SHOCK.

GROUP 3.

TO BE SUBMITTED TO MRS. OYEBODE.

 GROUP MEMBERS.
1 Victor Ajewole AUL/NSC/22/104

2 Etimbuk Akpan AUL/NSC/22/085

3 Goodness Anochie AUL/NSC/22/041

4 Precious Olatunji AUL/NSC/22/005

5 Chukwunonyelim Utomi AUL/NSC/22/092

6 Ifedolapo Olusegun AUL/NSC/22/111

7 Esther Obasanmi AUL/NSC/22/028

8 Oluwafolakemi Tomilawo AUL/NSC/22/042

9 Precious Fasuyi AUL/NSC/22/084

10 FAVOUR VINCENT-OSEMEHA AUL/NSC/22/036

11 Mercy Abe AUL/NSC/22/068

12 Mercy Adewole AUL/NSC/22/098

13 Victoria Adeniji AUL/NSC/22/027

14 Michelle Justice AUL/NSC/22/048

15 Divine Okechukwu AUL/NSC/22/022

16 Favour Olawepo AUL/NSC/22/035

17 Victoria Olanipekun AUL/NSC/22/008

TABLE OF CONTENT.

Contents
GROUP MEMBERS. ....................................................................................................................................................2
Definitions of shock.......................................................................................................................................................5
The pump and the bucket................................................................................................................................6
CLASSIFICATIONS OF SHOCK. ...............................................................................................................................6
There are four classifications of shock. ...........................................................................................................6
CAUSES OF SHOCK. ..................................................................................................................................................7
SIGNS AND SYMPTOMS OF SHOCK.......................................................................................................................7
FIRST-AID INTERVENTION. ....................................................................................................................................9
THEOLOGICAL THEORIES OF SHOCK ................................................................................................................13
General Nursing Assessments for Shock. ....................................................................................................................15
THE STAGES OF SHOCK .........................................................................................................................................15
GENERAL TREATMENT FOR SHOCK. .................................................................................................................19
Signs and treatment of hypovolemic shock ...............................................................................................20
Signs and treatment of distributive shock. ................................................................................................21
Signs and treatment of cardiogenic shock .................................................................................................23
Signs and treatment of obstructive shock ..................................................................................................24
Miscellaneous nursing interventions for a patient in shock ........................................................................25
CONCLUSION ..........................................................................................................................................................26
REFERENCES. .........................................................................................................................................................26
 Definitions of shock.
Generally, shock is a life-threatening condition that occurs when your body isn't getting
enough blood flow to vital organs like your brain, heart, and kidneys.

Simply put, shock is a syndrome of hypoperfusion (also known as hypotension or low blood
pressure) that prevents oxygen from getting to the tissues causing global hypoxia making the
organs in the body to fail.

We could also have:

1) Medical Shock:
Definition: A life-threatening condition where your body isn't getting enough blood flow to vital
organs like your brain, heart, and kidneys. This can be caused by various factors, including
severe blood loss, dehydration, sepsis, heart problems, and spinal cord injuries.

2) Psychological Shock:
Definition: A state of severe emotional and mental distress caused by a traumatic event. This can
manifest as symptoms like anxiety, depression, panic attacks, and flashbacks.

3) Electrical Shock:
Definition: The passage of an electric current through the body, which can cause tissue
damage, burns, and even death.

4) Physical Shock:
Definition: A sudden, violent blow or jarring that can cause physical injury or pain.

5) Emotional Shock:
Definition: A state of great surprise or astonishment that can be caused by a sudden or
unexpected event.
A quick study guide:

The pump and the bucket.

Huh? Are we talking about gardening all of a sudden? Nope…we’re talking about the general
physiologic factors that come into play when you’re dealing with a patient in shock.

The pump: this is the heart. If you think of the heart as a pump, it makes learning about shock
and the ways we treat it a little easier.

The bucket: Think of the body’s vasculature as a bucket…from heart to arteries to capillaries to
veins and back to the heart…it’s all a closed system, kind of like a very weirdly shaped bucket.
When the bucket is full, we have an adequate about of volume…when the bucket is low, we
don’t have enough volume. Conversely, you could also have the wrong-sized bucket…maybe it’s
too big for the amount of volume we currently have. This will all make sense as we get into each
of the classifications of shock.

CLASSIFICATIONS OF SHOCK.

There are four classifications of shock.

