Shock Priority: Oxygen or IV ?

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Hi everyone,

What is the Priority intervention (in ED) for a shock patient with history of Peptic Ulcer Disease ?

Is it Oxygen (at 2 Liters/nasal canula) or IV (of NS at 150 ml/hr) ?

This question came from hurst but its rationale is confusing.

My own answer was IV to promote to increase BP.

but the Hurst rationale is this:

Intiate Oxygen. The client is showing signs of shock and needs all of the above interventions. However, go back to the ABC's. Oxygen needs to be initiated first because of decreased blood volume.

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Specializes in Nursing Assistant.

Before reading your answer I went with the 02 for the fact of ABC's.

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Before reading your answer I went with the 02 for the fact of ABC's.

Sent from my iPhone using allnurses.com

Hi Jenn, im not sure but isnt O2 an airway intervention ?

I think shock is a volume decifit problem so why give O2 ?

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I would think because you want to maximize oxygen availability for the circulating volume that the patient has left. Then you would start fluids.

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Specializes in Nursing Assistant.

With low blood volume I believe that oxygen is not sufficiently profused to the brain and vital organs. It's a case of both are correct, (gotta love those questions!), but it asks for priority, so using ABC's and knowing the above I went with the oxygen.

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By definition shock occurs because tissues don't have the appropriate amount of oxygen. Therefore cells do not have enough nutrients to function properly. So for this question, you would treat the cause (oxygen deprivation) by giving oxygen before you treat the symptom of fluid deficit.

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Specializes in critical care.

We had unclear instruction on this in our adult class because of the transition from ABC to CAB. We didn't really get a clear answer, which is frustrating. Our weekly CARPs indicated it was O2, and I got it wrong because my instinct on this one says it should be circulation. Curious to see where this thread goes.

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Specializes in Pediatrics, Emergency, Trauma.
By definition shock occurs because tissues don't have the appropriate amount of oxygen. Therefore cells do not have enough nutrients to function properly. So for this question you would treat the cause (oxygen deprivation) by giving oxygen before you treat the symptom of fluid deficit.[/quote']

^This.

Further reading:

Pathophysiology of Shock:

http://www.ncbi.nlm.nih.gov/m/pubmed/2192723/?i=2&from=/11753724/related

The question addresses what interventions are the priority...Airway/oxygenation is paramount.

B is not a correct answer EVER...immediate treatment to the oxygen depravation in shock prevents further complications (organ failure) while establishing fluid access.

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Specializes in Emergency Department.

Another way to look at this is that in shock, cells need oxygen. There's some, but not a lot, of circulating volume. While you likely want to do both Oxygen and IV fluids, your priority is oxygen because you need to maximize oxygen delivery to the cells. IV fluid that isn't PRBC's or whole blood doesn't carry oxygen well at all and dilutes what blood hasn't been lost. Also, if you increase pressure too much, you risk popping any clots off and worsening the bleeding. Therefore, your priority is oxygen.

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Specializes in Cvicu/ ICU/ ED/ Critical Care.

In Medic we have a saying, BLS before ALS. You will, Of course, start a line but what is the first action? O2.

They are giving you a hint by saying shock with a PMH of Peptic ulcer disease. A complication is bleeding, so it stands to reason that the question wants answers to hypovolemic shock. Once you figure that out then its just a matter of finding out what is appropriate. In hypovolemic shock there is a loss of volume, correct. With losing volume you lose the ability to transport O2. So we know our patient has decreased perfusion and decreased o2 due to decreased volume.

So we fix the volume!!! Wait...NS doesn't carry O2. So if we fix the volume we get a hypoxic patient with a good BP....

So what we need to fix first is the O2 problem, then we can start to fix the volume. That gets us better patient outcome.

When you break it down you can see that while IV is a good answer, you are not addressing the patient's problem.

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I would choose Oxygen....ABC

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