Evaluation and management of shock States: hypovolemic, distributive, and cardiogenic shock

• Published in: Journal of pharmacy practice Vol. 24; no. 1; p. 44
• Main Authors: Moranville, Michael P, Mieure, Katherine D, Santayana, Elena M
• Format: Journal Article
• Language: English
• Published: United States 01.02.2011
• Subjects: Animals; Disease Management; Fluid Therapy - methods; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Hypovolemia - diagnosis; Hypovolemia - physiopathology; Hypovolemia - therapy; Perfusion - methods; Shock - diagnosis; Shock - physiopathology; Shock - therapy; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Vasoconstrictor Agents - pharmacology; Vasoconstrictor Agents - therapeutic use
• ISSN: 1531-1937
• DOI: 10.1177/0897190010388150

Shock states have multiple etiologies, but all result in hypoperfusion to vital organs, which can lead to organ failure and death if not quickly and appropriately managed. Pharmacists should be familiar with cardiogenic, distributive, and hypovolemic shock and should be involved in providing safe and effective medical therapies. An accurate diagnosis is necessary to initiate appropriate lifesaving interventions and target therapeutic goals specific to the type of shock. Clinical signs and symptoms, as well as hemodynamic data, help with initial assessment and continued monitoring to provide adequate support for the patient. It is necessary to understand these hemodynamic parameters, medication mechanisms of action, and available mechanical support when developing a patient-specific treatment plan. Rapid therapeutic intervention has been proven to decrease morbidity and mortality and is crucial to providing the best patient outcomes. Pharmacists can provide their expertise in medication selection, titration, monitoring, and dose adjustment in these critically ill patients. This review will focus on parameters used to assess hemodynamic status, the major causes of shock, pathophysiologic factors that cause shock, and therapeutic interventions that should be employed to improve patient outcomes.