EMT: Shock Terminology

Distributive shock

1. Associated with a decrease in intravascular volume 2. Massive systemic vasodilation 3. Increase in capillary permeability 4. Reduction in systemic and peripheral vascular resistance 5. Reduction in systolic blood pressure

Cardiogenic shock

1. Caused by ineffective pump function of the heart 2. Patient is prone to cardiogenic shock when more than 40 percent of the left ventricle is lost.

Hypovolemic shock

1. Caused by low blood volume 2. Most common type of shock 3. Generally caused by hemorrhage 4. Also caused by burns and dehydration

Metabolic or respiratory shock

1. Described as a fifth type of shock in some sources 2. Dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, off-load at the cell, or be used by the cell for metabolism

Cardiogenic shock

1. Most common causes a. Myocardial infarction b. Congestive heart failure c. Abnormal cardiac rhythm d. Overdose on drugs that depress the pumping function of the heart

Burn shock

1. Nonhemorrhagic hypovolemic shock resulting from a burn injury. 2. Burns may interrupt the integrity of the capillaries and vessels. 3. "Pull" effect draws fluid into the interstitial space, causing edema.

Obstructive shock

1. Results from a condition that obstructs forward blood flow 2. Possible causes a. Blood clot b. Tension pneumothorax c. Pericardial tamponade

Nonhemorrhagic hypovolemic shock

1. Results from the loss of fluid from the intravascular space. 2. Red blood cells and hemoglobin remain within the vessels. 3. Water, plasma proteins, and electrolytes are lost. 4. Blood volume, pressure and perfusion of cells are reduced.

Hemorrhagic or hypovolemic shock

1. Results from the loss of whole blood from the intravascular space. 2. Relates to whole blood loss that can occur from traumatic injury or medical illness.

What are the EMT management goals for shock?

1. Secure and maintain a patent airway. 2. Establish and maintain adequate ventilation. 3. Establish and maintain adequate oxygenation. 4. Do not hyperventilate. 5. Stop the bleeding using direct pressure. 6. Splint fractures. 7. Do not remove impaled objects. 8. Maintain the body temperature. 9. Keep the patient in a supine position. 10. Rapidly transport patient. 12. Consider ALS intercept.

Neurogenic shock

1. This is a type of distributive shock, also known as vasogenic shock. 2. May be caused by spinal cord injury a. May damage the sympathetic nerve fibers that control vessel tone. b. Vessels dilate. c. Systemic vascular resistance, blood pressure, and perfusion may drop. d. Blood will pool in the peripheral vessels. e. Preload, stroke volume, cardiac output, and systolic blood pressure will decrease.

Anaphylactic shock

1. This is a type of distributive shock. 2. Chemical mediators in the anaphylactic reaction cause massive and systemic vasodilation. 3. Capillaries become permeable and leak. 4. Fluid is forced out into the interstitial space. 5. Systemic vascular resistance is reduced. 6. Blood pressure and perfusion are decreased.

Septic shock

1. This is a type of distributive shock. 2. Results from an infection that releases bacteria or toxins in the blood. 3. Vessels dilate and become permeable. 4. Fluid leaks into the interstitial space. 5. Systemic vascular resistance, blood pressure, and perfusion are reduced. 6. Intravascular volume, preload, stroke volume, cardiac output, systolic blood pressure, and perfusion are decreased.

When treating a suspected shock patient, vital signs should be recorded approximately every ___ minutes.

5.

Inadequate volume results from?

A loss of whole blood from bleeding and may result from a loss of plasma volume from diarrhea, burns, excessive urination, increased capillary leakage, and excessive vomiting.

You should suspect shock in all of the following except

A mild allergic reaction.

Neurogenic shock is caused by

A radical change in the size of the vascular system.

Shock refers to:

A state of collapse and failure of the cardiovascular system.

What is shock?

A state of perfusion that is inadequate to meet the glucose and oxygen needs of cells.

Perfusion requires having a working cardiovascular system as well as

Adequate oxygen exchange in the lungs, adequate nutrients in the form of glucose in the blood, adequate waste removal.

To maintain perfusion and prevent shock, all these components must be present.

Adequate ventilation, oxygenation and delivery of oxygen and glucose.

The force or resistance against which the heart pumps

Afterload

A swelling of a part of an artery, resulting from weaking of the arterial wall.

Aneurysm

Which of the following MOST accurately describes septic shock?

Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation

_____ pressure is the pressure in the blood vessels at all times.

Blood .

Shock cause by inadequate function of the heart is called ____ shock.

Cardiogenic

_____ develops when the heart muscle can no longer generate enough pressure to circulate the blood to all organs.

Cardiogenic Shock.

What is obstructive shock?

Caused by mechanical obstruction which prevents adequate blood volume from filling heart chambers

Neurogenic shock usually results from damage to the spinal cord at the _____.

