Types of Shock Signs and Symptoms First Aid and Nursing Care

Types of Shock

Types of Shock

Definition of Shock

Shock may be defined as a state in which there is widespread, serious reduction of tissue perfusion, which if prolonged, leads to generalized impairment of cellular function.

Shock is a state or condition in which the cardiovascular and  Circulatory system fails to perfuse tissues adequately

It is an impaired cardiac pumping  circulatory system and or Fluid volume that can lead to compromised blood flow to Organs and tissues

It is a physiologic state characterized by the systemic reduction in Tissue perfusion and resulting in decreased tissue oxygen delivery.

Types of Shock 


Causes of hypovolemic shock:

  1. Hypovolemia:
  2. External fluid losses:
  3. Hemorrhage

*Traumatic causes can result from penetrating and blunt trauma. Common traumatic injuries that can result in hemorrhagic shock include myocardial laceration and rupture, major vessel laceration, pelvic and femur fractures, and scalp lacerations.

*Vascular disorder which can result in significant blood loss include aneurysm rupture, dissection, and bleeding from arteriovenous malformation.

*Examples of gastrointestinal disorders that can result in hemorrhagic shock include: bleeding oesophageal varices, bleeding peptic ulcers, Mallory – Weiss tears, etc

*Pregnancy-related disorders include ruptured ectopic pregnancy, placenta previa, and abruption of the placenta.

 Gastrointestinal Causes For Shock
  • Vomiting
  • Diarrhea
Renal Causes For Shock.
  • Diabetes mellitus
  • Diabetes insipidus
  • Excessive use of diuretics

Cutaneous Causes For Shock.

  • Burns
  • Exudative lesions
  • Perspiration and insensible water loss without replacement,

Internal sequestration Causes For Shock.

  • Fractures
  • Ascites (peritonitis, pancreatitis, cirrhosis)
  • Intestinal abruption
  • Hemothorax
  • Hemoperitoneum

Types of Shock Nursing Management and First aid

STEP   1

  • Place the patient in Trendelenburg position, Start nasal oxygen
  • Secure IV line using large bore IV cannula.
  • Take blood samples for blood grouping and cross-matching.
  • Once IV access is obtained, initial fluid resuscitation is with isotonic crystalloids such as lactated ringer’s solution (RL) or normal saline (NS).
  • An initial bolus of one to two liters is given for an adult or 20 ml/kg for a pediatric patient, and then the patient response is assessed.
  • If vital signs return to normal, the patient may be monitored to ensure stability, and blood samples should be sent for type and cross match.
  • If vital signs transiently improve, the crystalloid infusion should continue, and type-specific blood obtained.
  • According to the types of shock, If there is no response within 30 minutes start a colloid like haemaccel. Plan for blood transfusion.
  •  catheterize the bladder and assess urine output


  • monitor pulse rate, Blood Pressure, Respiration Rate continuously
  • Replace the blood if the shock is because of blood loss
  • If there is oliguria start dopamine infusion (2-4 micrograms/kg/mt)
  • All-female patients of childbearing years should have a pregnancy test done. if the patient is pregnant and shock. A pelvic Ultra Sonography S should be performed immediately in the emergency department. A culdocentesis may be performed, although in most places, ultrasound can be done in the ED, and yields more information on the source of bleeding


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Cardiogenic Shock First aid and Nursing Management

Types of Shock

Cardiogenic Shock  Acute pulmonary edema is a clinical condition wherein there is interstitial and alveolar edema compromising gas change in the lungs.

Usually the patient present with breathlessness of sudden onset,tachypnoea, anxiety, profuse sweating, cold  clammy skin, expectoration of pink frothy sputum and cyanosis. Auscultation may reveal a gallop rhythm (S3), bilateral crepitations and rhonchi

Cardiogenic Shock Common causes

Acute myocardial infarction / ischemia

Tight mitral stenosis

Advanced AS/AR

Severe HTN

Cardiac tamponade

Stepwise Cardiogenic Shock Management:


  • make the patient sit up in bed with a back rest, preferably with the legs dangling over the sides of the bed.


  • Administer 100% oxygen by nasal prongs at 5lit/minute.


  • Draw blood for routine investigations.start an IV line using 5% dextrose and infuse at a very slow  rate.


