A 35-year-old female presents with sudden onset of dizziness and weakness. Her skin is cool and clammy. Vital signs are BP 80/50 mmHg, HR 120 bpm, RR 20 bpm, SpO2 96%. Her ECG shows a narrow-complex tachycardia at 120 bpm, but she appears to be in compensated shock. What is the MOST immediate intervention?
- AInitiate vasopressor therapy with norepinephrine.
- BAdminister a 500 mL IV fluid bolus.
- CAdminister adenosine 6 mg IV rapid push.
- DPerform synchronized cardioversion at 50 J.
Show answer & explanationAnswer & explanation
Correct answer: B. Administer a 500 mL IV fluid bolus.
The patient is in compensated shock (hypotension, cool/clammy skin, tachycardia) with a narrow-complex tachycardia. While the tachycardia is present, the immediate life threat is hypoperfusion. Distributive shock is a common cause of tachycardia and hypotension; therefore, a fluid bolus is the most immediate intervention to address hypovolemia or vasodilation and improve perfusion. Adenosine or cardioversion would be considered if the tachycardia itself was causing instability and resistant to fluid, but fluid is typically first for shock.
Why the other options are wrong
- A. Vasopressors are typically used after fluid resuscitation has been attempted and failed to improve blood pressure.
- C. Adenosine is for stable SVT; this patient is unstable due to shock.
- D. Synchronized cardioversion is for unstable tachycardia, but fluid bolus is often attempted first if hypovolemia or distributive shock is suspected as the primary cause.
Shock Management Principles
Shock is a state of inadequate tissue perfusion. Initial management focuses on addressing the underlying cause, supporting circulation, and improving oxygen delivery.
- Identify and treat the underlying cause (e.g., hypovolemia, cardiac, distributive).
- Fluid resuscitation is often an initial step in many forms of shock.
- Vasopressors are used when fluid resuscitation is insufficient.
Memory trick: Shock: 'Fluids First' to 'Fill the Tank'!