Shock
A guide to understanding, assessing, and managing shock states.
Shock Scenario Challenge
Identify the type of shock based on the clinical presentation.
"A 70-year-old male is admitted after a severe motor vehicle accident with significant blood loss. He is pale, cool, and diaphoretic."
Vitals & Key Findings
BP: 80/40 mmHg, HR: 130 bpm, RR: 28, Temp: 97.0°F
Types of Shock
Understanding the underlying cause of hemodynamic instability.
| Type | Description | Common Causes |
|---|---|---|
| Hypovolemic Shock | Caused by insufficient circulating volume from loss of blood or fluid. | Hemorrhage (trauma, GI bleed), severe dehydration, burns. |
| Cardiogenic Shock | Caused by the heart's inability to pump effectively, leading to decreased cardiac output. | Myocardial infarction (most common), severe heart failure, cardiomyopathy, dysrhythmias. |
| Distributive Shock | Caused by widespread vasodilation and increased capillary permeability, leading to a "relative" hypovolemia. | Septic Shock (infection), Anaphylactic Shock (allergic reaction), Neurogenic Shock (spinal cord injury). |
| Obstructive Shock | Caused by a physical obstruction in blood flow, impeding the heart's ability to fill or pump. | Pulmonary embolism, cardiac tamponade, tension pneumothorax. |
Assessment Findings
Key signs and symptoms of shock.
| Cardiovascular | Tachycardia, hypotension, weak peripheral pulses, thready pulse, flat neck veins (in hypovolemic), JVD (in cardiogenic/obstructive). |
| Respiratory | Tachypnea (early), bradypnea (late), shallow breathing, crackles (in cardiogenic). |
| Neurological | Anxiety, restlessness (early), confusion, lethargy, coma (late). |
| Integumentary | Cool, clammy, pale skin (in hypovolemic/cardiogenic). Warm, flushed skin (early distributive). |
| Renal | Decreased urine output (<30 mL/hr). |
Diagnostic Tests
Common labs and procedures.
Arterial Blood Gases (ABGs)
To assess for metabolic acidosis (due to lactic acid buildup) and hypoxia.
Serum Lactate
Elevated levels (>2 mmol/L) indicate anaerobic metabolism and tissue hypoperfusion. A key marker of shock severity.
CBC & Coagulation Studies
To identify blood loss (low Hgb/Hct) or infection (high/low WBC). PT/INR/aPTT for bleeding risk.
Cardiac Enzymes (Troponin)
To rule out myocardial infarction as the cause of cardiogenic shock.
Echocardiogram (ECHO)
To assess cardiac function, ejection fraction, and rule out tamponade.
Blood Cultures
To identify the causative organism in septic shock.
Priority Nursing Interventions
Key actions for managing a client in shock.
- Ensure a patent airway and provide supplemental oxygen to maintain SpO2 >94%. Prepare for intubation if necessary.
- Establish large-bore IV access (two sites if possible) for rapid fluid and medication administration.
- Administer prescribed fluids (e.g., isotonic crystalloids like Normal Saline or Lactated Ringer's) for most shock states except cardiogenic shock, where fluids must be given cautiously.
- Administer vasoactive medications (e.g., norepinephrine, dopamine, dobutamine) as prescribed to support blood pressure and cardiac output.
- Continuously monitor vital signs, level of consciousness, oxygen saturation, and urine output.
- Place the client in a modified Trendelenburg position (supine with legs elevated) to promote venous return, unless contraindicated.
- Identify and treat the underlying cause (e.g., administer antibiotics for sepsis, control bleeding for hypovolemia).