s medical history and physical examination. A detailed respiratory...
What are the most important facts to know about obstructive shock?
Obstructive shock refers to the anatomical blockage of the great vessels of the heart, leading to decreased venous return, increased afterload, and...
How to help someone with obstructive shock?
Administer basic CPR to the person who’s experiencing obstructive shock until medical help arrives to try to get their heart to pump blood again. Employ your absolute best efforts to keep the person conscious and keep checking their pulse and circulation.
What to do if you are in obstructive shock?
The first thing you should do if you or someone in your vicinity is enduring obstructive shock is to get yourself or the person to the hospital as soon as possible. Never drive yourself to the hospital, especially if you’re feeling faint or lightheaded. Always ask someone else to take you. Administer basic CPR to the person who’s experiencing obstructive shock until medical help arrives to try to get their heart to pump blood again.
Why does the heart go into shock?
This lack of blood flow to the heart is caused by a major obstruction, which causes the organs and cells in the body to go into shock because they’re being deprived of the oxygen and vital nutrients they require to function at full capacity. Also read: Poor circulation: Common causes, symptoms, and diagnosis tips.
Is obstructive shock common?
Keep in mind that obstructive shock symptoms are also common among other medical conditions. Here’s a list of what you should be looking out for:
Can obstructive shock cause death?
All signs and symptoms of obstructive shock should be taken very seriously and treated immediately as they have the potential to cause death. The symptoms of obstructive shock may vary depending on the condition that’s causing it and the parts of the body that are being affected, so it’s recommended that you report any unusual medical occurrences to your doctor because early detection is important.
Is obstructive shock a two way street?
Obstructive shock is a two-way street in the sense that the heart might either not be receiving a sufficient supply of blood due to an external blockage in the body, or it might not be pumping a sufficient supply of blood to the other organs due to a blockage within its own vessels.
Is obstructive shock life threatening?
Obstructive shock is a very serious and life-threatening condition that should never be ignored. Although it initially affects the heart and the lungs, its symptoms can rapidly spread to other parts of the body that lack sufficient nutrients and oxygen that’s required to function normally and survive.
What is the best treatment for obstructive shock?
Heart lesions. Cardiac tamponade. The best way to treat obstructive shock is to treat the cause. However, initial treatment of shock includes medication and high volumes of intravenous fluid to increase the blood pressure.
Why are obstructive shocks considered emergencies?
The symptoms of obstructive shock are considered emergencies because they can lead to organ failure, tissue death, and death. Symptoms that are associated with neurological function include confusion, loss of consciousness, and inability to concentrate.
How to treat shock from aortic dissection?
Treatment for an aortic dissection and vena cava syndrome in an emergency situation is to perform surgery by removing the portion of torn aorta or vena cava and replacing it with a graft.
What causes obstructive shock?
As previously stated, obstructive shock occurs when there is an obstruction, which causes a decreased amount of blood to get to the heart. Several diseases or disorders can cause obstructive shock, such as: 1 Aortic dissection: the large blood vessel attached to the heart tears and cannot transport blood to and from the heart effectively 2 Tension pneumothorax: air leaks out of the lungs due to trauma 3 Vena cava syndrome: a major vein in the body becomes blocked and cannot carry blood from the body to the heart 4 High blood pressure: pulmonary or systemic hypertension 5 Pulmonary embolism: blood clot in the lungs 6 Heart lesions: obstruct the flow of blood from the heart 7 Cardiac tamponade: a pressure on the heart that keeps it from filling, which decreases blood pressure
What is Dave's procedure?
Once Dave arrives at the hospital, he is taken to the operating room to receive a graft on his aorta. This procedure corrects the problem that caused his obstructive shock. He's then monitored for several days in the intensive care unit while his body function returns to normal.
Why does my heart feel shock?
Shock then occurs due to the lack of blood getting to the organs and decreasing their functioning capacity.
How to treat tension pneumothorax?
The treatment for a tension pneumothorax is needle decompression. This involves a sterile needle to be inserted into the pleural space to draw out the excess air. A thoracostomy tube or chest tube is also placed to support the lung. Treatment for high blood pressure is to stabilize and decrease the blood pressure.
What causes obstructive shock?
Obstructive shock is caused by the inability to produce adequate cardiac output despite normal intravascular volume and myocardial function. Causative factors may be located within the pulmonary or systemic circulation or associated with the heart itself.
Where does obstructive shock originate?
