Initial Management of Shock

Published

Hello everyone, I am a bit confused as to why the administration of inotropic agents comes before fluid resuscitation

During the initial management of any patient in shock, the nurse knows that which of the following is an appropriate intervention?

[TABLE=class: t1]

[TR]

[TD=class: td1]a.

[/TD]

[TD=class: td1]Fluid resuscitation

[/TD]

[/TR]

[TR]

[TD=class: td1]b.

[/TD]

[TD=class: td1]Administration of vasopressors

[/TD]

[/TR]

[TR]

[TD=class: td1]c.

[/TD]

[TD=class: td1]Administration of inotropic agents

[/TD]

[/TR]

[TR]

[TD=class: td1]d.

[/TD]

[TD=class: td1]Administration of high-flow oxygen

[/TD]

[/TR]

[/TABLE]

ANS:C

An inotropic agent (e.g., dobutamine [Dobutrex]) is often added to offset the decrease in stroke volume.

Specializes in Critical Care. Has 10 years experience.

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

catnessk

38 Posts

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

letmebeanurseee

180 Posts

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

907 Posts

Has 2 years experience.

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

1,262 Posts

Specializes in PICU. Has 17 years experience.

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