There are four types of shock and your task is learning how to differentiate between each one.
Here’s a quick little overview…then we’ll talk about each one in more detail further down.
Ready?

1) Hypovolemic shock occurs when the body loses too much fluid through bleeding, vomiting
(so much vomiting) diarrhea (so much diarrhea-ing), burns, polyuria and third spacing. You may
see it referred to as either hemorrhagic or non-hemorrhagic, depending on what is causing the
fluid losses. In hypovolemic shock, the bucket does not have enough fluid in it. The result is
decreased venous return to the heart, which then leads to decreased cardiac output and
hypoperfusion.
2) Distributive shock occurs when the bucket is too big, more or less. The main one here is
septic shock, and other examples include anaphylaxis, spinal trauma and even endocrine
disorders. The main issue here is decreased peripheral vascular resistance.

3) Cardiogenic shock occurs when the pump (heart) has failed. This can be due to a massive
MI, a valve problem, arrhythmias or cardiomyopathy.

4) Obstructive shock occurs due to a mechanical barrier such as cardiac tamponade, a

pulmonary embolism, tumors or a tension pneumothorax. Basically, anything that obstructs the
circulating volume of blood can be a precursor to hypoperfusion.

CAUSES OF SHOCK.

Now, let us consider the factors that can cause shock.

1. Severe blood loss from internal or external injuries

2. Dehydration from severe diarrhea, vomiting, or burns

3. Severe allergic reactions (anaphylaxis)

4. Sepsis (a serious blood infection)

5. Heart problems like heart attack or heart failure

6. Spinal cord injuries

7. Poisoning.

SIGNS AND SYMPTOMS OF SHOCK.

Early recognition and treatment of shock are crucial to prevent organ damage and death. Here are
some key signs and symptoms to watch out for:
1) Changes in vital signs:

a) Rapid heartbeat: Over 100 beats per minute in adults and over 160 beats per minute in
children.

b) Weak pulse: A pulse that is difficult to feel or is irregular.

c) Low blood pressure: Lower than 90/60 mmHg for adults.

2) Changes in mental state:

a) Confusion

b) Disorientation

c) Restlessness or anxiety

d) Decreased level of consciousness

e) Coma in severe cases

3) Changes in skin and temperature:

a) Pale, cool, and clammy skin

b) Blue-tinged lips and fingernails

c) Excessive sweating

4) Other symptoms:

a) Rapid, shallow breathing

b) Nausea and vomiting

c) Diarrhea

d) Abdominal pain

e) Decreased urine output

 f) Loss of consciousness.

FIRST-AID INTERVENTION.

Immediate action is needed if you suspect someone is in shock. Call emergency services
immediately. But, while waiting, the following steps should be taken:

1. Call Emergency Services Immediately:

This is the most important step. Don't delay in calling for help, as every minute counts in shock.

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2. Lay the Person Flat:

Lay the person flat on their back with their legs slightly elevated (unless they have a suspected
head, neck, or spinal injury). This helps improve blood flow to the vital organs.

3. Keep them Warm:

Cover the person with a blanket or coat to prevent them from losing body heat.

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4. Loosen Restrictive Clothing:

Loosen any tight clothing around the person's neck, chest, and waist to improve blood
circulation.

5. Manage Bleeding:

If the person is bleeding, apply direct pressure to the wound to control the bleeding.

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6. Monitor Breathing and Pulse:

Check the person's breathing and pulse regularly. If they are not breathing or their pulse is weak
or absent, start CPR.

7. Don't Give them Anything to Eat or Drink:

Do not give the person anything to eat or drink, as this could worsen their condition.

8. Stay Calm and Reassure the Person:

Stay calm and reassure the person that help is on the way. This can help reduce their anxiety and
improve their chances of recovery.

Things to Avoid During First-aid:

a) Do not move the person unless absolutely necessary, as this could worsen their injuries.

b) Do not raise the person's head, as this can decrease blood flow to the brain.

c) Do not give the person anything to eat or drink, as this could worsen their condition.

d) Do not apply heat to the person, as this could worsen their burns or dehydration.
 THEOLOGICAL THEORIES OF SHOCK

1) Traditional view: In some theological traditions, particularly those emphasizing divine

retribution, shock events like natural disasters or sudden deaths are interpreted as God's
judgment upon human sin and disobedience. This perspective can offer comfort to those seeking
meaning in tragedy, but it can also raise concerns about divine wrath and its compatibility with a
loving God.

