Initial Management of Shock

ArmaniX, MSN, APRN · Apr 16, 2015

I would believe fluids to be the answer also.. so I Will be curiously looking for others input.

catnessk · Apr 16, 2015

I've figured out that the inotropes would be the first because not all the shocks need fluid resucitation (ex. cardiogenic and neurogenic)

letmebeanurseee · Apr 16, 2015

When I think of initiation, I think first and something that can be done quickly as well. Administering inotropic agents would be the fastest and efficient way of raising the blood pressure when a patient in shock. I would then most likely fluid resuscitate but that is more particular for burn victims who need the fluids more. With any patients who are in shock, their BP is low so that means decreased cardiac output. Dobutamine specifically is a STRONG beta-stimulatory (in general, inotropic medications are the most powerful way to increase contractility of the heart) which helps increase HR and cardiac output and therefore increases blood pressure, not the fluids. That is my logic at least [:

SubSippi · Apr 16, 2015

The wording of this question is confusing to me.

Anyway, in some cases a positive inotrope would be given first, because more fluid volume would just overwhelm an already ineffective heart.

But I agree with some of the other posters, the vast majority of the time I have given PRBCs, albumin, or even just NS before I start with the inotropes. Where was this question from?

RNNPICU, BSN, RN · Apr 16, 2015

I guess to try and think in NCLEX world - they want you to think that inotropes are what are used for shock. Perhaps since it is not specified septic, etc they wnat you to focus on shock management

In most of what I have seen though for septic shock., fluid resuscitation first, because you need volume. (Fill the tank first), but this is real world