Approach to shock: Clinical sciences

Shock is a life-threatening condition that occurs when inadequate tissue perfusion and oxygen delivery leads to end organ damage and potentially death.

Now, the four types of shock include distributive, hypovolemic, cardiogenic, and obstructive. Distributive shock occurs in the setting of excessive systemic vasodilation, leading to impaired blood flow distribution. Next up, hypovolemic shock occurs due to a critical loss of fluid volume. Cardiogenic shock results from a compromise of myocardial performance, leading to a severely decreased cardiac output. Finally, obstructive shock results from obstruction of blood flow from either filling the heart or ejecting into the great vessels, which also ultimately leads to a decreased cardiac output.

Now, patients presenting with signs and symptoms of shock will be unstable, so immediately perform an ABCDE assessment and begin acute management. Start by stabilizing their airway, breathing, and circulation. This means that you might need to intubate the patient. Next, obtain IV access, and consider giving IV fluids, as well as placing a central venous catheter for administration of medications and hemodynamic monitoring.

Additionally, you can insert an arterial catheter for continuous monitoring of the mean arterial pressure, or MAP. Occasionally, you may also place a pulmonary artery catheter, or PAC, to measure certain hemodynamic parameters. Finally, put the patient on continuous vital sign monitoring, including heart rate, pulse oximetry, and blood pressure.

Ok, now that you’ve initiated acute management, it’s important to obtain a focused history and physical, as well as order lab tests. Patients may describe generalized weakness, fatigue, lethargy, and postural dizziness.