Shock is a critical medical condition characterized by insufficient blood flow to the body's organs, resulting in inadequate oxygen and nutrient delivery. It can be categorized into four types: cardiogenic, hypovolemic, anaphylactic, and septic shock, each with distinct causes and symptoms. Management focuses on restoring perfusion, stabilizing blood pressure through various medical interventions, and treating the underlying cause of shock.

1. Adalberto Toledo
Javier Rivera
Stephanie Morales
Sheila Prado
Carlos Mendez Gutierrez

2. Shock is a life-threatening condition that occurs when
the body is not getting enough blood flow. The Lack
of blood flow means that the cells and organs do not
get enough oxygen and nutrients to function properly.
Multiple organs can suffer damage as a result.

3. Cardiogenic Shock Hypovolemic shock
Anaphylactic Shock Septic Shock

4. Cardiogenic shock is a condition where the heart has
been damaged so much that it is unable to supply
enough blood to the organs of the body.
The most common causes are serious heart
complications. These complications include:
 Pressure on the heart due to a buildup of fluid
around it
 Tear or rupture of the muscles or tendons that
support the heart valves, especially the mitral
valve
 Very slow heart rhythm or problem with the
electrical system of the heart

5.  Chest pain or pressure
 Coma
 Decreased urination
 Fast breathing
 Fast pulse
 Heavy sweating, moist skin
 Lightheadedness
 Loss of alertness and ability to
concentrate
 Restlessness, agitation, confusion
 Shortness of breath
 Skin that feels cool to the touch
 Pale skin color or blotchy skin
 Weak (thready) pulse

6. Hypovolemic shock is an emergency condition in which severe blood
and fluid loss make the heart unable to pump enough blood to the
body.
Causes: Losing about a fifth or more of the normal amount of blood in
your body causes hypovolemic shock.
Blood loss can be due to:
 Bleeding from cuts
 Bleeding from other injuries
 Internal bleeding, such as in the gastrointestinal tract
The amount of circulating blood in your body may drop when you
lose too many other body fluids. This can be due to:
 Burns
 Diarrhea
 Excessive perspiration
 Vomiting

7.  Anxiety or agitation
 Cool, clammy skin
 Confusion
 Decreased or no urine
output
 General weakness
 Pale skin color (pallor)
 Rapid breathing
 Sweating, moist skin
 Unconsciousness

8. Anaphylactic shock is a severe, whole-body
allergic reaction to a chemical that
has become an allergen.
Common anaphylaxis triggers include:
(depending what you are allergic to)
 Certain medications, especially
penicillin
 Foods, such as peanuts, tree nuts
(walnuts, pecans, almonds,
cashews), wheat (in children), fish,
shellfish, milk and eggs
 Insect stings from bees, yellow
jackets, wasps, hornets and fire ants

9. Septic shock is a serious condition that occurs when a
body-wide infection leads to dangerously low blood
pressure.
Sepsis can be caused by any type of infection:
bacterial, fungal, or viral. Sepsis commonly originates
from:
 abdominal or digestive system infections
 lung infections like pneumonia, bronchitis, or
lower respiratory tract infections, which are
responsible for around 25 percent of cases (NHS)
 urinary tract infection
 reproductive system infection

10.  Cool, pale arms and legs
 High or very low
temperature, chills
 Light-headedness
 Little or no urine
 Low blood pressure,
especially when standing
 Palpitations
 Rapid heart rate
 Restlessness, agitation,
lethargy, or confusion
 Shortness of breath
 Skin rash or discoloration

11. Overall Goal of Shock
management is the
restoration of adequate
perfusion; to restore
perfusion center on
achieving an adequate blood
pressure, increasing cardiac
output, and or optimizing
the oxygen content of blood;
in order to prevent cellular
and organ injury.
Restoration of hemodynamic
stability should be a priority
while simultaneous efforts to
treat the cause of shock care
implemented.

12. Common interventions:
Blood Pressure Fluids, vasopressor or vasodilator agent
Cardiac
Preload
Contractility
Afterload
Fluids, vasodilator agents
Inotropic agents
Vasopressor or vasodilator agents
Oxygen Content
Hemoglobin
Blood Transfusion
Hemoglobin Saturation
Oxygen demand
Supplemental oxygen,
mechanical ventilation
Mechanical ventilation, sedation, analgesia,
antipyretics

13. Electrocardiographic
BP with an arterial catheter
Pulse Oximetry
central venous pressure
renal perfusion concentration of
lactate
*Depending on the etiology of the shock will guide you on what specific vital signs
to focus on.

