Causes
Trauma. GI Bleeding. Postpartum. Severe. Dehydration. Fluid shifts. (Edema/Ascites). Burns
Critical Care Lessons
Hypovolemic Shock
Treatment
Blood products if bleeding, Crystalloids, LR and NS, Colloids (Stay in vascular space, e.g., Albumin), 2 Large IV’s
Symptoms
Weak Pulses, Tachycardia, Hypotension, ↓ Cardiac Output, ↓ CVP ↓ PCWP, ↓ CFT, Pale Skin, Confusion, Agitation
Lactated Ringer’s is an isotonic crystalloid with electrolytes similar to plasma. Used for fluid resuscitation to perfuse organs and increase urine output. Does not have dextrose. It has K+ so monitor K and do not give to clients with renal problems.Â
Cardiogenic Shock
Causes
Acidosis, Dysrhythmias, Cardiac Tamponade, Severe Hypoxemia, Acute MI, & CHF
Treatment
Oxygen, Vasopressors, (Epinephrine, Dobutamine, & Dopamine), Intraaortic Balloon Pump, Pulmonary Artery Catheter for management
Symptoms
↓ Cardiac Output, ↑ Central Venous Pressure, Tachycardia, Hypotension, Hypoxia (↓ O2 Saturations), Weak Pulses, ↑ Capillary Filling Time, JVD, Oliguria (Late sign), Dyspnea, Confusion (early symptom). Watch for dysrhythmias (Major complication!).
Septic Shock
Causes
Wound Infections, Invasive Procedures, Catheters, Pneumonia, Urosepsis (most common) & Peritonitis
Treatment
Oxygen, Fluids first then Vasopressors, Monitor for Organ dysfunction, Get blood cultures , Before giving antibiotics, Start with broad spectrum, Antibiotics, Prevent stress ulcers, Enteral nutrition if possible
Symptoms
Early= Warm, Late = Cold, Tachycardia, Hypotension, Fever, Restlessness, Oliguria, Coma, ↑ Lactic acid, & Acidosis
Early septic shock: ↑ CO, ↓ PCWP, ↓ CVP. Always send blood cultures before administering antibiotics.  Vasodilation lowers SVR and PCWP. The increased CO and HR are a compensatory mechanisms. In early shock, the increased Oxygen saturation happens because tissues are not extracting oxygen. In septic shock, monitor for DIC (Disseminated Intravascular Coagulopathy) = Impaired clotting (e.g., prolonged PT).
Anaphylactic shock
Causes
Foods (Peanuts), Medications, Bees, Latex, Insects, &Blood Products
Treatment
EPINEPHRINE, Diphenhydramine, Albuterol, Corticosteroids, Fluids, & Stay with client and monitor
Symptoms
Occur within 2 to 30 minof exposure to antigen, Rapid weak pulse, Hypotension, Vasodilation ↓ SVR, Hypoxia & Wheezing, Bronchoconstriction, Redness & Hives, Dyspnea, Impending doom, Dysrhythmias, & Cardiac Arrest
Epi Pen
Keep in dark room. Given IM in the thigh. Give immediately after first sign of reaction. Do not wait! Side effects: Dizziness, palpitations, & tachycardia
Neurogenic (Vasogenic) Shock
Causes
Spinal cord injury above T6, Spinal anesthesia, and nervous system damage. Parasympathetic system takes over leading to vasodilation. Loss of adrenergic/sympathetic stimulation
Treatment
Airway, intubate, IV fluids, and vasopressors. Blood pools so check for clots (e.g. thrombosis in legs or DVT).
Symptoms
↓ CO. ↓ CVP, ↓ Heart rate, ↓ BP, ↓SVR, ↓ Oxygen Saturation. Everything is relaxed.
| Type | CO | HR | CVP | PCWP | SVR | O2 Sat |
|---|---|---|---|---|---|---|
| Cardiogenic |  |  |  | | | |
| Hypovolemic | | | | | | |
| Septic (Early) | | |  | | | |
| Neurogenic | | | | | | |
| Anaphylactic | | | | | | |
Let's do some thinking!
- Neurogenic is easy: Everything goes down. CVP is unpredictable for all the shocks as you can see.Â
- Cardiogenic: Decreased CO and Decreased Oxygen Saturation (Makes sense. No blood flow to tissues = ↓ Oxygen). Everything elses goes up. CVP can go either way.
- Hypovolemic shock is similar to cardiogenic except for PCWP and CVP are low. The wedge pressure/CVP are down due to low volume. The Pulmonary Capillary Wedge Pressure fluctuates according to volume, to make it simple.
- Septic Shock: Vasodilation lowers SVR and PCWP. The increased CO and HR are a compensatory mechanisms. In early shock, the increased Oxygen saturation happens because tissues are not extracting oxygen. Â
- Anaphylactic Shock: Massive vasodilation. Everything goes down except heart rate. The heart rate increases as a compensatory mechanism, but in late anaphylactic shock, the heart can stop.