must tailor interventions to the type of shock, whether hypovolemic,
cardiogenic, or circulatory shock. Hypovolemic
shock, the most common type of shock, is characterized by
decreased intravascular volume. Body fluid is contained in
the intracellular and extracellular compartments. Intracellular
fluid accounts for about two thirds of the total body
water. The extracellular body fluid is found in one of two
compartments: intravascular (inside blood vessels) or interstitial
(surrounding tissues). The volume of interstitial fluid
is about three to four times that of intravascular fluid. Hypovolemic
shock occurs when there is a reduction in intravascular
volume by 15% to 30%, which represents a loss
of 750 to 1500 mL of blood in a 70-kg (154-lb) person
Medication Desired Action in Shock Disadvantages
Medication Desired Action in shock Disadvantages
Inotropic Agents
Dobutamine (Dobutrex Improve contractility, increase stroke Increase oxygen demand of the heart
Dopamine (Intropin) volume, increase cardiac output
Epinephrine (Adrenalin)
Milrinone (Primacor)
Vasodilators
Nitroglycerin (Tridil) Reduce preload and afterload, reduce hypotension
cause oxygen demand of heart
Nitroprusside (Nipride) Vasopressor Agents
Norepinephrine (Levophed) Increase blood pressure by vasoconstriction Increase afterload, thereby
Dopamine (Intropin) increasing cardiac
workload;compromise perfusion to
skin, kidneys, lungs, gastrointestinal
tract
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