2) Shock as Divine Testing to Grow through trials: Other theological views see shock as a
form of divine testing, meant to challenge individuals and communities to grow in faith and
resilience. These perspectives often emphasize God's presence and guidance even in the midst of
suffering, offering hope for transformation and spiritual deepening.

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3) Shock as a Call to Compassion: Still other theological approaches focus on the call to
compassion and solidarity in the face of shock. These perspectives highlight the ethical
imperative to respond to suffering with love, justice, and practical assistance, embodying God's
own love for the afflicted.

4) Shock and the Limits of Human Understanding: Some theologians acknowledge the
limitations of human understanding in the face of shock and suffering. They emphasize the
mystery of God's purposes and the importance of trusting in God's ultimate goodness even in the
midst of darkness. This perspective invites humility and openness to the mystery of God's grace
in the midst of tragedy.

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5) Shock and the Question of Theodicy. I.e Reconciling suffering with God's goodness: The
problem of reconciling God's goodness with the reality of suffering and shock has been a central
theological concern for centuries. Different theologians offer various responses, from
emphasizing God's ultimate victory over evil to acknowledging the inherent limitations of human
knowledge and embracing faith in God's hidden work in the world.

General Nursing Assessments for Shock.

As you are evaluating your patient in shock, there are some clinical signs and symptoms you’ll
assess regardless of which classification of shock you are dealing with. These are:

1. Heart rate
2. Respiratory rate and effort
3. Blood pressure
4. Hemodynamics
5. Mentation
6. Urine output (an EXCELLENT indicator of end-organ perfusion)
7. Skin signs (often overlooked but one of the BEST things you could monitor!)

THE STAGES OF SHOCK

Before we get into the nitty-gritty, let’s talk about the stages of shock. The really tough thing
about shock is that there often aren’t SUPER NOTICEABLE signs in the early stages. To catch
shock in an early stage, you’d usually need to have a high index of suspicion that your patient is
at risk for going into shock.

1) Initial shock (Class I): During this phase of shock, the body is typically compensating for the
hypoperfusion/hypotension so signs can be pretty easy to miss.
a) Mildly tachycardic: the heart rate is speeding up to compensate for the drop in
blood pressure and decreased oxygen delivery to the tissues. It very likely may not
be enough to set off alarm bells in your head. Generally, any sustained increase of
10-20 BPM should be evaluated. It could be pain, could be anxiety, could be fever.
There are many causes for elevated heart rate, so this one is VERY easy to miss.
b) Mildly tachypneic: also, VERY easy to miss. Your patient is breathing a little
faster because oxygen delivery to the tissues is impaired, there’s a little metabolic
acidosis going on thanks to altered cellular metabolism…and his body is
compensating by upping the respiratory rate. What else causes the respiratory rate
to increase? Yep…pain and anxiety.
c) Blood pressure is probably normal at this point: thanks to the body’s
compensatory mechanisms, the patient’s blood pressure may be normal…but if
you look closely you could possibly see a gentle downward trend (but the tough
part is, it’s probably still in the “normal” range…see how tough this is?)
d) Urine output will be maintained at this point as the kidneys haven’t yet taken the
full brunt of the shock state.
e) Extremities may be slightly cool in most cases (may be warm in distributive
shock). If your patient’s hands/feet were warm when you checked pulses at 07 :30
but are now cool at 10:30…you may want to investigate. This one is also easy to
miss because many people generally have cold hands/feet…think of all those little
old ladies who bundle up in blankets. Again, this is an easy one to miss…however
it is also one of the FIRST signs to pick up on, if you are diligent! Get those
gowns off and LOOK AT THE SKIN!
f) Anxiety could start coming into play. The patient may not be able to pinpoint the
reason for his/her increased anxiety, but you may notice more restlessness than
before. Not getting enough oxygen to the organs (brain!) can do that to a person.
Of course, this one is also VERY easy to miss because, guess what? Being in the
hospital is anxiety-producing all on its own. Oh boy…sounds like it’s going to be
really tough to catch shock in the initial phase, huh?
2) The next stage is what we call compensatory shock (Class II). The body really kicks into
high gear to compensate at this point, and this is the stage where you’re most likely to catch on
that your patient is in trouble. The decreased tissue perfusion triggers an endocrine response
that tells the SNS it needs to join the party. What happens when the SNS is activated?

