Shock Etiology Signs/symptoms Management

Hypovolemic Hemorrhagic (trauma, iatrogenic) 1. equal to giving blood ABC

1. Minor: <10% Non-hemorrhagic (bowel obstruction, 2. tachy, tilt positive, thirst, cool extremities IV fluids (crystalloids lactated ringers;
blood loss GI losses, biliary drainage, pancreatic colloids blood)
2. Mild: 20% fistula) 3. hypotensive, tachy, confusion,
3. Mod: 30% vasoconstriction, decrease urine output Control hemorrhage
4. Severe: 50%
4. profound hypotension, loss of
femoral/carotid pulse, no urine output

Septic Gram or + or fungal organisms 1. Fever, diaphoretic, flushed, tachy, Control primary process (antibiotics)
tachypneic
1. Warm (early) Sources of Gram -: Drainage
2. Cold (late) - urinary tract 2. Cold, clammy, lethargic, unresponsive,
- pulmonary oliguric, hypotensive; progress to MSOF IV fluids
- GI
- Burns Respiratory support
- Soft tissue infections
- Indwelling catheters Vasodilators/vasoconstrictors
Cardiogenic Ischemic heart disease (acute MI, VSD Recognize etiology
(Pump failure) rupture, cardiac aneurysm, papillary
muscle rupture) Judicious fluid administrationdo not
fluid OD
Valvular heart disease (acute mitral/AI,
severe AS) Swan Ganz catheterto keep eye on
pressures
Arrhythmias (SV, V)
Medical: increase contractility, alter
Trauma (tension pneumothorax, pre/afterload, control arrhythmias
pericardial tamponade Becks triad,
cardiac contusion) Mechanical support (release
pneumothorax, pericardiocentesis, intra-
aortic balloon pump, ventilation)
Neurogenic CNS dysfunction Hypotension Supportive: IV fluids; maintain temp.

Trauma (most common) Normal/slow pulse Vasoconstrictors (neosynephrine)

Iatrogenic (regional anesthetics) Warm extremities Surgical intervention

Little or no agitation

Loss of motor function