Managing mixed-shock states

Many problems can create a combination of more than one type of shock, and these situations require careful management. In this video from our Resuscitation Essentials course, you'll learn how to recognize and manage shock presenting as mixed-types, such as anaphylaxis, sepsis, and trauma.

Learn how to evaluate and treat shock and to differentiate between types of shock (obstructive, cardiogenic, distributive, hypovolemic). With our Resuscitation Essentials course, you'll master a step-by-step approach for managing patients near to, or experiencing, cardiac arrest in any environment.

[00:00:00] Many problems create a combination of more than one type of shock. For example, sepsis often causes a distributive shock but also creates hypovolemia through insensible losses and may result in aseptic cardiomyopathy decreasing cardiac function. Patients often require volume repletion in addition to antibiotic therapy and source control and may require vasoconstrictors to support their perfusion. Anaphylaxis,

[00:00:30] by definition, affects multiple organ systems. In addition to a vasodilatory shock, cardiogenic shock may occur. Bronchial constriction may lead to hypoxemia and decreased oxygen delivery to the heart and may also cause increased pulmonary vascular resistance and right-heart dysfunction; and gastrointestinal upset in capillary leaking may cause volume depletion. Elimination of the antigen when possible and epinephrine are the mainstays of treatment, which work on several of these pathways. Additional

[00:01:00] adjunctive therapies like antihistamines and steroids may help with symptoms and prevent relapse in some cases. Shock associated with trauma often has multiple components. Hemorrhage may lead to hypovolemic shock but the patient may also have concomitant injuries like a tension pneumothorax or hematoma, which can lead to obstructive shock. A neurologic injury may cause a neurogenic component as well. Interruption of the sympathetic ganglia may cause vasodilation and bradycardia with inability to compensate

[00:01:30] cardiac output. In addition to volume replacement, interventions to relieve obstruction or correct causes of bleeding may be necessary. Patients with neurologic injury may require vasopressors or chronotropes, usually after other causes have been addressed.