14. Vasoactive medications are frequently used in the
emergency management of shock to increase mean arterial
blood pressure (MAP) and restore organ perfusion and
oxygen delivery. Classically, these medications are
administered when intravenous fluid resuscitation fails to
restore adequate oxygen delivery.

15. Inotropic agent any of a
class of agents affecting
the force of muscle
contraction, particularly a
drug affecting the force of
cardiac contraction;
positive inotropic agents
increase, and negative
inotropic agents decrease
the force of cardiac muscle
contraction.

16. Norepinephrine is similar to
adrenaline. It works by
constricting (narrowing) the
blood vessels and increasing
blood pressure and blood
glucose (sugar) levels.
Norepinephrine is used to treat
life-threatening low blood
pressure (hypotension) that can
occur with certain medical
conditions or surgical
procedures. This medication is
often used during CPR (cardio-pulmonary
resuscitation).

17.  Norepinephrine is injected
into a vein through an IV.
 Norepinephrine is usually
given for as long as needed
until your body responds to
the medication. Some people
must receive norepinephrine
for several days.
 Your blood pressure,
breathing, and other vital
signs will be watched closely
while you are receiving
norepinephrine.

18. Epinephrine is a chemical that narrows blood vessels and
opens airways in the lungs. These effects can reverse
severe low blood pressure, wheezing, severe skin itching,
hives, and other symptoms of an allergic reaction.
Epinephrine injection is used to treat severe allergic
reactions (anaphylaxis) to insect stings or bites, foods,
drugs, and other allergens. Epinephrine is also used to
treat exercise-induced anaphylaxis.

19.  Dobutamine stimulates heart muscle and improves blood flow by helping
the heart pump better.
 Dobutamine is used short-term to treat cardiac decompensation due to
weakened heart muscle.
 Dobutamine is usually given after other heart medicines have been tried
without success.
Dobutamine is injected into a vein through a catheter. You will receive this
medicine in a hospital or clinic setting to quickly treat any serious side effects
that occur. While using dobutamine, you may need frequent medical tests.
Your heart function may need to be checked using an electrocardiograph or
ECG (sometimes called an EKG).

20. Dopamine injection (Intropin) is used to treat certain
conditions, such as low pressure, that occur when you are in
shock, which may be caused by heart attack, trauma, surgery,
heart failure, kidney failure, and other serious medical
conditions.
 Dopamine injection is injected into a vein through an IV.
 Your breathing, blood pressure, oxygen levels, kidney
function, and other vital signs will be watched closely while
you are receiving dopamine.

21. Intravenous therapy is used to correct electrolyte
imbalances, to deliver medications, for blood
transfusion or as fluid replacement to correct, for
example, dehydration.

22. There are two main types of volume expander; crystalloids and colloids. Crystalloids
are aqueous solutions of mineral salts or other water-soluble molecules. Colloids
contain larger insoluble molecules, such as gelatin. Blood is a colloid.
 Colloids preserve a high colloid osmotic pressure in the blood, while, on the other
hand, this parameter is decreased by crystalloids due to hemodilution. Crystalloids
generally are much cheaper than colloids. (blood, albumin, plasma, etc.)
 The most commonly used crystalloid fluid is normal saline, a solution of sodium
chloride at 0.9% concentration, which is close to the concentration in the blood
(isotonic). Lactated Ringer's (also known as Ringer's lactate) and the closely related
Ringer's acetate, are mildly hypotonic solutions often used in those who have
significant burns (normal saline, ringer lactate, dextrose, etc.)

23. Safety
Precautions
 Dextrose 5% in waters should not
used to treat hypovolemic shock.
 0.45% saline is not appropriate for
volume expansion
 Smaller bolus amounts are
indicated for patients with
suspected or known cardiogenic
shock.
 Fresh frozen plasma should be
used only for correction of
coagulopathy and not for volume
replacement.
 Oxygen demand should also be
decreased when possible.

24. A 25-year old woman presents to the emergency
department complaining of a cough productive of
tenacious greenish yellow mucus. Vital Signs are
temperature 101.8 F, Heart rate 129/min, respiratory
rate 27/min, and blood pressure 112/68 mm Hg.

25.  Vital Signs - heart rate
high, temperature high,
respiratory rate high
 Laboratory tests – Blood
work up
 Infection around the
body
 Low blood oxygen level
 Disturbances in the
body's acid-base balance
 Poor organ function or
organ failure
 Oxyhemoglobin
saturation test

26.  Start adequate antibiotic therapy (proper
dosage and spectrum) as early as possible
 Fluids given directly into a vein
(intravenously)
 Oxygen as needed