Hypovolemic Shock BP MAP HR RAP/CVP PAP PAWP CO/CI SVR Cardiogenic Shock BP MAP HR PAWP CO/CI SVR Anaphylactic Shock BP MAP HR RAP/CVP PAP PAWP CO/CI SVR Neurogenic Shock BP MAP HR RAP/CVP PAP PAWP CO/CI SVR Characterized as fluid loss, either absolute or relative Causes: hemorrhage, GI loss, fistula drainage, diuresis, third spacing Manifestations: poor skin turgor, oliguria, thirst, bleeding Collab care: fluid resuscitation (isotonic crystalloid), monitor for complications, treat the cause Characterized as systolic or diastolic dysfunction resulting in compromised cardiac output. Causes: MI, cardiomyopathies, blunt cardiac injury Manifestations: chest pain, anxiety, agitation, confusion, pulmonary congestion, pallor Collab care: restore blood flow to the myocardium, cardiac catheterization, hemodynamic monitoring, intra-aortic balloon pump (IABP), ventricular assist device, cardiac transplant Characterized by massive vasodilation due to a hypersensitivity reaction Causes: hypersensitivity reaction Manifestations: anxiety, confusion, wheezing, swelling, hives, angioedema Collab care: removal of offending agent, maintain patent airway, epinephrine, antihistamines, corticosteroids, fluid resuscitation Characterized disruption of the sympathetic nervous system due to spinal cord injury. Causes: spinal cord injury at T5 or above Manifestations: hypothalamic dysfunction, temperature dysregulation, bradycardia Collab care: treatment dependent on the cause (spinal cord injury), bradycardia treated with atropine or may require pacemaker, manage hypotension, monitor for hypothermia Septic Shock [Warm Phase] BP Characterized by organ dysfunction due to dysregulated host response to infection. MAP Causes: release of mediators of the inflammatory process in response to overwhelming infection HR Manifestations: bounding pulses, warm and flushed skin, oliguria, change in mental status, PAWP hyperthermia, increased WBCs, increased glucose, decreased platelets CO/CI Collab care: measure lactate, obtain blood cultures, administer broad-spectrum antibiotics, fluid SVR resuscitation (all done within 3 hours) SVO2 Septic Shock [Cold Phase] BP MAP Manifestations: weak and thready pulses, cool and clammy skin, anuria, decreased LOC, HR hypothermia, decreased glucose, decreased platelets PAWP Collab care: give vasopressors, measure lactate again, DVT prophylaxis, stress ulcer prophylaxis, CO/CI glucose control SVR SVO2