Obstructive shock may originate in the thorax. Auto-PEEP is the process by which the respiratory system is unable to return to functional residual capacity at the end of the expiratory phase of ventilation.
What is tamponade shock?
Tamponade physiology is classified under obstructive shock. It is most common after penetrating trauma. Pericardial fluid (blood) compresses the myocardium and inhibits diastolic filling. Patients may develop cardiogenic shock as the myocardium is stressed against the obstruction. Clinical signs of tamponade physiology include distended neck veins, muffled heart tones, and hypotension. This constellation of findings is called Beck’s triad. One may also identify an abnormal peripheral pulse called pulsus paradoxus. This is when the systolic blood pressure decreases >10 mm Hg during inspiration. As a result, the radial, brachial, or femoral pulse is weakened or disappears momentarily. Distended jugular veins from a rise in venous pressure with inspiration is called Kussmaul’s sign. An exaggerated drop in diastolic central venous pressure is known as Friedreich’s sign. Definitive treatment is evacuation of the pericardial blood and repair of the myocardium via a sternotomy or anterolateral thoracotomy. Temporizing measures include pericardiocentesis with aspiration of blood. Leaving a flexible catheter with a three-way stopcock can be useful to frequently aspirate blood based on physiologic demands while transferring to definitive care.
What is extracardiac shock?
Extracardiac obstructive shock results from an obstruction to flow in the cardiovascular circuit (see Box 22-2 and Fig. 22-1 ). Pericardial tamponade and constrictive pericarditis directly impair diastolic filling of the right ventricle. Tension pneumothorax and intrathoracic tumors indirectly impair right ventricular filling by obstructing venous return. Massive pulmonary emboli (two or more lobar arteries with >50% of the vascular bed occluded), nonembolic acute pulmonary hypertension, large systemic emboli (e.g., saddle embolus), and aortic dissection may result in shock owing to increased ventricular afterload.
What is the best way to treat hemodynamically unstable patients?
No further emergency department imaging may be needed in a hemodynamically unstable patient with a single identified source of hemorrhagic shock. Patients with shock and abdominal or chest injuries typically are taken to the operating suite for surgical intervention. Patients with pelvic injuries resulting in shock usually receive external pelvic fixation and pelvic angiographic embolization of actively bleeding vessels. Preperitoneal packing is also sometimes used to tamponade bleeding. Patients with extremity hemorrhage or active external bleeding are usually treated with limb splinting and local compression to limit bleeding. If these interventions plus fluid resuscitation succeed in stabilizing the patient, then additional imaging with CT can be performed to evaluate more comprehensively for injuries.
What is shock physiology?
Shock is a dynamic physiologic state that is the final end point for various disease processes. Hypovolemic, cardiogenic, distributive, and obstructive shock are the major physiologic mechanisms by which we define shock. However, a combination of these mechanisms may play a role in individual patients with shock.
What causes shock in trauma?
Circulation. Shock in trauma is due to hypovolemia until proved otherwise. Other causes, such as obstructive shock (due to tension pneumothorax) or neurogenic shock (due to spinal cord transection or spinal vasoparesis), must be excluded.
What is obstructed shock?
Obstructive shock occurs when adequate oxygen and nutrient delivery to the organs and tissues of the body is compromised as a direct result of an obstruction to blood flow into or out of the heart. If blood flowing INTO the heart is obstructed, it causes a decrease in cardiac output because of impaired diastolic filling.
What are the components of obstructive shock?
The following should be considered: positioning, airway and breathing, vascular access, fluid resuscitation, monitoring, frequent reassessment, lab studies, medication therapy, and expert consultation.
Why does obstructive shock occur in children?
The most common causes of obstructive shock in children are tension pneumothorax, pulmonary embolism, and cardiac tamponade. There are also several congenital abnormalities that can cause obstructive shock.
How to treat obstructive shock caused by tension pneumothorax?
The definitive treatment for obstructive shock caused by tension pneumothorax is needle decompression and chest tube placement to the affected area.
What is the treatment for tamponade?
The primary treatment for cardiac tamponade is pericardiocentesis. If cardiac tamponade is suspected and the patient is not in cardiac arrest, expert consultation should take place. If cardiac arrest is ongoing or impending and cardiac tamponade is suspected, emergency pericardiocentesis can be performed.
Is obstructive shock dependent on the cause?
Both signs and symptoms of obstructive shock and the management and treatment of obstructive shock are dependent upon the cause. Click each cause to review the signs, symptoms, and management of each major cause is reviewed.
