Emergency Nursing & Triage Q 10

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A client arrived at the emergency department after suffering multiple physical injuries including a fractured pelvis from a vehicular accident. Upon assessment, the client is incoherent, pale, and diaphoretic. With vital signs as follows: temperature of 97°F (36.11° C), blood pressure of 60/40 mm Hg, heart rate of 143 beats/minute, and a respiratory rate of 30 breaths/minute. The client is mostly suffering from which of the following shock?

  

    A. Distributive

    B. Hypovolemic

    C. Obstructive

    D. Cardiogenic

    

    

Correct Answer: B. Hypovolemic

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Hypovolemic shock occurs when the volume of the circulatory system is too depleted to allow adequate circulation to the tissues of the body. A fractured pelvis will lose about one liter of blood hence symptoms such as hypotension, tachycardia, and tachypnea will occur. If left untreated, these patients can develop ischemic injury of vital organs, leading to multi-system organ failure.

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Option A: Distributive shock results from a relative inadequate intravascular volume caused by arterial or venous vasodilation. In distributive shock, systemic vasodilation leads to decreased blood flow to the brain, heart, and kidneys damaging vital organs. Additionally, fluid leaks from the capillaries into the surrounding tissues, further complicating the clinical picture. further complicating the clinical picture.

Option C: An obstructive shock is a form of shock associated with physical obstruction of the major vessels of the heart itself. Obstructive shock is a less common, but important cause of shock in critically ill infants and children. It is caused by mechanical obstruction of blood flow to and/or from the heart and causes can include tension pneumothorax, cardiac tamponade, pulmonary embolism, or cardiac defects resulting in left-sided outflow tract obstruction.

Option D: Causes of cardiogenic include massive myocardial infarction or other causes of primary cardiac (pump) failure. Cardiogenic shock is a primary cardiac disorder characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia. Clinical criteria include a systolic blood pressure of less than or equal to 90 mm Hg for greater than or equal to 30 minutes or support to maintain systolic blood pressure less than or equal to 90 mm Hg and urine output less than or equal to 30 mL/hr or cool extremities.

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