  • Administer morphine in a dose of 3-5mg IV well diluted over several minutes .
  • Naloxone may be given if respiratory depression occurs(0.4mg IV)


  • Lasix 60-80 mg IV slowly


  • Administer nitroglycerine 0.4-1.2mg sublingually


  • Give aminophylline 5-6mg / kg diluted in 20 ml of dextrose over 20 minutes followed by 0.2-0.5mg/kg/hour in 5% dextrose as maintenance.


  • if there is no response to treatment, And if the patient systolic BP is <80 mmHg or has declined by at least 30 mmHg below the previous level


  • patient having signs of peripheral  insufficiency like cold moist skin and cyanosis


  • urine output <20ml/hour with dulled sensorium
  • Use inotropic support with Dopamine 5-10 µg/kg/minute


  • Dobutamine 5-10 ug/kg/minute

Call the specialist

Monitor Vital Signs

Heart rate                    ECG

BP                                   Chest X – Ray and

Lung signs                      ABG

Urine output

Septicaemic shock Management

  • Resuscitation as Hypovolemic shock
  • Start antibiotics
  • Hydrocortisone (200mg stat to be followed by  100mg IV 6 hourly)s
  • Septic  focus to be dealt with.

Anaphylaxis Shock management


Anaphylaxis refers to an allergic reaction in which there are prominent dermal and systemic signs and symptoms. The full-blown syndrome includes urticaria and /or angioedema with hypotension and bronchospasm.Anaphylaxis may be mild, moderate or severe.

Mild Reaction:-

  • Urticarial rash with pruritus,
  • Sneezing,
  • Rhinorrhoea
  • +/- Tachycardia, normal BP

Moderate reaction:

  • Above feature
  • + Tachypnoea,
  • Hypotension
  • +/- Bronchospasm

Severe reaction:

  • Extensive urticaria,
  • Perioral and periorbital angioedema,
  • Severe hypotension,
  • Bronchospasm +/-
  • Laryngeal Edema.

Anaphylactic Shock Management

Mild cases:

Step 1

  • *Make  the patient lie flat on the bed
  • *reassurance of the patient.
  • Assured unobstructed air way
  • *remove clothing and observe the extent of rash.
  • *record pulse rate, respiratory rate and blood pressure
  • Inj. Adrenaline 0.1 mg IM(one ampule diluted to 10ml with distilled water, and inject 1ml)

Step 2

  • Injection pheniramine maleate (Avil) 50mg IM (1 mg/kg)
  • Injection hydrocortisone 100 mg IM (2 mg/kg)

Moderate causes:

Step 1

  • Make the lie flat on a bed.
  • Reassurance of the patient
  • Assure unobstructed air way
  • Remove clothing and observe the extent of rash.
  • Record pulse rate respiratory rate and blood pressure
  • Inj. Adrenaline 0.25 – 0.5 mg IM

Step 2

  • Secure IV line using a large bore IV cannula (18 or 2 G)and infuse RL or NS rapidly 1-2 litres till blood pressure normalizes.
  • Oxygen  via a nasal catheter nasal prongs or venturi mask at the rate of 4-6 liters/minute.
  • Inject pheniramine maleate(avil)50MG IM(1 mg/kg)
  • Injection hydrocortisone 100 mg IM(2 mg /kg)

Severe cases:

Step 1

  • *make the patient lie flat on the bed.
  • *Assure unobstructed air way
  • *Record pulse rate respiratory rate and blood pressure
  • *secure IV line using a large bore IV cannula(18 or 20 G) and inject adrenaline 0.1 mg IV stat ( dilute 10 ml with distilled water, give 1 ml IV)
  • *infuse RL /NS rapidly  1liter in 10 minutes
  • .*monitor pulse and BP continuously and titrate IV adrenaline and IV fluids,
  • Oxygen via Nasal catheter nasal prong or venturi Mask At the rate 5 ltr/Min,
  • Step  2,
  • Injection Pheniramine malate 50 mg / kg,
  • Injection Hydrocortisone 200 mg  IV Stat to be repeated according to Clinical Response,
  • Injection Aminophylline 10 ml in 5 % Dextrose  IV Stat Slowly if there is associated Bronchospasm,

Call Specialist,

  • Monitor Vitals :-
  • Pulse,
  • Respiration,
  • Blood Pressure,
  • Monitor vitals Continuously Till patient recovers from Cardiogenic Shock Symptoms,