Shock

Remember Perfusion ….

Shock is inadequate perfusion (aka Hypoperfusion)

The organs and tissues of the body do not get enough oxygen and nutrients.

Shock

It can occur with either

traumatic injuries or serious medical

conditions

What causes Shock?

• Pump (Heart)

• Tubing (Blood Vessels)

• Fluid (Blood)

Shock is the result of a malfunction of at least 1 of 3 systems

(colors have significance)

What are the types of shock?

Remember MASHNCPR Metabolic Excessive loss of fluid &

electrolytes with non-hemorrhagic cause

1. GI: vomiting/diarrhea/ urination, 2. burns3. drugs4. hyperglycemia5. heat stroke

Anaphylactic Systemic allergic reaction causing widespread vasodilation and generalized edema ; has an upper respiratory component

1. insect sting or bite2. ingestion (eg legumes), 3. Rx (eg penicillin PCN)4. inhalants (pollen, dust)

Septic Systemic infection, usually bacterial, damages vessel walls resulting in leakage and vasodilation;

1. untreated wound, 2. surgery, 3. trauma (peritonitis);4. disease (pericarditis), or 5. contagion (meningitis, pneumonia)

Hypovolemic Loss of fluid volume (blood) with hemorrhagic cause (eg trauma); could be external or internal

Bleeding due to 1. Blunt trauma to solid abdominal organ, 2. great vessel tear, 3. major bleed from laceration or fx

Neurogenic Sudden loss of the control by CNS of nerves & muscles, causing vasodilation & muscle paralysis

1. brain => Increased Intercranial pressure due to trauma, tumor, bleeding

2. spinal cord => due to fx, vertebral bleeding, or tumor

Cardiogenic Heart muscle can no longer generate enough pressure to circulate blood to all organs; leads to pulmonary edema

1. Myocardial Infarction 2. Disease (CHF, pericarditis), 3. Electrical, 4. Trauma (Pericardial tamponade)5. Valve dysfunction,

Psychogenic fainting resulting from temporary vascular dilation (loss of blood pressure) and lack of blood to brain

Shock to senses, strong emotional response, or psychotic crisis

Respiratory Insufficiency

Inability to oxygenate the blood at level required

1. Disease (Asthma, COPD) 2. Trauma (pneumothorax, flail chest)3. obstruction

Progression of Shock: Compensated Shock

When the body’s systems work to maintain perfusion by going into “overdrive”

Progression of Shock: What do you see

Compensated Shock – Brain = anxiety, restlessness, ALOC Heart = weak rapid pulse, OK to BP

Respiration = rapid, shallow TV, noise Skin Sx = pale, cool, clammy Cap Refill = > 2 secs

Other: nausea or vomiting; decrease in body temp

Body’s efforts to maintain perfusion fail.

Children can compensate longer than adults, but crash quickly

Falling BP is the key sign.

Progression of Shock: Decompensated Shock

Progression of Shock: What do you see

Decompensated ShockBrain = ALOC -> unconsciousnessHeart = thready or irr or absent, BP Respiration = laboredSkin Sx = ashen, cyanotic, diaphoreticCap Refill = > 2 secs

Other: nausea or vomiting; decrease in body temp; dull eyes; dilated pupils

What can you do? ---

• BSI, ABCs - Open airway, Control Bleeding

- Provide high flow O2; assist respirations

• Place patient supine with legs elevated 6” to 12” above heart; If spinal injury elevate backboard

• May use other position of comfort for heart patient, breathing distress, etc

• Keep patient warm (easy hypothermia)

What can you do? ---

• Record vitals every 5 minutes

• Splint bone or joint injuries

• Give nothing by mouth; have suction ready

• Emergency evacuation

Anticipate Shock!!

Plan Ahead

Always anticipate shock when a suitable mechanism of injury or illness exists

Early anticipation and care can prevent or delay decompensated shock

TransportHead up or down?

• Normally, for shock, head down (want feet elevated)

• BUT, what if head injury and signs of shock? Judgment call – head (brain swelling) would be priority

Anaphylactic Shock – What can you do? --- The only truly effective treatment

is EPINEPHRINE (opens airway) followed by ANTIHISTAMINE (reduces bronchial swelling)

Many people with known serious allergic reactions carry epipens