Chapter 12: Shock

treatment for obstructive shock

dependent on cause: -ALS assist and/or rapid transport -administer high-flow O2

treatment of psychogenic (fainting) shock

determine duration of unconsciousness position patient supine record initial vital signs and mental status suspect head injury if patient is confused or slow to regain consciousness transport promptly

Skills Objectives 1. Demonstrate how to control shock. (pp 499-504)

refer to table...

treatment for hypovolemic shock

secure airway assist ventilations administer high flow O2 control external bleeding keep warm transport promptly consider ALS

6. Describe the steps to follow in the emergency care of the patient with various types of shock. (pp 499-505)

-Follow standard precautions. -Control all obvious external bleeding. -ensure open airway -Maintain manual in-line stabilization if necessary, and check breathing and pulse. -Always provide oxygen, assist with ventilations, and use airway control adjuncts as needed. -Monitor the patient's breathing. -Place blankets under and over the patient. -Transport the patient and treat additional injuries en route. -Consider rendezvousing with ALS if possible, and consider aeromedical transport. -Do not give the patient anything by mouth, no matter how urgently you are asked.Give the patient a moistened piece of gauze to chew or suck. -Accurately record the patient's vital signs approximately every 5 minutes throughout treatment and transport.

2. Identify the causes of shock. (p 490)

1. pump failure 2. low tidal volume 3. poor vessel function

5. Discuss key components of patient assessment for shock. (pp 497-499)

1. scene size up -hazards and PPE -police is needed -observe for MOI and NOI 2. primary assessment -rapid exam for life threatening concerns -bleeding -determine if shock is present 3. history taking -med history -SAMPLE 4. secondary assessment -repeat primary asess -do focused assessment -obtain baseline vitals 5. reassessment -vitals, interventions, chief complaint, ABCs, mental status

3. Differentiate among the various types of shock. (pp 491-496) Cardiogenic shock

Cardiogenic shock: inadequate function of heart or heart failure. -edema The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area. -pulmonary edema leads to impaired respiration CO depends on: -myocardial contractility -preload: increase in preload = incease in volume of blood in ventricles, causing greater contraction and CO -afterload: increase in afterload = decrease in CO Cardiogenic shock may result from low cardiac output due to high afterload, low preload, poor contractility, or any combination of the three.

4. Describe the signs and symptoms of shock including compensated and decompensated. (pp 496-497)

Compensated shock is the early stage of shock, when the body can still compensate for blood loss. decompensated shock The late stage of shock when blood pressure is falling. Expect shock in: Massive external or internal bleeding Multiple severe fractures Abdominal or chest injury Spinal injury A severe infection A major heart attack Anaphylaxis -by the time you detect a change in BP, shock is well developed

Distributive ShocK

Distributive shock results when there is widespread dilation of the small arterioles, small venules, or both. 4 types: Septic shock -Occurs as a result of severe infections, usually bacterial, in which toxins are generated by the bacteria or by infected body tissues -The toxins damage the vessel walls, causing increased cellular permeability. -The vessel walls leak and are unable to contract well. Neurogenic shock is usually the result of high spinal cord injury -The muscles in the walls of the blood vessels are cut off from the sympathetic nervous system and nerve impulses that cause them to contract. -signs of this shock are: absence of sweat below level of injury -normal and low heart rate in presence of hypotension, and normal warm skin Anaphylactic shock Occurs when a person reacts violently to a substance to which he or she has been sensitized -Cyanosis is a late sign of anaphylactic shock. -there is widespread vascular dilation, increased permeability, and bronchoconstriction. psychogenic shock Shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting (syncope). -can be caused by receiving bad news or a brain aneurysm

Hypovolemic shock

Hypovolemic shock is the result of an inadequate amount of fluid or volume in the circulatory system. -results from injuries that cause bleeding -Vomiting and diarrhea may result in nonhemorrhagic hypovolemic shock. Hypovolemic shock also occurs with severe thermal burns. Hypovolemic shock is characterized by rapid, weak pulse; low blood pressure; a change in mental status; cyanosis; cool, clammy skin; and an increased respiratory rate.

Obstructive Shock

Obstructive shock is caused by a mechanical obstruction that prevents an adequate volume of blood from filling the heart chambers 3 most common examples: Cardiac tamponade: -Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output. -A pericardial effusion is a collection of fluid between the pericardial sac and the myocardium. -Large pericardial effusions can lead to cardiac tamponade -Signs and symptoms are referred to as Beck triad: 1. The presence of jugular vein distention 2. Muffled heart sounds 3. A narrowing pulse pressure where the systolic and diastolic blood pressures start to merge (systolic pressure drops and the diastolic pressure rises) Tension pneumothorax: -Caused by damage to the lung tissue -This damage allows air normally held within the lung to escape into the chest cavity. -The lung collapses. -tension pneumothorax An accumulation of air or gas in the pleural space that progressively increases pressure in the chest, which interferes with cardiac function, with potentially fatal results. Pulmonary embolism A blood clot that occurs in the pulmonary circulation and blocks the flow of blood through the pulmonary vessels

treatment for cardiogenic shock

Position comfortably, administer high flow oxygen, assist ventilations, transport promptly, consider ALS

treatment for anaphylactic shock

manage the airway assist ventilations administer high-flow O2 determine cause assist with epinephrine transport promptly consider ALS

treatment for neurogenic shock

secure airway spinal immobilization assist ventilations administer high flow O2 preserve body heat transport promptly consider ALS

cardiovascular system

shock A condition in which the circulatory system fails to provide sufficient circulation, and therefore inadequate oxygen and nutrient delivery, to maintain normal cellular functions; also called hypoperfusion. CO2 travels to lungs via: -carbon dioxide travels via bicarbonate ions = water + CO2 -dissolved in plasma -attached to hemoglobin Clots are unstable and prone to rupture because blood keeps moving as a result of pressure generated by the contractions of the heart and the actions of the blood vessels as they dilate and constrict (blood pressure). Pulse pressure is the difference between the systolic and diastolic pressures (systolic - diastolic = pulse pressure) Signifies the amount of force the heart generates with each contraction Blood flow through the capillary beds is regulated by the capillary sphincters, circular muscular walls that constrict and dilate. The sympathetic portion of the ANS releases ep. and norep. to do the following: -increase HR -increase strength of cardiac contractions -vasoconstrictions in nonessential areas

1. Describe the pathophysiology of shock (hypoperfusion). (pp 487-490)

shock results from: -bleeding -resp. failure -acute allergic reactions -overwhelming infection damage occurs bc of insufficient perfusion of organs and tissues

treatment for septic shock

transport promptly administer high-flow O2 assist ventilations keep patient warm consider ALS