a) Increased heart rate: now your increase will most likely get noticed as it
will be more significant than in the initial stage. This increase in heart rate
helps keep cardiac output up.
b) Vasoconstriction: By squeezing down on the vessels, we can help keep
blood pressure up. This is a result of the renin-angiotensin system you
learned about in A&P (hint: angiotensin II is a pretty potent
vasoconstrictor!)
c) Increased respiratory rate: that mild tachypnea has progressed and now your
patient is breathing in the high 20s-low 30s. No bueno. This is the body’s
attempt to compensate for two things: lower oxygen levels and the
metabolic acidosis caused by all that lactate production
d) Increased glucose via glucogenolysis: have you checked a blood sugar
lately? An elevated blood sugar in a NON-diabetic patient is definitely
cause for concern.
e) Decreased urine output: endocrine system gets hip to the fact that we’re in
trouble, so it puts out more ADH (antidiuretic hormone) which causes the
kidneys to retain fluid in an effort to keep BP optimized. Recall that
optimal urine output is 0.5mg/kg/hr. If your patient is putting out less than
this, you gotta let somebody know. Another cause for decreased urine
output is hypoperfusion of the kidneys, so this is definitely something you
want to watch like a hawk.
f) Decreased bowel sounds: the body will shunt blood from the less vital
organs in order to perfuse the brain and heart. If your patient’s gut isn’t
making a lot of noise, this could be the reason.
g) Delayed capillary refill and cold extremities: here we are again with the
poor skin perfusion, only at this stage it is likely to be more obvious.
 h) May see diaphoresis at this point and the patient is often agitated and/or
restless.

3) In progressive shock (Class III), your patient is in a very bad state. The compensatory
mechanisms are starting to fail and hemostasis cannot be maintained. You will likely see:

a) Hypotension: if you are seeing hypotension, this is typically a late sign and you
might be kicking yourself that you didn’t pick up on the earlier clues. Don’t beat
yourself up…sometimes the patient transitions through the stages of shock very
quickly.
b) Altered Level of Consciousness: your patient has progressed from being restless or
agitated to being really confused or lethargic.
c) Increased Respiratory Rate and Work of Breathing: as the global hypoxia
continues, your patient will try to make up for it by breathing faster and harder.
Many patients get intubated at this point as this level of respiratory effort is not
sustainable.
d) Lactic acidosis: as those waste products build up, you’ll see an elevated lactate
and an acidic pH.
e) Continued progression of all the other signs: tachycardia, decreased urine output,
poor skin perfusion. At this stage the patient is looking at multiple organ
dysfunction (MODS)

4) In the final stages of shock, called refractory shock (Class IV), it’s going to be very
difficult to save the patient. It is called “refractory” because it is typically not responsive to
treatments.

a) Decreased Level of Consciousness (possibly obtunded)

b) Urine output severely low (usually > 5ml/hr)
c) Respiratory rate is going to be pretty high…usually above 35. The patient cannot
sustain this for long, so if he’s not intubated you might want to call the doc.
d) Skin signs are VERY poor at this point…most likely to see mottling at this stage.
e) Blood pressure low despite fluids and vasoactive medications
 f) Low O2 saturation despite oxygen; patient may be on maximum ventilator settings
at this point.

GENERAL TREATMENT FOR SHOCK.

The treatment for all shock states is generally the same with a few differences relative to the
shock classification. The idea is to stabilize the patient as much as you can with broad-based
treatment and then target your therapies based on what is specifically happening with the patient.

1) Optimize oxygen delivery. This involves:

a) Provide oxygen! Many patients will need to be intubated, but if you catch
shock early, you may be able to give O2 via a mask or even a high -flow
nasal cannula. The sicker they are, the more likely they’ll get themselves an
ET tube.
b) Restore volume! Give fluids and/or PRBCs to fill up that bucket.
c) Medications (will depend on type of shock the patient is experiencing).

2) Reduce oxygen consumption. This involves:

a) Decrease WOB (intubate or give oxygen!)

b) Treat pain, treat anxiety
c) Keep patient normothermic (shivering increases oxygen demands as does
fever)
d) Decrease oxygen demands with mechanical ventilation, sedation, or even
neuromuscular blocking agents like Nimbex or Vecuronium.
 Now, let’s get specific with each type of shock!

1) Hypovolemic shock.