Cervical Level.

The early stage of shock, in which the body can still compensate for blood loss, is called _____ shock.

Compensated

What is the Body's Response to Shock?

Compensatory mechanisms 1. Direct nerve stimulation a. Increase in heart rate b. Increase in force of ventricular contraction c. Vasoconstriction d. Stimulation of the release of epinephrine and norepinephrine 2. Release of hormones a. Epinephrine stimulates alpha and beta receptors.

What are the 3 Stages of Shock?

Compensatory shock, Decompensatory shock and Irreversible shock

Bluish color of the skin resulting from poor oxygenation of the circulating blood

Cyanosis

Signs of cardiogenic shock include?

Cyanosis, Nausea, Anxiety.

_____ pressure occurs during cardiac relaxation, while _____ pressure occurs during cardiac contractions.

Diastolic, systolic

What is Compensated Shock?

Early Stages of Shock.

The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affeced area

Edema

Which age groups deteriorate rapidly if in shock?

Elderly persons and infants

What is syncope?

Fainting.

The cardiovascular system consists of the ______, _____, and _____.

Heart; vessels; blood

A balance of all systems of the body

Homeostasis

What is another term for Shock?

Hypoperfusion.

The categories of shock are?

Hypovolemic shock, Distributive shock, Cardiogenic shock, Obstructive shock and Metabolic or respiratory shock

Inadequate vessel tone may result from?

Inadequate vessel tone may result from an injury to the spinal cord or released chemical mediators that cause a systemic dilation of vessels.

The autonomic nervous system controls the _____ actions of the body.

Involuntary

The final stage of shock, resulting in death, is called ____ shock.

Irreversible

Hypovolemic shock is a result of

Low volume.

Inadequate pump function may result from?

May result from an injury to the heart that reduces its ability to generate strong enough contractions It may result from weakening over time from disease, old age, or injury and may result from mechanical obstruction of the movement of blood into the heart

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels is called ____ shock.

Neurogenic

An insufficient concentration of ______ in the blood can produce shock as rapidly as vascular causes.

Oxygen.

Blood pressure is a rough measurement of _____.

Perfusion.

The precontraction presuure in the heart as the volume of blood builds up

Preload

What does Blood Pressure provide us?

Provides a rough messure of perfusion.

______ is a sudden reaction of the nervous system that produces temporary vascular dilation and fainting.

Psychogenic Shock

What do Sphincters do?

Regulate blood flow in capillaries.

What does the Autonomic Nervous System do?

Regulates involuntary body functions.

Shock caused by severe infection is called ____ shock.

Septic

What is Septic Shock?

Severe Bacterial Infection.

What is Anaphylaxis?

Severe allergic reaction.

Inadequate circulation that does not meet the body's needs is known as ______.

Shock (Hypoperfusion)

______ are circular muscle walls in capillaries, causing the walls to _____ and ______.

Sphincters; contract; dilate

Which of the following statements regarding anaphylactic shock is correct?

Subsequent exposure after sensitization often produces a more severe reaction.

What is Perfusion?

Sufficient circulation to meet cell needs.

Blood flow throught the capillary beds is regulated by what?

The Capillary Sphincters

In septic shock

There is an insufficient volume of fluid in the container, the fluid that has leaked out often collects in the respiratory system, there is a larger-than-normal vascular bed to contain the smaller-than-normal volume of intravascular fluid.

What are the signs of poor perfusion?

a. Altered mental status such as anxiety, restlessness, irritability b. Pale, cool, clammy skin c. Delayed capillary refill d. Decreased urine output e. Weak or absent peripheral pulses.

Clinical signs of compensated shock include all of the following, EXCEPT:

absent peripheral pulses.

What are two important shock signs to watch for in the elderly?

altered mental status and tachypnea

The action of hormones such as epinephrine an norepinephrine stimulates ___________ to maintain pressure in the system and, as a result, perfusion of all vital organs.

an increase in heart rate, an increase in the strength of cardiac contractions, vasoconstriction in nonessential areas.

Noncardiovascular causes of shock include respiratory insufficiency and ______.

anaphylaxis.

Regulation of blood flow is determined by

cellular need

Neurogenic shock occurs when:

failure of the nervous system causes widespread vasodilation.

The three basic etiologies of shock are?

inadequate volume, inadequate pump function, and inadequate vessel tone.

The body's response to shock is to try to?

maintain homeostasis

Basic causes of shock include

poor pump function, blood or fluid loss, blood vessel dilation.

The autonomic nervous system regulates involuntary functions by

sweating, digestion, constriction and dilation of capillary sphincters.

The Golden Period refers to the first 60 minutes after

the injury occurs.

In anaphylactic shock, the combination of poor oxygenation and poor perfusion is a result of

widespread vasodilation.