The most common form of SHOCK - page 2

Hello, what type of shock would you classify as the most common ? ideally i would say "Anaphylaxis" but i am unsure. Thanks.... Read More

  1. by   TazziRN
    Quote from shellsincanada
    I think what each of will find out our own personal experiences will determine what kind of shock we see.

    Weeeeell.......since people of different specialties have answered this thread and all of us named hypovolemic first, I would be willing to bet that hypovolemic is the most common..........
  2. by   Thedreamer
    I dont know about you guys but the most common form of shock I get is daily gas prices :X

    P.s. Hypovolemic all the way.
  3. by   blueheaven
    I am guessing (from my experience)
    Hypovolemic
    Septic
    Cardiogenic (but I don't work in CCU)
  4. by   EmerNurse
    Agree with Tazzi and Blueheaven - Hypovolemic, septic, cardiogenic - almost never see anaphylactic.
  5. by   incublissRN
    I see a lot of cardiogenic.
  6. by   mamalle
    Hypovolemic and Septic where I work mainly..
  7. by   BrnEyedGirl
    According to TNCC hypovolemic is most common,..of course that is probably true w/Trauma pts,...haven't actually seen stats on pts in general,.my vote would be hypovolemic, then cardiogenic
  8. by   MsPiggy
    Hypovolemic, never had a anaphalactic pt, but was one myself last summer-Not fun!
  9. by   ZASHAGALKA
    Hypovolemic. Then Septic, then Cardiogenic.

    The thing is, in many cases, septic shock is exacerbated by volume status. When people are sick, they don't take in as much fluids. So, WE see lots of clearly 'septic shock', in that people are clearly septic, that dramatically improves with volume replacement.

    (To clarify, based on the next post, in sepsis, in ADDITION to relative dehydration, there is the aspect of vasodilation that occurs combined with increased volume permeability that causes available volume to not be where it is most needed, in circulation. Sepsis presents most often as a circulatory system no longer primed by volume to be an effective pump. IF you look at Starling's Law, the heart is absolutely volume dependent to be a good pump. As long as the pump itself - the heart - is in relatively decent working order, hypoperfusion is most often the result of volume deficiency. So, the solution, while continuously evaluating the status of the pump - for example, through lung sounds to check for CHF - is to replace volume.)

    The point I'm trying to make is that, many times, septic shock has an underlying hypovolemic element. That, combined with purely hypovolemic shock would lead me to believe that hypovolemic shock is more common.

    I'm always surprised that hypovolemic shock is treated 500 ml at a time, in all too many cases. The answer is, subject to cardiac capability (not going into CHF), VOLUME VOLUME VOLUME.

    (I'm also always surprised at how often pressors are a first line response. If you don't prime the pump, it doesn't matter how much you pressure the pump. Volume first, pressors distant second.)

    If it takes 5 liters, don't dole it out over 2-3 days. Give a liter, check cardiac status (lung sounds), give some more, check, give some more, check, give some more.

    Crystalloid (IV fluids), Crystalloid, Colloid (blood, albumin, hespan), Crystalloid. I've seen people pull out with rapid volume replacement that I know full well wouldn't have with a 'take it slow' attitude.

    The take home lesson: for all but cardiogenic shock: volume now, volume often. I always consider hypovolemic shock to be AT LEAST a component of septic shock.

    (The first line treatment for cardiogenic shock should be a balloon pump, and probably, if able, a trip to the cath lab.)

    That's my take.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Apr 7, '07
  10. by   Mommy TeleRN
    We just covered shock on our last exam. Timothy - my book explains it similiar to the way you do. Hypovolemic is lack of volume and you can have absolute (hemorrhage) or relative (internal bleeding, or vasodilation such as occurs in distributive shock eg septic shock)
    Septic shock is a type of distributive shock (as is neurogenic and anaphylactic) You HAVE the volume, but because of increased capillary permeability it leaks out of the vascular space and creates relative hypovolemia.
    My teacher, a former MICU/CCU nurse, said she would see cases where they were weeping fluid because of the edema but that you kept bolusing the fluids because it would keep leaking out of the vessels and you had to keep "filling the tank" because they would remain hypotensive. She also commented on the lopressors. I can't remember her exact phrasing but she talked about nurses who were so happy with themselves to get a higher BP yet the pt was still low fluids or something to that effect. She stressed fluids FIRST then vasopressors.

    I looked through my text and it doesn't say the most common. But it does say that sepsis is the most common cause of death in ICUs.
  11. by   ZASHAGALKA
    Quote from Mommy Nurse2b
    We just covered shock on our last exam. Timothy - my book explains it similiar to the way you do. Hypovolemic is lack of volume and you can have absolute (hemorrhage) or relative (internal bleeding, or vasodilation such as occurs in distributive shock eg septic shock)
    Septic shock is a type of distributive shock (as is neurogenic and anaphylactic) You HAVE the volume, but because of increased capillary permeability it leaks out of the vascular space and creates relative hypovolemia.
    My teacher, a former MICU/CCU nurse, said she would see cases where they were weeping fluid because of the edema but that you kept bolusing the fluids because it would keep leaking out of the vessels and you had to keep "filling the tank" because they would remain hypotensive. She also commented on the lopressors. I can't remember her exact phrasing but she talked about nurses who were so happy with themselves to get a higher BP yet the pt was still low fluids or something to that effect. She stressed fluids FIRST then vasopressors.

    I looked through my text and it doesn't say the most common. But it does say that sepsis is the most common cause of death in ICUs.
    Actually, I believe that a common result of sepsis, as well as some other processes, is the most common cause of death in the ICU: multi-system organ failure. I will agree that sepsis is the most common cause of MSOF and so, could be identified as the most common disease process that leads to MSOF. It is not the only cause of MSOF, however, and death by sepsis is a continuum that leads to MSOF.

    It's a quibble, I know: sepsis can rightly be said to be the most common disease process that leads to death in ICUs, but only in that it leads to the most common condition that results in death: MSOF. And, sepsis is NOT the only cause of that. Any extended period of hypoperfusion can result in MSOF.

    In ALL too many cases, MSOF is most often a result of extended hypoperfusion that can frequently directly be tied to hypovolemic status.

    The solution: volume, volume, volume. As long as the pump itself isn't the CAUSE of the problem, prime that pump, early and often.

    In all but cardiogenic shock, the principle consideration of shock should be volume replacement. In cardiogenic shock, the principle consideration should be treating the pump itself, as opposed to priming the pump.

    (btw, lopressor is a specific drug - a betablocker, and not a vasopressor to boot. Vasopressors are a class of drugs.)

    When I went to my CCRN review class, my instructor stated that the ONE takeaway she wanted us to remember as CCRNs was this: volume, volume, volume.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Apr 7, '07
  12. by   Mommy TeleRN
    Quote from ZASHAGALKA

    (btw, lopressor is a specific drug - a betablocker, and not a vasopressor to boot. Vasopressors are a class of drugs.)

    ~faith,
    Timothy.
    oops..that is what happens after hours on end of studying - brain is fried! Thanks for pointing out my error!
  13. by   ZASHAGALKA
    Quote from Mommy Nurse2b
    oops..that is what happens after hours on end of studying - brain is fried! Thanks for pointing out my error!
    No problem, I wasn't trying to pick on ya. I understand that all those concepts can swirl while in school, and it takes time to sort them out.

    Besides, your comments were excellent, and, if you see, I amended my post right before that to account for YOUR comments more thoroughly.

    Your contribution here was supurb.

    ~faith,
    Timothy.

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