Central Mindanao University

College of Nursing
Cardiogenic Shock Hypovolemic
Shock
Neurogenic
Shock
Septic Shock Anaphylactic
Shock
Defnition Cardiogenic shock
is when the heart
has een
damaged so much
that it is unale to
supply enough
lood to the
organs of the
ody!
Hypovolemic
shock is an
emergency
condition in which
severe lood and
"uid loss make
the heart unale
to pump enough
lood to the ody!
#his type of shock
can cause many
organs to stop
working!
Neurogenic
shock is a type of
medical shock
that resulted
from a disruption
in the
sympathetic
out"ow leading
to unimpeded
vagal tone or the
control of the
autonomic
nervous system
over
vasoconstriction!
Septic shock is a
serious condition
that occurs when
a ody$wide
infection leads to
dangerously low
lood pressure!
Anaphyla%is is a
life$threatening
type of allergic
reaction!
Anaphyla%is is a
severe& whole$
ody allergic
reaction to a
chemical that
has ecome an
allergen!
Signs and
Symptom
s
Chest pain or
pressure
Coma
Decreased
urination
'ast reathing
'ast pulse
Heavy
sweating& moist
skin
(ightheadednes
s
An%iety or
agitation
Cool& clammy
skin
Confusion
Decreased or
no urine
output
)eneral
weakness
*ale skin color
+pallor,
Hypotension
-radycardia
Hypothermia
.ther symptoms
of shock include
the following/
A rapid and deep
shallow
reathing
Di0culty
reathing
Cold and clammy
skin
Septic shock can
a1ect any part of
the ody&
including the
heart& rain&
kidneys& liver&
and intestines!
Symptoms may
include/
Cool& pale
arms and legs
High or very
low
Symptoms
develop 2uickly&
often within
seconds or
minutes! #hey
may include the
following/
Adominal
pain
Anormal
+high$pitched,
reathing
sounds
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
(oss of
alertness and
aility to
concentrate
7estlessness&
agitation&
confusion
Shortness of
reath
Skin that feels
cool to the
touch
*ale skin color
or lotchy skin
8eak +thready,
pulse
7apid
reathing
Sweating&
moist skin
Unconsciousne
ss
*ale skin
appearance
Nausea and
vomiting
Di99iness and
lightheadednes
s
'ainting
7apid and weak
pulse
8eakness is
e%perienced as
a result of
insu0ciency in
the lood
supply
4n severe state of
neurogenic
shock& the
symptoms may
also e
accompanied
with the
following
symptoms/
-lank stares or
the eyes
staring at
nothing
temperature&
chills
(ight$
headedness
(ittle or no
urine
(ow lood
pressure&
especially
when standing
*alpitations
7apid heart
rate
7estlessness&
agitation&
lethargy& or
confusion
Shortness of
reath
Skin rash or
discoloration
An%iety
Chest
discomfort or
tightness
Cough
Diarrhea
Di0culty
reathing
Di0culty
swallowing
Di99iness or
light$
headedness
Hives&
itchiness
Nasal
congestion
Nausea or
vomiting
*alpitations
Skin redness
Slurred
speech
Swelling of
the face&
eyes& or
tongue
Unconsciousn
ess
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
An%iety
Change in
mental state or
confusion and
disorientation
Unresponsive to
stimuli
-luish
discoloration of
the lips and
fngers which
signify a
deprivation of
o%ygen in the
ody
(ow urine output
or urine may
cease
6%cessive
sweating
Signifcant chest
pain
Unconsciousness
8hee9ing
Drugs :ou may need
medicines to
increase lood
pressure and
improve heart
Medicines may e
needed to
increase lood
pressure and the
amount of lood
Dopamine and
other inotropic
agents may e
infused in case
of inade2uate
#he person may
receive
antihistamines
& such as
diphenhydram
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
function&
including/
Doutamine
Dopamine
6pinephrine
(evosimendan
Milrinone
Norepinephrine
pumped out of
the heart +cardiac
output,& such as/
Dopamine&
Doutamine&
6pinephrine&
and
norepinephrine
"uid
resuscitation!
'luid is always
the initial
treatment of
shock&
especially
since
concomitant
hemorrhagic
shock must e
e%cluded
following
trauma! Most
institutions will
additionally
utili9e pressor
agents to
achieve
hemodynamic
staility!
Dopamine
+4ntropin, is
often used
either alone or
in comination
with other
inotropic
agents!
5asopressin
ine and
corticosteroids&
such as
prednisone& to
further reduce
symptoms
+after lifesaving
measures and
epinephrine are
given,!
:ou may e
given
medications
including/
6pinephrine
+adrenaline, to
reduce your
ody;s allergic
response
4ntravenous
+45,
antihistamines
and cortisone
to reduce
in"ammation
of your air
passages and
improve
reathing
A eta$agonist
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
+antidiuretic
hormone
<ADH=,<>=
Certain
vasopressors
+ephedrine&
norepinephrine
,!
*henylephrine
may e used
as a frst line
treatment& or
secondarily in
patients who
do not respond
ade2uately to
dopamine!
