EMT-B Chapter 12 - Shock (Multiple)
cardiogenic shock
Shock caused by inadequate function the heart, or pump failure.
What is a Strain?
Stretching or tearing of a muscle.
What is Cushings Triad?
Tachypnea- High BP, Bradycardia - Low Heart Rate, Hypertension.
What happens in the Irreversible stage of shock?
The patien is pretty much dead
Shock
Widespread inadequate tissue perfusion
What is a transverse fraction?
a break straight through bone
Obstructive shock
blockage of blood flow to the lungs. Producing a Pulmonary embolism
Which of the following injuries would MOST likely cause obstructive shock?
cardiac tamponade
What is anascoria?
disorder of unequal pupils. Accounts for 3% of population.
What is rule #3 for splinting?
don't tape or strap over injuries or uninjured joints( you don't want to cut off distal CMS.)
Neurogenic shock occurs when:
failure of the nervous system causes widespread vasodilation.
speed of intercranial bleeding of the intracerebral
fast
A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should:
follow appropriate standard precautions.
What is a displaced fracture?
fracture where there is deformity
Neurogenic shock is caused by
radical change in size of blood vessels
Which of the following clinical signs is unique to anaphylactic shock?
wheezing
sphincters
Circular muscles that encircle and, by contracting, constrict a duct, tube, or opening.
Thrombosis
Clot in the lung
What are the three stages of Shock?
Compensated, decompensated and Irreversible
what is a nondisplaced fracture?
Crack of bone
syncope
Fainting.
Diffusion
Gas Exchange
How do you tapedown a big bulky trauma dressing on a patient?
Hashtag or cross.
Myocardial Infarction
Heart Attack
What are symptoms of a contusion?
ICP, widening pulse pressure, watch for Cushings triad symptoms.
What special precaution should you look out for when dealing with patients who went through Psychogenic shock or a Syncople episode?
If a patient falls check for injuries and take spinal precautions.
What does Aspirin do?
It is a platelet inhibitor.
Spinal injury assos. w/ what shock?
Neurogenic Shock
Anaphylactic Shock
Occurs when a person reacts violently to a substance.
Signs and Symptoms of Hypovolemic Shock
Rapid weak pulse low BP Cyanosis lips nail beds cool clammy skin dehydration/thirsty INCREASED RESPIRATORY RATE
A sick patient who is vomitting and has diahrreah is assos. w/ which shock?
Metabolic/Hypovolemic Shock.
respiratory Insufficiency
Not enough Oxygen flow to the blood can produce shock
Psychogenic Shock
Occurs after a patient faints and has no blood return to head.
Treatment for Neurogenic Shock
Oxygen, Blanket, Supine position to let body fight it out.
Treatment for Septic Shock
Oxygen, semi-fowlers or fowlers, can use blankets.
What kind of movement does a flail chest depict?
Paradoxical movement?
Syncople Episode
Patient faints and blood returns to the head.
What is a contusion?
Permanent damage(Bruise to the head)
Fainting is assos. with which shock?
Psychogenic shock?
Signs and Symptoms of Anaphylactic Shock
QUICK ONSET mild itching rash burning skin vascular dilation generalized edema especially around face and lips pallor/cyanosis dizziness/fainting sneezing/tightness in chest/cough WHEEZING
What is paraorbital achimosis?
Racoon eyes.
What are the control centers?
Respiratory, Cardiac, Vasomotor and R.A.S(Reticular Activating System)
Infections are assos. w/ what type of shock?
Septic Shock
anaphylactic shock
Severe shock caused by an allergic reaction.
psychogenic shock
Shock caused by a sudden temporary reduction in blood supply to the brain that causes fainting (syncope).
hypovolemic shock
Shock caused by fluid or blood loss.
septic shock
Shock caused by severe infection, usually a bacterial infection.
obstructive shock
Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.
When treating a patient who exhibits signs and symptoms of shock, which of the following actions would not be appropriate?
Splint all suspected extremity fractures.
What is rule #2 for splinting?
Splint in position found, unless there is no distal cms, then move it.
