The document discusses various types of shock including hypovolemic, cardiogenic, distributive, and obstructive, detailing their causes, signs, symptoms, and management strategies. It outlines pathophysiological mechanisms such as fluid depletion, pump failure, and vessel dilation, along with crucial vital signs and clinical findings associated with each type. Additionally, the document lists antibiotics and their applications in treating infections related to septic shock, including dosage and precautions.

1. Types of shock and management
Types of
shock
Causes Pathophysiology Signs & symptoms Management
Hypovolemic Body fluid depletion
- hemorrhage
(internal/external)
-dehydration
- too little blood volume causes
reduced MAP so that body’s
need for oxygen not met.
( reduced CO, reduced CVP,
reduced PAP, reduced PCWP)
High respirations, prolonged capillary
refill, weak & rapid pulse, low or
absent urine output, low blood
pressure, thirst, agitation, anxiety, low
blood pressure, reduced SpO2,
cyanotic
Cardiogenic Direct pump failure
-MI, cardiac arrest
-Ventricular Dysrhythmia
Heart cannot contract
effectively
Fluid volume not affected
Low CO Low afterload -> low
MAP
( low CO low CVP low PAP
low PCWP)
Tachycardia, u/o <30cc/H,
Hypotension, agitation, pulmonary
congestion, tachypnea, poor peripheral
circulation
Distributive Decreased vascular volume
or tone
- Neural sympathetic
stimulation of nerves
controlling blood
vessels is decreased,
smooth vessel
muscles relax
causing vasodilation
- Chemical,
anaphylaxis, sepsis,
capillary leak
syndrome
Vasodilation with pooling
causes decreased preload and
decreases in stroke volume and
CO
Fluid shifted from central
vascular space
Anaphylactic: (low CO, Low
CVP, Low PAP, Low PCWP)
Early sepsis :
(High CO normal or high PAP
+ PCWP)
late sepsis:
Anaphylactic: damage to cells cause
release of histamine which dilates
vessels and increases capillary
permeability causing severe
hypovolemia and vascular collapse.
Decreased contractility and
dysrhythmias occur, bronchial edema
and pulmonary obstruction. Whole
body hypoxia
Septic : associated with DIC> toxins
and endotoxins released into blood
cause systemic inflammatory response
syndrome. Metabolism becomes
aerobic because of low MAP, clot

2. (low CO low CVP Low PAP
Low PCWP)
formation in capillaries and poor cell
uptake of O2.
Capillary leak : fluid shift from blood
to interstitial space.
Obstructive Indirect pump failure
- Cardiac tamponade
- Pulmonary
embolism
Cardiac function decreased by
non cardiac factors
Total body fluid volume not
affected
Low CO High CVP High PAP
High PCWP
Cardiac tamponade: JVD, paradoxical
pulse, low CO, muffled heart sound
Pulmonary embolus : sudden onset
dyspnea, pleuritic chest pain,
apprehension, restlessness, cough,
feeling of impending doom,
hemoptysis, tachypnea, low grade
fever, low SpO2

3. Drug name Potential use Dose Frequency Maximum Cautions / Comments

4. (Generic) Dose
Piperacillin-
Tazobactam
Intra-abdominal,
genitourinary, skin/soft
tissue, pneumonia
infections, febrile
neutropenia
3.375-
4.5g
(IV) Q6 hours 4.5gm IV
Common first line broad
spectrum antibiotic in septic
shock
Cefepime
Intra-abdominal,
genitourinary, skin/soft
tissue, meningitis,
pneumonia infections,
febrile neutropenia
1-2g
(IV)
Q8-12
hours 2gm IV
Common first line broad
spectrum antibiotic in septic
shock.
Similar uses as piperacillin-
tazobactam
Vancomycin
Severe bacterial
infections, especially
MRSA, pneumonia,
endocarditis, systemic
anthrax, meningitis
15-20
mg/kg/
dose (IV)
Q8-12
hours 3gm IV
Common first line broad
spectrum antibiotic in septic
shock used in combination
with cefepime or
piperacillin-tazobactam
Ceftriaxone Meningitis, pneumonia, 1-2g (IV) Q24 hours 2gm IV First line medication for

5. UTI, endocarditis,
typhoid fever,
gonococcal infections,
pelvic inflammatory
disease
bacterial meningitis in
adults, also commonly used
for UTIs and community-
acquired pneumonia
Ciprofloxacin
UTI, intra-abdominal
infections, prostatitis,
pneumonia, bone/joint
infections, typhoid
fever,
salmonella/shigella
infections
200-
400mg
(IV)
Q8-12
hours
400mg IV
(1000mg PO)
Can prolong QT interval and
increase risk for tendon
rupture
Metronidazo
le
Anaerobic coverage for
intra-abdominal
infections, Pelvic
inflammatory disease,
C. difficile
500mg
(IV)
Q8-12
hours
500mg IV
(500mg PO)
Causes disulfiram-like
reaction with alcohol (avoid
alcohol with this
medication)
Azithromycin Community-acquired 500mg Q24 hours 500mg IV Can prolong QT interval

6. pneumonia, chlamydial
infections, COPD
exacerbation, MAC
treatment, pertussis
then
250mg
(IV) (1000mg PO)
Often given IV with
ceftriaxone for community
acquired pneumonia
patients