Atropine
+administer if
radycardia is
severe!,
+such as
aluterol, to
relieve
reathing
symptoms
#reatmen
t and
*rocedur
es
8hen a heart
rhythm
disturance
+dysrhythmia, is
serious& urgent
treatment may e
needed to restore
a normal heart
)et immediate
medical help! 4n
the meantime&
follow these
steps/
?eep the person
comfortale and
warm +to avoid
Severe
radycardia can
e managed with
45 infusion of
atropine given
@!Amg to B mg
every A minutes
for a total
#reatment may
include/
-reathing
machine
+mechanical
ventilation,
Dialysis
Drugs to treat
During an
anaphylactic
attack& an
emergency
medical team
may perform
cardiopulmonar
y resuscitation
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
rhythm! #his may
include/
6lectrical
CshockC therapy
+defrillation or
cardioversion,
4mplanting a
temporary
pacemaker
Medications
given through a
vein +45,
:ou may also
receive/
*ain medicine
.%ygen
'luids& lood&
and lood
products through
a vein +45,
.ther treatments
for shock may
include/
Cardiac
catheteri9ation
with coronary
angioplasty and
stenting
Heart
hypothermia,!
Have the person
lie "at with the
feet lifted aout
BD inches to
increase
circulation!
However& if the
person has a
head& neck&
ack& or leg
inEury& do not
change the
person;s position
unless he or she
is in immediate
danger!
Do not give
"uids y mouth!
4f person is
having an
allergic reaction&
treat the allergic
reaction& if you
know how!
4f the person
must e carried&
try to keep him
or her "at& with
the head down
dosage of F!@ mg
or a pacemaker if
necessary! High
dosage of
methylprednisolo
ne on the other
hand may e
given within G
hours following
the onset of
neurogenic
shock in cases
where
neurological
defcit has
already een
present!
4mmediate
transfer to the
nearest hospital
is necessary
once the patient
has een
staili9ed for
further treatment
and to further
ensure the safety
of the patient
including life
preservation!
low lood
pressure&
infection& or
lood clotting
'luids given
directly into a
vein
+intravenously,
.%ygen
Sedatives
Surgery
#he pressure in
the heart and
lungs may e
checked! #his is
called
hemodynamic
monitoring! #his
can only e done
with special
e2uipment and
intensive care
nursing!
+C*7, if you
stop reathing
or your heart
stops eating!
.%ygen& to
help
compensate
for restricted
reathing
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
monitoring to
guide
treatment
Heart surgery
+coronary
artery ypass
surgery& heart
valve
replacement&
left ventricular
assist device,
4ntra$aortic
alloon
counterpulsatio
n +4A-*, to help
the heart work
etter
*acemaker
5entricular
assist device or
other
mechanical
support
and feet lifted!
Staili9e the
head and neck
efore moving a
person with a
suspected spinal
inEury!
#he goal of
hospital
treatment is to
replace lood and
"uids! An
intravenous +45,
line will e put
into the person;s
arm to allow
lood or lood
products to e
given!
#ests that may e
done include/
-lood
chemistry&
including kidney
function tests
and those tests
looking for
evidence of
heart muscle
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6mergency Disaster Nursing
Central Mindanao University
College of Nursing
damage
Complete lood
count +C-C,
C# scan&
ultrasound& or
%$ray of
suspected areas
6chocardiogram
+sound wave
test of heart
structure and
function,
6ndoscopy
+tue placed in
the mouth to
the stomach
+upper
endoscopy,
andHor
colonoscopy
+tue place
through the
anus to the
large owel,
7ight heart
+Swan$)an9,
catheteri9ation
Urinary
catheteri9ation
+tue placed
3eseca Mae 3! #oledo -SN$ 45
6mergency Disaster Nursing
Central Mindanao University
College of Nursing
into the ladder
to measure
urine output,
7eferences
)heorghiade M& 'ilippatos )S& 'elker )M! Diagnosis and management of acute failure syndromes! 4n/
-onow 7.& Mann D(& Iipes D*& (iy *& eds! -raunwald;s Heart Disease/ A #e%took of Cardiovascular
Medicine! Jth ed! *hiladelphia& *A/ SaundersK D@BB/chap DL!
Hollenerg S! Cardiogenic shock! 4n/ )oldman (& Schafer A4& eds! )oldman;s Cecil Medicine! D>th ed!
*hiladelphia& *A/ Saunders 6lsevierK D@BB/chap B@L!
7ivers 6! Approach to the patient with shock! 4n/ )oldman (& Schafer A4& eds! Cecil Medicine! D>th ed!
*hiladelphia& *a/ Saunders 6lsevierK D@BB/chap B@M!
3ones A6& ?line 3A! Shock! 4n/ Mar% 3A& Hockerger 7S& 8alls 7M& et al& eds! 7osen;s 6mergency Medicine/
Concepts and Clinical *ractice! Gth ed! *hiladelphia& *a/ Mosy 6lsevierK D@BF/chap M!
Schwart9 (-! Systemic anaphyla%is& food allergy& and insect sting allergy! 4n/ )oldman (& Schafer A4& eds!
Cecil Medicine! D>th ed! *hiladelphia& *a/ Saunders 6lsevierK D@BB/chap DMB!
http://www.nlm.nih.gov/medlineplus/ency/article/000185.htm
http/HHwww!nlm!nih!govHmedlineplusHencyHarticleH@@@BML!htm
http/HHmedicalmd!hupages!comHhuHNeurogenic$Shock$Defnition$Symptoms$Causes$#reatment
http/HHwww!nlm!nih!govHmedlineplusHencyHarticleH@@@MMG!htm
http/HHwww!nlm!nih!govHmedlineplusHencyHarticleH@@@G>>!htm
3eseca Mae 3! #oledo -SN$ 45
6mergency Disaster Nursing