What is the Ventury effect?
Sucking in of air
Pedal Edema also known as Pitting Edema
Swelling of the feet
What is a Sprain?
Tearing of ligaments
myocardial contractility
The ability of the heart to contract.
irreversible shock
The final stage of shock, resulting in death.
afterload
The force or resistance against which the heart pumps.
decompensated shock
The late stage of shock when blood pressure is falling.
autonomic nervous system
The part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion, and sweating.
What position is used to splint for the wrist or hand?
The position of function.
preload
The precontraction pressure in the heart as the volume of blood builds up.
edema
The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area.
Perfusion
Transfer of oxygenated blood
Signs and Symptoms of Septic Shock
WARM SKIN tachycardia low BP
What is the Reflex arc?
When a sensor in the arc detects an irritating stimulus, instead of going to the brain the message is sent to a motor nerve. (e.g.: Detecting Heat, sharps ect.)
What is cavitation
When pressure waves exert force on an object as it passes through its trajectory.(e.g.: exit wound on a bullet)
When does Anemia occur?
When there is an abnormally low number of red blood cells
How do you treat a patient with a Jugular Vein Laceration?
You get an acclusive dressing and tape all 4 sides.
Which of the following patients is in decompensated shock?
a 20-year-old female with absent radial pulses and dilated pupils
Basic causes of shock:
a)pump failure b)blood or fluid loss c)blood vessel dialation
Clinical signs of compensated shock include all of the following, EXCEPT:
absent peripheral pulse
You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:
apply pressure directly to wound
Which of the following MOST accurately describes septic shock?
bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
When assessing a patient with signs and symptoms of shock, it is MOST important to remember that:
blood pressure may be the last measurable factor to change in shock.
One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is:
carbon dioxide
A collection of fluid between pericardial sac and myocardium caused by blunt force trauma to chest/ type of obstructive shock
cardiac tamponade/pericardial tamponade
Pulmonary edema and impaired ventilation occur during: A) neurogenic shock. B) anaphylactic shock. C) septic shock. D) cardiogenic shock.
cardiogenic shock
Nuerogenic shock usually develops from damage to spinal cord at the:
cervical level
When treating an 80-year-old patient who is in shock, it is important to remember that:
changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.
Capillary sphincters are:
circular muscular walls that regulate blood flow through the capillaries.
When assessing breathing for a patient in shock, an increased respiratory rate can be a sign of:
compensated shock
Pulmonary Edema
develops when the Right ventricles pump blood back down to the feet
Shock is the result of:
hypoperfusion to the cells of the body.
In an acute injury setting, neurogenic shock is commonly accompanied by: A) hypovolemia. B) diaphoresis. C) tachycardia. D) hypothermia.
hypothermia
In compensated shock, the pulse of the patient usually:
increases
Speed of Intercranial bleeding of the Epidur
it is super fast
Hypotension in a child with blunt or penetrating trauma is particularly significant because:
it often indicates the loss of half of his or her blood volume
Which of the following would MOST likely result in hemorrhagic shock? A) liver laceration B) excessive sweating C) severe vomiting D) repeated diarrhea
liver laceration
Hypovolemic shock is result of
low blood volume
Causes of Obstructive Shock
mechanical obstruction of cardiac muscle leading to pump failure
Hypovolemic shock caused by severe burns is the result of a loss of:
plasma
Patients develop septic shock secondary to
poor vessel function and severe volume loss
What is a sudden reaction of nervous system causing temporary vasodilation and fainting?
psychogenic shock
Speed of intercranial bleeding of the subdural
slow
When the body senses a state of hypoperfusion, the sympathetic nervous system releases epinephrine, the effects of which include:
tachycardia
type of obstructive shock caused by damage to lungs allowing air to escape into chest cavity and apply pressure to structures in mediastinum such as the heart
tension pneumothorax
The Golden Period is the first 60 minutes after
the injury occurs
What is rule #4 for splinting?
the splint should extend past 2 nearest uninjured joints distal and proximal to injury.
At what systolic blood pressure should you recognize that an adult patient is in decompensated shock?
