Shock & Resuscitation

Lesson Objectives

By the end of this topic, learners should be able to:

1. Define shock and its types.

2. Describe the pathophysiology of different types of shock.

3. Recognize clinical features and early warning signs.

4. Understand principles of resuscitation and fluid therapy.

5. Apply nursing and medical student perspectives in management.

 Key Glossary Terms

1. Shock

• Definition: A life-threatening condition of inadequate tissue perfusion and oxygen delivery.

• Clinical Signs: Hypotension, tachycardia, cold clammy skin, confusion, oliguria.

• Mnemonic: SHOCK = Skin changes, Hypotension, Oliguria, Confusion, K tachycardia.

2. Types of Shock

a) Hypovolemic Shock

• Cause: Fluid/blood loss (trauma, burns, GI bleeding).

• Signs: Rapid thready pulse, hypotension, cold extremities, low urine output.

• Management: Fluid resuscitation (crystalloids first, then blood).

b) Cardiogenic Shock

• Cause: Pump failure (MI, arrhythmias, cardiomyopathy).

• Signs: Hypotension, distended neck veins, pulmonary edema.

• Management: Inotropes, revascularization, oxygen, avoid fluid overload.

c) Septic Shock

• Cause: Severe infection → vasodilation + capillary leak.

• Signs: Warm skin early, cold clammy skin late, hypotension, fever.

• Management: IV fluids, broad-spectrum antibiotics, vasopressors.

d) Anaphylactic Shock

• Cause: Severe allergic reaction → histamine release.

• Signs: Hypotension, bronchospasm, urticaria, airway obstruction.

• Management: IM adrenaline (epinephrine), IV fluids, antihistamines, steroids.

e) Neurogenic Shock

• Cause: Spinal cord injury → loss of sympathetic tone.

• Signs: Hypotension, bradycardia, warm dry skin (different from others).

• Management: IV fluids, vasopressors, atropine for bradycardia.

3. Stages of Shock

• Initial Stage: Cellular hypoxia, subtle signs.

• Compensated Stage: Tachycardia, vasoconstriction maintain BP.

• Progressive Stage: Hypotension, metabolic acidosis, organ dysfunction.

• Irreversible Stage: Severe cell/organ damage, death inevitable.

4. Resuscitation

• Definition: Measures to restore perfusion and oxygen delivery.

• Principles (ABC):

  • Airway (ensure patency, intubation if needed).

  • Breathing (oxygen, ventilation support).

  • Circulation (IV access, fluids, control bleeding).

5. Fluid Resuscitation

• Crystalloids: Normal saline, Ringer’s lactate (first-line).

• Colloids: Albumin, starches (less commonly used now).

• Blood Products: PRBCs, FFP, platelets (for hemorrhagic shock).

• Massive Transfusion Protocol (MTP): Balanced ratio of PRBCs, plasma, platelets.

6. ABCDE Approach in Trauma/Resuscitation

• A – Airway with cervical spine protection.

• B – Breathing and oxygenation.

• C – Circulation with hemorrhage control.

• D – Disability (neurological status, GCS).

• E – Exposure (undress, prevent hypothermia).

7. Vasopressors & Inotropes

• Adrenaline (Epinephrine): Used in anaphylaxis, cardiac arrest.

• Norepinephrine: First-line in septic shock.

• Dopamine/Dobutamine: In cardiogenic shock.

8. Shock Index

• Definition: HR / SBP (Heart rate divided by systolic BP).

• Normal: < 0.7

• > 1.0: Indicates significant hypovolemia or shock.

 Clinical Notes & Mnemonics

• Types of Shock Mnemonic: “SHAN C”

  • Septic

  • Hypovolemic

  • Anaphylactic

  • Neurogenic

  • Cardiogenic

• Septic Shock Early vs Late Signs:

  • Early = Warm, flushed skin.

  • Late = Cold, clammy skin.

• First Drug for Anaphylaxis: IM Adrenaline (NOT IV fluids alone).

 Tables

Table 1: Types of Shock

Table 2: Stages of Shock