Editing Medical-Surgical Nursing (section)

== Shock, Sepsis, and Burns ==

=== Shock ===

Shock is inadequate tissue perfusion. Hypovolemic shock follows hemorrhage or fluid loss; cardiogenic shock follows pump failure such as large myocardial infarction; distributive shock includes septic, anaphylactic, and neurogenic types; obstructive shock includes tension pneumothorax, cardiac tamponade, and massive pulmonary embolism.

Early compensated findings are restlessness and anxiety, tachycardia, tachypnea, cool clammy skin, and a narrowing pulse pressure with a still-normal systolic pressure. Hypotension is a later finding, and decreased urine output below about thirty milliliters per hour is an early and reliable indicator of poor perfusion. Neurogenic and early septic shock are exceptions to the cool skin rule, presenting with warm, dry, or flushed skin, and neurogenic shock characteristically causes bradycardia rather than tachycardia.

Anaphylaxis requires immediate intramuscular epinephrine, airway support, oxygen, and rapid fluids, with antihistamines and corticosteroids as adjuncts, not as first-line treatment.

=== Sepsis ===

Suspect sepsis with infection plus fever or hypothermia, tachycardia, tachypnea, altered mentation, and hypotension. Obtain blood cultures before administering antibiotics when this does not delay treatment, give broad-spectrum antibiotics within the first hour, give rapid crystalloid resuscitation, measure serum lactate and remeasure it, and add vasopressors if hypotension persists after fluids. Time to antibiotics drives survival, so any delay is reported and escalated.

=== Burns ===

Estimate extent with the rule of nines in adults: head and neck nine percent, each arm nine percent, each leg eighteen percent, anterior trunk eighteen percent, posterior trunk eighteen percent, and perineum one percent.

The first priority in any burn is the airway. Facial burns, singed nasal hairs, soot in the mouth or sputum, hoarseness, or stridor signal inhalation injury and impending airway obstruction; secure the airway early, before edema makes intubation impossible. Carbon monoxide poisoning is treated with one hundred percent oxygen, and pulse oximetry is unreliable in that setting.

Fluid resuscitation in the first twenty-four hours commonly uses the Parkland formula, four milliliters of lactated Ringer solution per kilogram per percent of total body surface area burned, with half of the total given in the first eight hours calculated from the time of injury, not from the time of arrival, and the remaining half over the following sixteen hours. Titrate to urine output of roughly thirty to fifty milliliters per hour in adults.

The emergent phase risks hypovolemia and hyperkalemia as fluid and potassium shift out of cells and into the interstitium. The fluid remobilization phase that follows risks hypervolemia and hypokalemia. Circumferential burns can cause compartment syndrome and may require escharotomy. Nutrition requirements are very high in protein and calories, and infection is the leading cause of later death.