90 mm Hg
Signs and Symptoms of Neurogenic Shock
BRADYCARDIA Low BP SIGNS OF NECK INJURY
Major Heart attack are assos. with what shock?
Cardiogenic Shock
What does the Ventury effect cause in the human body?
Causes an embolysm also known as Thrombosys in the lungs.
Obstructive shock is usually seen in?
Diving accidents
Symptoms for Septic Shock
Hot, flush and diaphoretic.
Tension pneumothorax
Pressure in the Pleura
What is Cu-Contra-Cu?
Sloshing of the brain/internal organs
Distributive shock occurs when:
widespread dilation of the blood vessels causes blood to pool in the vascular beds.
In anaphylatic shock poor oxygenation and poor perfusion is a result of
widespread vasodilation
compensated shock
The early stage of shock, in which the body can still compensate for blood loss.
Septic shock
Toxins damage the vessel walls, causing leaking and impairing contraction. Usually ALOC due to head trauma.
Noncardiovascular causes of shock are respiratory failure and?
anaphylaxis
Regulation of blood flow is determined by?
cellular need
Signs and Symptoms of Cardiogenic Shock
chest pain irregular weak pulse/low BP cyanosis cool clammy skin anxiety rales in breathing pulmonary edema/possibly short of breath
All of the following conditions would make you suspect shock, EXCEPT:
tachycardia
Symptoms of Classic Compensated Shock
weak rapid pulse, More than 2 seconds on Cap. Refill, rapid breathing, Pale Skin, Marked Thirst,**** Blood pressure maintained at adequate level***
Epinephrine dosages for adults and pediatrics
.3mg for adults and .15mg for pediatrics.
examples of respiratory insufficiency
1- Carbon monoxide poisoning 2- Cyanide Poisoning 3- Anemia
What are the steps to administer an EPI-Pen?
1- Locate mid-lateral thigh. 2- Rub alcohol from big circle to small circles. 3- Administer epi for 10 seconds. 4- Place in sharps box. 5- Massage administered area.
Effects of Epinephrine on the body
1- Vaso-constrictor 2- dialates bronchioles 3- Increased heart rate
In infants and children, a capillary refill time (CRT) that is greater than ______ second(s) is a sign of poor peripheral perfusion.
2
when treating shock patient frequently check vitals every
5 minutes
homeostasis
A balance of all systems of the body.
shock
A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.
hypothermia
A condition in which the internal body temperature falls below 95 degrees Fahrenheit (35 degrees Celsius), usually as a result of prolonged exposure to cool or freezing temperatures.
distributive shock
A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.
What is a linear fraction?
A fraction where the skull seals itself when fully developed.
What is an epiphyseal fracture?
A fracture near the growth plate
What is a closed fracture?
A fracture that does not break the skin
aneurysm
A swelling or enlargement of a part of an artery, resulting from weakening of the arterial wall.
Intrapulmonary shunting occurs when: A) blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state. B) a decrease in respiratory rate and depth causes carbon dioxide accumulation in the alveoli and an overall decrease in blood oxygen levels. C) any impairment in circulatory function causes a reduced ability for oxygen and carbon dioxide to diffuse across the alveolar-capillary membrane. D) the presence of pulmonary surfactant causes a decrease in alveolar surface tension, thus impairing the exchange of gases in the lungs.
A) blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state.
When perfusion to the core of the body decreases: A) blood is shunted away from the skin. B) the voluntary nervous system releases hormones. C) decreased cardiac contractility occurs. D) blood is diverted to the gastrointestinal tract.
A) blood is shunted away from the skin.
Head injury indicators
ALOC, Acute iindicator of neurological damage and should be looked at close.
Neurogenic Shock
Affects vasomotor center. Damage to cervical spine may affect the size and muscular tone. 2 tone skin.
What is an open fracture?
Also known as a Compound fracture is an external wound associated with fracture.
What is an acclusive dressing?
An air tight dressing.
anaphylaxis
An unusual or exaggerated allergic reaction to foreign protein or other substances.
