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In shock, the first hour of treatment is most

critical. Early detection is key.
There are different ways to categorize shock.
Basically, shock presents three potential
 Not enough fluid in the blood vessels (hypovolemia)
 Fluid has moved outside the vessels, so cannot be
pumped to the organs (distributive) OR

Heart cannot pump fluid that is present (cardiogenic)
Shock and Temperature

In septic shock, the skin and body

temperature may increase. In other shock
states, body and skin temperature will
Shock and Heart Signs

Early stages of shock activate the sympathetic

nervous system. So in early stages, the client
will not always be hypotensive.
Bradycardia is a very late sign in shock.
Another late sign is cardiac arrhythmia (other
than sinus tachycardia). Arrhythmias reflect less
perfusion of the coronary arteries and
As the myocardium receives less perfusion,
heart pumps less.
Because less blood perfuses the brain, level of
consciousness drops
Shock and Urinary Output

Average adult urinary output is 0.5 to 1.0

ml/kg/hr. Less than 35 ml/hour reflects
decreased renal blood flow. Acute renal
failure can result.
Shock and Respiration

As blood flow to lungs decreases, less gas

exchange will occur.
When tissues receive less oxygen, they
produce more lactate and metabolic
acidosis sets in. Metabolic acidosis
increases risk of cardiac arrhythmias.
For a client in shock, body cells receive
less oxygen and nutrients. Thus treatment
aims at increasing both available oxygen
and volume of blood in vessels (unless the
heart has failed).
Shock and Respiration

Medications can improve tone of blood

vessels (inotropes) or treat the cause of
shock (corticosteroids, antibiotics).
When treating a trauma client, you must
quickly assess ABCs. After you know the
client is breathing and has a pulse, vital
signs can wait while you stop any bleeding
and start other interventions (such as
starting IV). Don't rely only on the vital sign