Question

Copy and fill out the following table then describe the three classes of shock in terms of how each is diagnosed and treated.

Physiologic Variable	Preload	Pump Function	Afterload	Tissue Perfusion	Frequency of Systole
Clinical Measurement	PCWP	CO	SVR	SvO2	HR
Hypovolemic
Cardiogenic
Distributive

Answer 1

Physiologic Variable	Preload	Pump Function	Afterload	Tissue Perfusion	Frequency of Systole
Clinical Measurement	PCWP	CO	SVR	SvO2	HR
Hypovolemic	Decreased	Decreased	Increased	Decreased	Increased heart rate(120 beats/min)
Cardiogenic	Increased	Reduced	Increased	Decreased	Decreased heart rate(less than 60 beats/min)
Distributive	Decreased/Normal	Increased	Decreased	Increased	More than 90 beats/min

Hypovolemic Shock

           Hypovolemic shock is a condition in which more than 20% of fluids or blood is losing from the body. This makes the heart unable to pump sufficient blood all over the body.

             Hypovolemic shock can be diagnosed by doing the general observation and physical examination.

· The faster heart rate and lower blood pressure indicates the hypovolemic shock

· Change in the color of skin (pale color) and reduced capillary refill in the nail beds.

· Identify the presence of nay bruises in the body

· Blood tests to monitor the electrolytes imbalances

· CT scan and Ultrasound to assess any bleeding from the internal organs

· Electrocardiogram to monitor the heart rate

· Insertion of the urinary catheter to monitor the urine outflow

Treatment

            Goal of the treatment is to stop the fluid loss and to maintain the fluid volume levels stable.

· Administration of IV fluids

· Replacement of blood products –transfusion of plasma, Red Blood Cells, platelet transfusion

· Administer medications such as dopamine, epinephrine etc. to improve the pumping strengthen of heart.

Cardiogenic shock

             Cardiogenic shock is a condition in which the heart is not able to supply enough blood to the body the meet the needs of the body. As a result, Blood pressure becomes fall and organs become failing.

Cardiogenic shock can be diagnosed by:

· Blood tests to detect the proteins that are released in to the blood stream due to the heat attack

· Electrocardiogram to detect the abnormalities in the electrical activity of the heart

· Coronary angiography to detect the blockage in the coronary arteries

· Chest X-ray to obtain the picture of the heart to assess any damage in the heart.

Treatment

       This shock is a life threatening condition and emergency treatment is required in this case.

· Administration of the oxygen and insertion of the catheter in the arteries to remove the blockages

· If Arrhythmia is the cause for the shock, then defibrillation will provide to the patient

· Administration of medications to improve the blood pressure and heart functioning.

Distributive shock

        Distributive shock is a condition in which there is inadequate supply of blood to the body’s tissues and organs. Hence there is not enough oxygen carrying blood to meet the metabolic needs of organs and tissues.

Distributive shock can be diagnosed by:

· Monitoring the Vital signs

· Assessing the heart rate by checking the pulse

· Monitoring the Blood pressure

· Assessing the breathing rate

Treatment

        Goal of the treatment is to achieve the hemodynamic stabilization

· Administration of Vasopressor and Inotropes medications

· Fluid resuscitation

· Administration of Epinephrines