Understanding Shock and Cardiac Mechanisms in Critical Care

This article discusses the diagnosis and management of hypovolemic shock and sepsis in critical care. It also explores the importance of understanding cardiac mechanisms in treating patients with dysrhythmia.

1 Review the following case study and discuss the questions that follow.
CC is a previously healthy 27-year-old man admitted to the critical care unit after an accident in which he
was hit by a car and dragged along the pavement for nearly 100 feet. He suffered a frontal contusion,
fractured clavicle and ribs, and extensive abrasions on his arms, legs, side, back, and buttocks. On
admission, he was tachycardic, hypotensive, unresponsive, and ventilating poorly. He was placed on a
mechanical ventilator and given IV fluids for the treatment of his shock. CC responded well to fluids,
with an increase in blood pressure and an improvement in urine output.
A, Based on his case history and responsiveness to fluid therapy, what type of shock was CC
experiencing?
According to the case scenario and the patient’s responsiveness to the provided fluid resuscitation, the
patient had hypovolemic shock. The primary cause of hypovolemic shock is bleeding secondary to cuts,
contusions, internal bleeding, abrasions, and other injuries altering the flow of blood from the heart
thus affecting other organs (Trentz, 2014).
B, What other clinical findings would be helpful in confirming the type of shock? Why?
Hypovolemic shock is majorly diagnosed through examination and observation. According to the case
scenario, the signs and symptoms of hypovolemic shock include hypotension, tachycardia, and poor
ventilation. Other clinical findings for confirmation of hypovolemic shock include syncope, dehydration,
mental contusion, sleepiness, insufficient production of urine, pallor, nausea, and vomiting. This occurs
because in hypovolemic shock is associated with the depletion of the intravascular volume through loss
of blood or extracellular fluid. Blood loss results in kidney dysfunctions causing reduction in urine
output. Loss of body fluid results in paleness, dehydration, and syncope due to weakness (Trentz, 2014).
C, Because of his many open wounds and invasive lines, CC is at risk for sepsis and septic shock. What
clinical findings would suggest that this complication has developed?
Sepsis is associated with massive response of the immune system to bacterial, fungal, or viral infections
which spreads in the bloodstream. The clinical findings suggesting the complication include hypotension,
pyrexia, hypothermia, cyanosis, shivering, chills, tachycardia, diaphoresis, tachypnea, fatigue, dyspnea,
mental contusion, reduced urine output, anxiety, malaise, and confusion (Palmer & Martin, 2014).
D, What is the link between sepsis and multiple organ dysfunction syndrome (MODS)?
Sepsis involves the spread of infection to the bloodstream resulting in inflammation of various body
organs. Sepsis is linked to MODS since it affects the functioning of multiple body organs including the
brain, the heart, and the kidneys. Additionally, sepsis is regarded as a “Systematic Inflammatory
Responsive Syndrome” which is usually activated by the invasive infection. The patient who sustains SIRS
develops MODS due to failure of functioning of critical body organs (Gulati, 2016).

2. How does an understanding of the mechanisms of the heart help you in treatment of your patient
regardless of the illness? How does basic cardiac monitoring factor into caring for your patient? How
do you care for patients with dysrhythmia? Share some of your best practices.
Understanding cardiac mechanism is essential since it facilitates the implementation of the most
appropriate interventions. The heart plays an essential role in the process of body metabolism and any
cardiac dysfunctions results in severe impacts to the functioning of other body organs such as the brain,
the kidney, and the lungs. Understanding of cardiac mechanisms helps in the identification of the
specific patient’s problem based on the rate and rhythm of the pulse. Understanding the mechanisms of
heart would also be useful in minimizing the precipitating factors of cardiac arrhythmias which affects
the functioning of the body organs. According to the case scenario, the patient has tachycardia which
resulted from the alteration of the pattern of cardiac mechanisms (McLean, 2016).
Cardiac monitoring is a crucial tool that can be used in the clinical assessment of the patient. Cardiac
monitoring in this patient would be essential in the detection of the variations in cardiac rate,
conduction, and rhythm. The patient may be having arrhythmias which are life-threatening which can be
detected in cardiac monitoring for the implementation of the most appropriate measures or
interventions to save his life. Dysrhythmia can be managed using medical and nursing approaches. In
medical management, the patient should be given antiarrhythmic drugs, beta blockers, Calcium channel
blockers, and dietary supplement. Supportive and nursing care should also incorporate cardiac
monitoring, patient education on lifestyle modification, application of vagal maneuvers, and
cardioversion (Gulati, 2016).

References
Gulati, A. (2016). Vascular endothelium and hypovolemic shock. Current vascular pharmacology, 14(2),
187-195.
McLean, A. S. (2016). Echocardiography in shock management. Critical Care, 20(1), 275.
Palmer, L., & Martin, L. (2014). Traumatic coagulopathy Part 1: Pathophysiology and diagnosis.‐ Journal
of veterinary emergency and critical care, 24(1), 63-74.
Trentz, O. (2014). Polytrauma: pathophysiology, priorities, and management. In General Trauma Care
and Related Aspects (pp. 69-76). Springer, Berlin, Heidelberg.