Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Shock

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In one line

·Shock means the body cannot deliver enough oxygen-rich blood to cells, so cells start to die.

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Normal physiology

·Oxygen delivery to cells depends on three things working together: enough blood volume (the tank), a strong heart pump, and blood vessels that squeeze or relax to control pressure. Heart output (how much blood the heart pumps per minute) times oxygen content (how much oxygen each drop of blood carries) equals oxygen delivery. Blood pressure equals heart output times how tight the vessels squeeze (resistance). Keep this picture in your head—every shock finding is a break in one of these three things.

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What goes wrong

·Shock happens when one of the three parts of the oxygen-delivery system breaks: the tank runs dry (not enough blood volume), the pump fails (heart can't squeeze), or the pipes go haywire (vessels open too wide or get blocked). Once that break happens, cells don't get oxygen, and the body's emergency responses kick in to protect the brain and heart—but those responses can't hold forever.

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Hallmark signs

·Fast heart rate (tachycardia)
·Low blood pressure (hypotension)
·Cold, clammy, pale skin
·Weak or absent pulses
·Confusion or agitation
·Very little or no urine (oliguria or no urine output (anuria))
·Fast, shallow breathing (tachypnea)
·Mottled or blotchy skin (livedo reticularis)

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Red flags · escalate now

·Blood pressure stays low even after you give fluids through the IV tube
·The person is confused, very sleepy, or cannot wake up all the way
·Skin is cold, sweaty, and blotchy or has a blue color
·Urine output drops to almost nothing (less than 0.5 mL per kg per hour)
·Blood lactate level is high and going up (above 4 mmol/L). This shows tissues are not getting enough oxygen

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Workup

·Serum lactate
·Complete blood count (CBC) with hemoglobin and hematocrit
·Basic metabolic panel (BMP) — sodium, potassium, creatinine, blood urea nitrogen (BUN)
·Arterial blood gas (ABG)
·Blood cultures (two sets from different sites before antibiotics)
·Electrocardiogram (ECG)
·Chest X-ray
·Point-of-care ultrasound (POCUS) or echocardiogram

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Treatment

·Identify the type of shock by physical exam: Check neck veins (full veins = heart or obstructive problem), listen to lungs (crackles = heart failure backing up), look at skin (cold and pale = hypovolemic or cardiogenic; warm and flushed = distributive like sepsis).
·Hypovolemic shock (bleeding or dehydration): Give IV crystalloid fluids rapidly (30 mL per kg in the first hour, about 2 liters in an average adult), give packed red blood cells if hemoglobin is under 7 g/dL or actively bleeding, and find and stop the bleeding source (surgery, endoscopy, or clotting products like tranexamic acid).
·Distributive shock — sepsis: Give IV crystalloid fluids (30 mL/kg in first hour), start broad-spectrum antibiotics within 1 hour of recognizing septic shock (guideline target per Surviving Sepsis Campaign), draw blood cultures before antibiotics, add norepinephrine (a vasopressor that tightens blood vessels) if MAP stays under 65 mmHg after fluids, and find and remove the source of infection (drain abscess, remove infected catheter).
·Distributive shock — anaphylaxis: Give intramuscular epinephrine 0.3–0.5 mg immediately (into the thigh), lay the patient flat and elevate legs, give IV fluids rapidly, give inhaled albuterol if wheezing, give IV antihistamines (diphenhydramine) and corticosteroids (methylprednisolone), and remove the allergen trigger if possible.
·Cardiogenic shock: Open blocked arteries fast (emergency cardiac catheterization with stent placement for STEMI, guideline target door-to-balloon time under 90 minutes), give inotropes like dobutamine (2.5–20 mcg/kg/min) to strengthen the heartbeat, add norepinephrine if blood pressure is still low, use mechanical support (intra-aortic balloon pump or ventricular assist device) if medications are not enough.
·Obstructive shock: Needle decompression (large needle into chest) for tension pneumothorax (collapsed lung squeezing the heart), pericardiocentesis (needle into the sac around the heart) to drain fluid squeezing the heart, thrombolysis (clot-busting drugs like tPA) or surgical/catheter removal for massive pulmonary embolism (a clot lodging in a lung artery) (blood clot blocking the lung arteries).
·Monitor lactate every 2–4 hours and urine output hourly to know if the body is getting oxygen back; do not chase one number alone — instead ask: Is the upstream break fixed? Is the patient's mental status improving? Are the kidneys making urine again?

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NCLEX trap

·In shock, blood pressure is already too low — the body cannot get blood to the organs. Medicines that open blood vessels wider make pressure drop even more. The right move is to bring blood back first by giving fluids, blood, or medicines that squeeze vessels tighter (pressors like norepinephrine). Never open vessels wider when the pump is already failing.
·Shock has four types, each caused by a different upstream break. Not-enough-blood shock (hypovolemic) needs fluids and bleeding control. Heart-cannot-pump shock (cardiogenic) needs heart medicines and opening clogged arteries. Something-blocking-flow shock (obstructive) needs to remove the blockage. Vessels-too-wide shock (distributive, like from infection) needs fluids first, then medicines that tighten vessels. The fix is completely different for each. Figure out which type first, then give the right treatment.
·Shock is a medical emergency. Every minute with low pressure under 65 raises the chance of organ damage and death. Make the patient safe first (oxygen, IV line). Figure out what type of shock it is in the first few minutes (quick exam, lactate blood test, chest picture, bedside ultrasound). Then give the real fix. Do not wait. Time is tissue.
·In not-enough-blood shock and vessels-too-wide shock, give fluids fast — a big amount at once, not a slow drip. In heart-cannot-pump shock, go slow because the heart cannot pump the extra fluid out and lungs will fill with water. Know which type you are treating. Slow fluids in not-enough-blood shock means the patient dies while you wait.
·Lactate is a waste product cells make when they do not get enough oxygen. It rises when cells are suffocating, but it takes time to rise and it clears slowly. Early shock or very fresh shock may have normal lactate. Trust the blood pressure, heart rate, and skin (cold, pale, wet) first. Lactate confirms shock but does not rule it out if it is normal.
·Shock has four types with four different upstream breaks. Not-enough-blood needs volume (fluids, blood) and bleeding control. Heart-cannot-pump needs medicines that tighten vessels (like norepinephrine) and heart medicines (like dobutamine) and opening blocked heart arteries. Vessels-too-wide needs fluids first, then norepinephrine or epinephrine if pressure stays low. Something-blocking-flow needs to remove the blockage (tube for collapsed lung, surgery for heart squeeze, clot medicine or surgery for massive clot in lung arteries). Match the medicine to the broken thing.

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