What is shock treatment?
The true goal of treatment for shock is to correct the underlying cause, but except for some causes of shock (STEMI, hypovolemia) that's not usually immediately possible. Interim goals for treatment for shock are to augment perfusion and oxygen delivery and minimize organ damage until the body's natural homeostatic mechanisms return. While simple in theory, the complexity of the body's response to shock and its therapies can make realtime goal-directed management of shock surprisingly challenging.
What is lactate in shock?
Lactate is produced during tissue hypoxemia and hypoperfusion, and is useful but flawed as a goal for the treatment of shock. Lactate production and clearance are complex and inconsistent between shock states and patients. In cardiogenic and hypovolemic shock, lactate rises as tissue hypoxemia results in increased anaerobic metabolism. In distributive (usually septic) shock, mechanisms other than pure tissue ischemia (anaerobic metabolism) may contribute to elevated lactate levels. Impaired liver function (either pre-existing or due to shock) may reduce lactate clearance in any patient with shock, resulting in persistently high lactate values even after perfusion is restored and lactate production normalizes.
Does continuous scvo2 reduce mortality?
The use of continuous ScvO2 monitoring as part of the seminal "sepsis bundle" was famously shown to markedly reduce mortality from septic shock; this central tenet of the care of severe sepsis has been questioned and challenged, and is being tested further in three randomized trials.
Is it safe to use a prespecified target for cardiac output?
Therefore, using a prespecified target for cardiac output is not recommended; rather, a trends in response to treatment should be used (if cardiac output is used at all). As a goal of therapy for shock, cardiac output should take a back seat to other methods of assessing response to therapy, authors suggest.
Is lactate clearance a surrogate for central venous oxygenation?
With the above recognized limitations, serial lactate measurements can undoubtedly be useful for assessing the response to therapies for shock. Lactate clearance has shown promise as a surrogate for central venous oxygenation in randomized trials, and the utility of lactate clearance as a goal of sepsis therapy is periodically debated.
How to treat shock patients?
Timely empiric treatment for the shock patient is crucial to minimize morbidity and mortality. Critical findings involving the airway, breathing, and circulation (i.e. “the ABCs”) should be emergently addressed. Ensuring proper oxygenation is critical for all of the etiologies of shock, and arterial oxygen saturation should be maximized. Intubation should be strongly considered for airway protection, optimization of oxygenation and ventilation, and reducing the metabolic load incurred from work of breathing. However, it is important to consider that some induction and sedative medications used to facilitate intubation, as well as positive pressure ventilation itself, can reduce preload and have negative hemodynamic effects. This is of particular importance in patients with conditions in which preload is impaired, such as some obstructive or distributive shock states. In these circumstances, interventions to optimize hemodynamics (i.e. needle decompression in tension pneumothorax; rapid fluid bolus in septic shock) prior to intubation may be indicated before intubation, if feasible.
What is the importance of early recognition of shock and institution of empiric treatment?
Early recognition of shock and institution of empiric treatment is of utmost importance. Some patients in shock present with a readily identifiable etiology (i.e. gunshot wound to the abdomen), while others may be undifferentiated.
What are the symptoms of cardiogenic shock?
Cardiogenic or obstructive shock may be suggested by chest pain, shortness of breath, recent leg swelling, or syncope.
What is the pump and tank in a physical examination?
The pump refers to cardiac function as measured by cardiac output in terms of cardiac contractility and heart rate (HR). The tank refers to the amount of preload present, often measured by central venous pressure (CVP), and the pipes are assessed by systemic vascular resistance (SVR).
What are the symptoms of shock?
In many cases, non-focal, vague complaints such as weakness, altered mental status, or malaise may be the only presenting symptoms of shock. Physical Exam: A comprehensive physical examination provides important information to assist in narrowing a differential diagnosis for the patient in shock.
What is shock in biology?
Shock is a pathophysiologic state in which the oxygen supply to body tissues inadequately meets metabolic demands, resulting in dysfunction of end-organs. Shock may arise by impaired delivery of oxygen to tissues, impaired utilization of oxygen by tissues, increased oxygen consumption by tissues, or a combination of these processes.
Why do I have lethargy when I'm in shock?
History: Patients in shock may complain of lethargy or weakness, or they may present because of altered mental status (i.e. CNS end-organ damage). Symptoms are frequently nonspecific, such as chest pain or dyspnea, and may be due to the primary insult (i.e. ACS, PE) or a result of end-organ tissue ischemia secondary to shock.
