Types Of Shock

Types of Shock:

All types of shock occur due to an underlying lack of tissue perfusion. (Fluid loss, significant vasodilation, pump failure):

Four causes of shock

Hypovolemic shock – from blood loss or excessive fluid loss

Cardiogenic shock – the heart is unable to circulate enough blood volume to maintain adequate tissue perfusion. This can happen after a heart attack or during an acute episode of heart failure.

Obstructive shock – can be caused by an obstruction in the cardiovascular system. Examples include a pulmonary embolism (blood clot in the lung) and pneumothorax (collapsed lung).

Distributive shock – occurs as a result of poor distribution of blood to the tissues, leading to inadequate tissue perfusion. This type of shock is seen in spinal, septic, and anaphylactic shock. This is also known as relative hypovolemia.

  • Respiratory
  • Anaphylactic: exposure to substance you are extremely allergic to causes a reaction between the antigen and the antibody, large histamine release
  • Neurogenic: severe spinal or brain injury makes nervous system unable to control blood vessel dilation (no epinephrine), blood pools up in a container that is too big
  • Cardiogenic: profound failure of the pump due to AMI, obstruction, heart failure
  • Hypovolemic: Most common, loss of blood or fluid
  • Psychogenic: fainting
  • Metabolic
  • Septic: infection leads to massive vasodilation

Cardiogenic shock may be differentiated from hypovolemic shock by the following:

  • Chief complaint – chest pain
  • Heart rate
  • Signs of CHF such as JVD
  • Dysrhythmia

Other types of shock (Neurogenic, Anaphylactic, Septic) can be differentiated by:

  • Mechanism that suggests vasodilation
  • Warm, flushed skin
  • Lack of tachycardia

Managing Shock

  • Ensure a patent airway
  • Provide adequate oxygenation and ventilation
  • Restore perfusion
  • Repair or stop the cause

Fluid Replacement: IV lines counter blood loss by introducing fluid into the intravascular space >> restoring circulatory volume. Most commonly used solutions:

  • Lactated Ringers, isotonic
  • 0.9% sodium chloride (normal saline), isotonic
  • 5% dextrose in water (D5W), hypotonic glucose

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