CLASSIFICATION AND DIFFERENCIATION OF SHOCK

TYPE CAUSE PATHO SYMPTOMS SIGNS VITAL SIGNS

PHYSIOLOGY
PR RR SKIN SPO2 GCS BP
1 HYPOVOLUMIC LOSS OF REDUCED VOLUME, GIDDINESS, LETHARGY, PALLOR COOL,
BLOOD, VENOUS RETURN, ANXIOUS, AMS,LOC SWEATING, COLD,
FLUIDS CARDIAC OUTPUT, BP ANXIOUS CHILL,
RESTLESS CLAMMY,
MOTTLED
2 CARDIOGENIC MI,VALVE PUMP FAILURE CARDIAC CHEST PAIN, ANXIOUS,
FAILURE, VALVE FAILURE DIZZINESS, LETHARGY
TAMPONAD DIAPHORESIS,
E, DRUGS NAUSEA, VOMITING,
PALPITATIONS,

3 ANAPHYLACTIC DRUGS BRONCHOSPASM SOB, ITCH, GIDDINESS, WHEEZING, N/ N/

BITES VASODILATION & EXUDATE URTICARIA, EARLY WARM,
STINGS POOLING OF BLOOD HIVES, LATE COOL
REDUCED VENOUS
RETURN & BP
4 SEPTIC BACTERIA, VASODILATION, CAPILLARY SITES OF INFECTION ANXIOUS, EARLY WARM,
VIRUSES, LEAKAGE, POOLING OF FLUSHED, LATE COOL
FUNGI- BLOOD, RESTLESS,
LUNGS, UTI, REDUCED VENOUS LOC
GIT, POST OP RETURN & BP

5 NEUROGENIC CERVICAL SPINAL CORD INJURY, TRAUMA, UNABLE TO PARALYSIS, N EARLY WARM, N N
INJURY, SYMPATHETIC DAMAGE, MOVE, NUMBNESS, PARAESTHESIA LATE COOL
SPINAL VASODILATION, POOLING TINGLING, ,WARM PINK
DRUGS OF BLOOD REDUCED NECK PAIN, UNABLE P.,PRIAPISM,
VENOUS RETURN & BP TO BREATH, INCONTINENC
E, REDUCED
TONE COPYRIGHT- Dr AAli
 CLASSIFICATION OF HAEMORRHAGIC SHOCK
NO SIGNS CLASS I CLASS II CLASS III CLASS VI
1 Blood Loss:
Percentage < 15% 15 – 30% 30-40 %  40%
Volume < 750 ml 750 – 1500 ml 1500-2000 ml  2000 ml

2 Blood Pressure:
Systolic Unchanged Normal Reduced Very Low
Diastole Unchanged Raised Reduced Unrecordable
3 Pulse Rate 100 bpm 100-120 bpm > 120 bpm  120 bpm
 thready
4 Capillary Refill Normal Slow Slow Undetectable

5 Respiratory Rate Normal Normal > 20 /min > 20 /min

6 Urinary Flow Rate ml/h > 35 20-35 10-20 0-10

7 Extremities Normal Pale, Cool Pale, Cold Pale, Cold, Clammy

8 Complexion Normal Pale Pale Ashen

9 Mental Status Alert Anxious Confused, Drowsy, Stupor,

Restless Aggressive Unconscious
 SHOCK CLINICALLY SUSPECTED

HYPOVOLEMIC DISTRIBUTIVE OBSTRUCTIVE CARDIOGENIC

Volume Resuscitation Goal directed therapy Pericardiocentesis for ACLS for Dysrhythmias
Control Haemorrhage Tamponade
Adrenaline, Antihistamine, Dobutamine, Dopamine
Steroids, Removal of agent Fibrinolysis for PE
Imm reperfusion with PCI
Dopamine & Atropine for Needle thoracostomy for
Neurogenic Shock Tension PTX
NO
VITAL SIGNS VALUE RANGE REMARKS
1 PULSE RATE
Infants <160 bpm 10. VITAL SIGNS
Preschool <140 bpm
School <120 bpm
Adult <100 bpm 60 – 80 bpm Volume?
2 RESPIRATION Rate, TV
Infant 25 – 50 bpm
School 15 – 30 bpm
Adult 12 – 20 bpm 12 - 30 bpm <10 , >30
3 TEMPERATURE 37C >38.5C
4 GLASGOW COMA SCALE 3 - 15
5 OXYGEN SAT % > 97% <95% , <90%
6 BLOOD PRESSURE
Infant 70 mm Hg
School 80 (2 age in years)
Adult 120/80 mmHg MAP?
7 PAIN SCALE 0 - 10
NORMAL SERUM LEVELS FOR EMERGENCY

GLUCOSE - Fasting <5.6 Hb g/L 130.0-170.0

-Random <7.8 HCT L/L 0.40-0.50
-PP <11.1 RBC 10”12/L 4.50-5.50
Sodium mmol/L 136-145 WBC 10”9/L 4.0-10.0
Potassium 3.6-5.2 Platelet 10”9/L 150-400
Chloride 99-109 Amylase U/L 30-118
CO2 20-31
Anion Gap 10-20
Urea 3.2-8.2
Creatinine 54-97
Triglyceride <1.7
Total Chol <5.2
HDL >1.10
LDL <2.59
EARLY WARNING SCORING SYSTEM
VITAL SIGN SCORE 3 2 1 0 1 2 3
SYSTOLIC BP < 70 71 - 80 81 - 100 101 - 179 180 - 199 200 - 220 > 220
(mm Hg)
HEART RATE - < 40 41 - 50 51 - 100 101 - 110 110 - 130 > 130
(beats/min)
RESPIRATORY RATE - <8 8 - 11 12 - 20 21 - 25 26 - 30 > 30
(breaths/min)

OXYGEN SAT < 85 86 - 90 90 - 94 > 95 - - -

(%)
AVPU - - CONFUSION A V P U
URINE OUTPUT < 80 80 - 120 120 - 200 >800 - -
(Past 4 hours/mls)
TREATMENT with 60% 90 – 94% ANY OTHER
O2 (NRFM) THERAPY

SCORE 3 = ALERT # SCORE 5 = URGENT # SCORE 7 = IMMEDIATE