Injections, Stings, ingestion and inhalation of a substance or substances are assos. w/ what type of shock?
Anaphylactic Shock
HOw do you treat a patient with a Flail Chest?
Big bulky trauma dressing and tapedown.
What happens in the Decompensated stage of shock?
Blood Pressure is below 90 Systolic
What kills brain tissue?
Blood on brain tissue.
Subcutaneous Emphysema
Blood rising to top of skin. (Rice Crispies)
cyanosis
Bluish color of the skin resulting from poor oxygenation of the circulating blood.
What happens in the Compensated stage of shock?
Body fights, goes into fight or flight mode.
What is a fracture?
Broken bone
what is Rule #1 for splinting?
CMS before an dafter splinting
Non-traumatic brain injuries are?
CVA- Cerebral vascular Accident or a Stroke.
perfusion
Circulation of blood within an organ or tissue in adequate amounts to meet the cells' current needs.
neurogenic shock
Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.
A 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while traveling at a high rate of speed. She has signs and symptoms of shock, which you suspect are the result of intrathoracic bleeding. Which of the following interventions will provide this patient with the greatest chance for survival? A) full immobilization of her spine B) application of the pneumatic antishock garment (PASG) C) 100% oxygen administration D) rapid transport to a trauma center
D) rapid transport to a trauma center
A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 100/64 mm Hg. Her skin is warm and moist. You should be MOST suspicious that she is experiencing: A) pump failure. B) a local infection. C) decompensated shock. D) septic shock.
D) septic shock.
sensitization
Developing a sensitivity to a substance that initially caused no allergic reaction.
What is a dislocation?
Disruption of a joint
What does the acronym D.I.C.E stand for?
Drug dose, Integrity of container, color and clarity, expiration date.
Which of the following statements regarding anaphylactic shock is MOST correct?
Each subsequent exposure following sensitization often produces a more severe reaction.
What is compartment syndrome?
Elevated pressure within a fascial compartment.
What happens in Anaphylactic Shock?
Foreign body invaders attach to the Mast Cells and explode releasing Leukotrenes and Histamines.
Treatment for Cardiogenic Shock
Fowlers or semi-fowlers, Blanket and Oxygen. Only go Code 3 if there is Myocardial Infarction.
Treatment for Anaphylactic Shock
Fowlers position, Oxygen, and blanket
Perfusion Triangle
Heart, Blood Vessels, and Blood
Hypovolemic Shock
Hemorragic(Hypovolemic shock) and non-hemorragic(Metabolic). Loss of fluids and Electrolytes due to vomitting and or diahrreah.
Causes of Hypovolemic Shock
Hemorrhagic fluid/blood loss -burns can cause plasma loss
Signs and Symptoms of Anaphylactic Shock
Hot, Flush, Diaphoretic 1 -Wheezing, due to contricted bronchioles. 2- Itchy, Body is telling you to get rid of it. 3- Blood pressure drops- Hypotensive. 4- Eutokarya - Red skin bumps.
Abdominal and/or Chest injuries Assos. w/ what shock?
Hypovolemic shock
Severe Fractures are assos. w/ what type of shock?
Hypovolemic shock
Angina Pectoris
If the heart becomes esquemic or oxygen deprived.
Name one good thing about scalp lacerations?
If there is fair ammount of bleeding it is good because there is not much room for ICP to present itself.
Cardiogenic shock may result from all of the following, EXCEPT:
Increaded preload
Cardiogenic shock
Is a pump failure due to tissue becoming esquemic on the coronary arteries.
What is a fracture of the the proximal femur?
Isolated midshaft femur fracture.
What is a greenstick fracture?
It is a bend that is common with children
What is a concussion?
It is a brain injury with no permanent damage.
Paracardial tamponaude/ Myocardial Tamponaude
Jugular Vein Distention (JVD), Muffled heart sounds, heart filled with fluids, hypotensive.
What skull fractions account for 80% of skull fractions?
Linear fractions.
dehydration
Loss of water from the tissues of the body.
Hypotensive
Low blood pressure
