BIOLOGIC CRISIS:

SHOCK
HYPOVOLEMI • This results from loss of circulating volume
C • Ex. Hemorrhage, dehydration (N/V, Diarrhea, Polyuria)
SHOCK Burns, Trauma and Ascites (Third Spacing
CARDIOGENI
• Decreased CO – MI, Dysrhythmias, CHF, Cardiac
C Tamponade
SHOCK
 • Massive vasodilation.
DISTRIBUTIV • Neurogenic Shock or Spinal Shock – Generalized vasodilation due to
conditions affecting the medulla oblongata and SNS (Spinal Cord Injury,
E OR Head injury, Anesthesia, Opiates, overdose, Barbiturates, tranquilizers
• Septic Shock or Toxic Shock – Severe infection commonly caused by a
VASOGENIC gram-negative organism. Endotoxins released by microorganisms cause
massive vasodilation
SHOCK • Anaphylactic Shock – Severe allergic reaction; mediated by Histamine,
Bradykinin, Leukotrienes and Prostaglandins.
Early Stage of
Shock
• 1. Early Stage of Shock
• Restlessness, confusion Late Stage of Shock
• Tachycardia • 2. Hypotension Oliguria to anuria
• Tachypnea
• Shallow Respiration
• Diaphoresis; cold clammy skin
• Decreased body temperature • Hypothermia
• Decreased urine output • Decreased bowel sounds
• Thirst, dry mucous membrane • Hyperkalemia, respiratory and
• Hypokalemia metabolic acidosis.
• Respiratory alkalosis
Collaborative management of client with shock
• Whole blood and blood products
• Colloids, e.g. albumin, plasma protein factor
• Plasma expanders, e.g. dextran, hetastarch, mannitol
• Crystallized solutions, e.g. 0.9% NaCL, ½ NS, D5W, Lactated Ringer’s
Collaborative management of client with shock
• Position: MODIFIED TRENDELENBURG
• Supine, head supported with pillow, to prevent cerebral venous congestion, legs extended and
elevated at 20-30 degree angle, pelvis slightly higher than torso. Increases venous return to the
heart. This in turn increases strength of cardiac contractility and improves cardiac output

Intraaortic balloon pump or counter
pulsation device. Improves coronary
artery and Myocardial tissue
perfusion and reduce LV workload
Medical anti-shock trouser (MAST)
abdominal and leg panels can be
inflated by a foot pump. Improves
venous return and increase cardiac
workload. Specifically useful in
shock due to hemorrage
 • Administer oxygen therapy
Assist with
• Suction as needed
Respiratory Support • Use of Mech vent – Positive –end
Expiratory pressure for ARDS
Renal Support
• MIO, BUN, Crea
• Administer Furosemide,
Mannitol – Promote
Diuresis
• Administer
DOBUTAMINE as
prescribe to –promote-
RENAL TISSUE
PERFUSION
GI Support
(Prevent Stress
Ulcer)
• Insert NGT- connect NGT to low
suction to prevent gastric
distention
• Administer Antacid,H2 Blockers,
PPI to prevent ulcer
Promote Safety
• Prevent Falls
• Protect the client from
infection and from chills
• Prevent Complications
of Immobility
Drug therapy in Shock

Vasoconstrictors (Chronotropic and

Inotropic effects)  Maintain Normal BP
• Norepinephrine (Levophed) – 2-10mcg/kg/min
• Epinephrine
• Dopamine
• Dobutamine
• Metaraminol (aramine)

Na bicarbonate – Reverese Acidosis

Antibiotics – control sepsis
Heparin – treat DIC
Steroids – produce anti-inflammatory effect
Glucagon – increase blood sugar
Cimetidine or Omeprazole – prevent
stress ulcer
Glucose 50% - meet increased demand for
energy during shock.
Drug therapy in Shock

Diphenhydramine (Benadryl) for anaphylaxis

Narcotics – relieve pain – used with great care
because these may cause respiratory depression
Cardiotonic medications –
Treat Dysrhythmias
• Lidocaine
• Bretylium
• Quinidine
• Procainamide
Treat Bradycardia – Unstable
Isoproterenol
Atropine SO4 – 1mg q3-5mins , MAX:3mg
SVT –
Stable – Physiologic : Vagal Maneuver – Carotid Massage for 10 secs *Check
for bruit sound) , Cough, Anal Dilation

Supravenous
Pharmacologic: if unresponsive to vagal Maneuver
DOC: Adenosine

Tachycardia 1st: 6mg fast IV/IO in 1-3 seconds push

2nd: 12mg if needed 1-2 mins after
VT w/ Pulse Pharmacologic:
Amiodarone 150mg IV/IO slow in 10mins, followby maintenance
Stable infusion of 1mg/min for first 6hrs
 Sedate

Unstable SVT Synch Cardioversion

Biphasic 50J initial

Monophasic – 200j
 Sedate:
VT Cardioversion 100J

Unstable AF : 120-200 biphasic / 200 mono