『Shock, Sepsis & SIRS: Early Clues, Fast Actions & Bedside Nursing Pearls』のカバーアート

Shock, Sepsis & SIRS: Early Clues, Fast Actions & Bedside Nursing Pearls

Shock, Sepsis & SIRS: Early Clues, Fast Actions & Bedside Nursing Pearls

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 Visit thinklikeanurse.orgComprehensive Episode Notes1. What Shock Really IsCore definition: inadequate tissue perfusion, leading to anaerobic metabolism, rising acid, cellular hypoxia, and eventual organ failure.All shock types follow the same three-stage progression:Stage 1: Compensated – tachycardia, tachypnea, cool pale skin, anxiety, decreased urine output; BP may still look normal.Stage 2: Decompensated – severe tachycardia, severe tachypnea, drop in BP, narrowed pulse pressure, mental status changes, oliguria/anuria, metabolic acidosis.Stage 3: Irreversible – refractory hypotension, multiorgan failure, disseminated intravascular coagulation, poor response to pressors or fluids.2. The Big Three Shock CategoriesA. Hypovolemic Shock — “The Empty Tank”Causes: bleeding, trauma, burns, dehydration, massive fluid shifts (DKA, vomiting, diarrhea).Key assessment:Pale, cool, clammyFlat neck veinsThready pulsesLow urine outputLab clues:Low hemoglobin/hematocrit (bleeding)High hemoglobin/hematocrit (hemoconcentration from dehydration)BUN-to-creatinine ratio over 20:1 → prerenal dehydrationPriority actions:Two large-bore IVs, rapid fluid resuscitationBlood products if bleedingKeep patient warm; control source of fluid lossB. Cardiogenic Shock — “The Broken Pump”Causes: massive heart attack, myocarditis, pulmonary embolism, cardiac tamponade.Key assessment:Cold + wetJugular vein distentionCrackles, pulmonary edema, pink frothy sputumNew S3 heart soundAdvanced hemodynamics:High wedge pressureLow cardiac indexPriority actions:Avoid aggressive fluidsReduce afterloadStart inotropes (dobutamine, milrinone)Pressors if needed (norepinephrine is first-line)Immediate cardiology intervention (cath lab, mechanical support)C. Distributive Shock — “The Leaky Pipes”Includes:SepticAnaphylacticNeurogenicAdrenal crisisEarly septic shock often looks warm:Warm, flushed skinBounding pulsesWide pulse pressureHigh cardiac output, low vascular resistanceNeurogenic shock exception:Warm, dryBradycardicCaused by spinal cord injury above T63. SIRS vs. Sepsis-3SIRS (old criteria): too sensitive, not specific; triggered by many non-infectious conditions.Sepsis-3 definition:Life-threatening organ dysfunction caused by a dysregulated response to infection.SOFA ScoreICU tool measuring organ failure across six systems.QS-SOFA Bedside ScreenSuspected infection + 2 of 3:Respiratory rate 22 or higherAltered mentationSystolic pressure 100 or less→ Activate sepsis pathway immediately.4. Defining Septic ShockSepsis PLUS:Vasopressors needed to maintain a MAP of 65Lactate level over 2 despite adequate fluid resuscitation→ Mortality increases dramatically.5. Universal Nursing Actions for ShockAirway, breathing, circulation firstHigh-flow oxygenTwo large-bore IVs immediatelyGoal-directed fluidsUrine output target: 0.5–1 per hour → early marker of organ perfusionSerial lactatesFor sepsis:Blood cultures before antibiotics if no delayBroad-spectrum antibiotics within 60 minutesPressors through central line when possibleMaintain warmth; initiate stress-ulcer and DVT prevention6. 5-Minute Bedside Differentiation TriadHypovolemic: Cold + flat veinsCardiogenic: Cold + wet lungsDistributive (early septic): Hot + flushedNeurogenic: Warm + bradycardicMaster these patterns → fast, accurate recognition. Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com
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