Signs and treatment of hypovolemic shock

As you recall, hypovolemic shock means the bucket does not have enough fluid in it. This can be
due to hemorrhage or non-hemorrhagic causes. Common signs associated with hypovolemic
shock include:

a) Decreased cardiac output (normal is 4-8L/min)

b) Increased SVR (normal is 900-1300)
c) Decreased CVP (normal is 2-6 mmHg)
d) Cool skin, delayed cap refill
e) Low BP, low urine output
f) Tachycardi.

Treatments for hypovolemic shock:

a) To improve oxygen delivery in hypovolemic shock, you’ll fill up the bucket! If it’s
due to blood loss, give blood…if it’s due to fluid loss (vomiting, burns, diarrhea,
polyuria), then you’ll give fluid!
b) Identify and treat the source of the loss. If your patient is bleeding, they need
intervention STAT! If they’re vomiting uncontrollably, try to fix it (Zofran,
Reglan, Phenergen are all common medications). If it’s due to polyuria, are they in
diabetes insipidus? You get the idea.
c) Ensure your patient has two large-bore IVs at all time…may need a central line as
well.
d) Monitor your patient for improvements in HR, BP and urine output. You’ll
typically see the heart rate improve first, then the blood pressure, then urine output
last.
2) Distributive Shock.

Signs and treatment of distributive shock.

In distributive shock, the causes are so varied that your targeted treatment is going to be pretty
different depending on what’s causing it. The signs will also vary as well, but let’s just talk about
a few of the most common ones (anaphylactic, septic and neurogenic).

Anaphylactic shock occurs with massive allergic reactions. Large amounts of vasoactive
substances are released from mast cells causing systemic vasodilation and increased capillary
permeability. The result is a sudden and global drop in blood pressure. The most acute problem
your patient has is the respiratory compromise that accompanies the reaction.

3) Anaphylactic shock.

Signs of anaphylactic shock

a) In addition to hypotension and tachycardia…

b) Wheezes, hives, uticaria, itching, cutaneous flushing
c) Tightness in chest, throat swelling/fullness

Additional treatment for anaphylactic shock

a) Maintain the airway (get that ETT in there!)

b) Epinephrine epinephrine epinephrine
c) Fluids to support blood pressure
d) Histamine blockers (Pepcid, Tagamet, Benadryl)
e) Bronchodilators.
f) Steroids to reduce airway inflammation

Septic shock occurs in cases of severe infection that trigger a complex series of events leading to
massive vasodilation and increased capillary permeability. The result is hypotension and global
tissue hypoxia.
Signs of septic shock

a) Elevated temperature above 38 (note that the elderly, young children and
immunocompromised may show low temps below 36)
b) Tachycardia (sepsis screening triggers at HR > 90) and tachypnea
c) Elevated WBC or very low WBC
d) Decreased CVP and SVR
e) Hypotension despite fluid resuscitation

Additional treatment for septic shock

a) When a patient screens positive for sepsis they’re going to get fluids. We classify
them as in “septic shock” when their hypotension persists despite getting all these
fluids (30ml/kg)
b) Vasopressors (levophed is first, then vasopressin, then epinephrine and
phenylephrine) to increase SVR and, ultimately, blood pressure.
c) Antibiotics (control the source of the infection…this is KEY!!!)

4) Neurogenic shock occurs in patients with spinal cord injury and is due to a loss of
sympathetic innervation. It’s more likely to present in patients with an injury at C3-C5 level. In

Signs of neurogenic shock

a) Massive vasodilation and decreased venous return leading to decreased SVR,

CVP, CO and PAWP
b) Decreased HR (recall that the PNS is now driving the train!)
c) Pooling of blood in vessels
d) Warm, flushed skin
e) Hypotension with wide pulse pressure

Additional treatment for neurogenic shock

 a) Obviously, if this is a new spinal cord injury, you’ll work with your team to
stabilize the spine. Your patient will be on a backboard and be wearing a c -spine
collar. Hopefully you’re at a trauma center. Spine stabilization is key to getting the
SNS working again.
b) IV fluids to help restore preload
c) Vasopressors to support the blood pressure
d) Treat bradycardia as needed

5) Cardiogenic shock: is a pump problem! The heart has failed and is no longer able to pump
adequately. The signs will be specific to whatever is causing the pump to fail, but one of the
most common is left-sided heart failure. And since right-sided heart failure is a common cause of
left-sided heart failure we’ll talk about both here:

Signs and treatment of cardiogenic shock

a) Left-sided heart failure (thinks about where blood is coming from BEFORE it gets
to the left-side and this will help you remember the pathophysiology…it’s the
lungs, so this where the fluid backs up!)

I. Pulmonary congestion
II. Dyspnea
III. Coarse lung sounds
IV. Distant heart sounds
V. Elevated PAWP
VI. Low cardiac output
b) Right-sided heart failure (before blood gets to the right side, it’s in the systemic
vasculature so this is where it backs up)
I. Systemic venous congestion and peripheral edema
II. Elevated CVP
III. Jugular venous distention (JVD)
IV. Normal or low PAWP
Treatment for cardiogenic shock

a. Reduce myocardial oxygen demand while improving oxygen supply

b. Give fluids (unless pt is fluid overloaded)
c. Inotropes to improve cardiac output

I. Dobutamine or dopamine
II. Milrinone to also decrease afterload (has vasodilatory effects)

d. Possibly give diuretics to remove excess fluid

e. Vasopressors to increase BP via vasoconstriction
f. Very sick patients may need an IABP
g. In the cases of myocardial infarction, patient needs revascularization .

6) OBSTRUCTIVE SHOCK.

Signs and treatment of obstructive shock

Whenever there is a THING obstructive blood flow in the great vessels or the heart itself, we
consider this obstructive shock. This “thing” can be fluid around the heart (cardiac tamponade), a
tension pneumothorax that’s putting pressure on the heart and great vessels, or a blood clot in the
lungs (pulmonary embolism). The signs/symptoms can vary based on the cause of the
obstruction:

a) Signs of pulmonary embolism

I. SOB, increased WOB, tachypnea, dropping O2 sats

II. Feeling of impending doom
III. Chest pain
IV. Cough with or without hemoptysis
V. Pulsus paradoxus (SBP increases on expiration, drops on inspiration by
10mmHg or more)
b) Signs of tension pneumothorax

I. Drop in BP due to decreased venous return

II. Increased SOB and WOB; drop in O2 sats
III. Displaced trachea if it’s really bad
IV. Decreased or absent lung sounds on the side of the pneumothorax.

c) Signs of cardiac tamponade

I. Beck’s triad: elevated CVP, decreased BP, muffled heart tones

II. PEA (pulseless electrical activity) …obviously this is a very bad sign!
III. Pulsus paradoxus

Treatment for obstructive shock

The goal with obstructive shock is to remove the thing causing the obstruction…easy enough,
right?

I. Tension pneumothorax gets a needle decompression and/or chest tube

II. Cardiac tamponade needs a pericardiocentesis
III. Pulmonary embolism needs heparin, thrombolytic therapy and/or an IVC filter

Miscellaneous nursing interventions for a patient in shock

In addition to recognizing and treating each various type of shock, there are a few other general
things you’ll want to do for a patient heading down this road:

I. Foley catheter so you can monitor urine output very closely

II. Anticipate a fair amount of lab studies…CBC, coags, chemistry, cardiac enzymes,
ABG, lactate and blood cultures
III. Make sure the patient is on a cardiac monitor (and get a 12-lead while you’re at it)
IV. Anticipate the MD placing a central line, pulmonary artery catheter and/or an
arterial line
 V. Set up hemodynamic monitoring lines (CVP, ABP, etc)

Most of all, don’t be afraid to voice your concerns for your patient. Even small changes can
indicate a worsening shock state, so keep on top of your thorough assessments and advocate
fiercely for your patient. You’ll do great!

CONCLUSION.

In conclusion, shock is also a medical emergency that occurs when there is a significant decrease
in blood flow throughout the body, leading to inadequate oxygen and nutrient supply to the
tissues and organs. And if you suspect someone is experiencing shock, it is crucial to call for
emergency medical assistance immediately. Emergency medical professionals have the training
and equipment to assess the situation, provide appropriate care, and transport the person to a
medical facility for further treatment. Early intervention is key to improving the chances of a
positive outcome in cases of shock.

REFERENCES.

• National Institutes of Health: https://www.uptodate.com/contents/definition-classification-

etiology-and-pathophysiology-of-shock-in-adults

The Mayo Clinic: https://www.mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620

• studocu: https://www.studocu.com/en-us

• Nursing Answers: https://nursinganswers.net/

• Registered Nurses Association of

Ontario: https://sigma.nursingrepository.org/handle/10755/332003

• Nurse Buff: https://www.nursebuff.com/