Shock

Objectives

• Vocab• Define Shock• Types of Shock• Stages of Shock• Treatment

Vocab

– Tachycardia– Tachypnea– Oxygen saturation– Platelets– Resistance blood vessel– Sepsis– Shock– Anticoagulant– Cardiac output(These are the ones I feel are important. More in book)

Shock

• Hypoperfusion- inability of body to deliver sufficient oxygenated blood to body tissues

Shock in Context

• Life threatening • Not immediately obvious• Can be provoked by trauma AND medical

emergencies

Anatomy/Physiology of Shock

Anatomy/Physiology of Shock

• Structures- heart, vessels, lungs

• Fluids- Blood, plasma

Case Study

“You come to the scene on a mountain summit, where a 30 something woman is struggling to breathe and franticly motioning with her arms. She is panicked and unable to speak. She seems to have fallen from a ledge 8 ft above and her shirt above her left shoulder is soaked with blood. How do you proceed?”

Types of Shock

Means of hypoperfusion• Hypovolemic

• Cardiogenic

• Distributive

• Obstructive(Proctor biddie making herself a fruit salad)

Hypovolemic shock

• not enough blood is available to distribute oxygen to tissues

Where might the volume go?external bleedinginternal bleedingadsorption of water from plasma

(dehydration)

Hypovolemic Shock

• 4.7- 5.5 liters of blood in body• < 1 liter loss – compensated. Tachycardia,

tachypnea, AMS• 1-2 liter loss – decompensated. Further HR

rise, shallow respiration. Decreased responsiveness as organs fail.

• 2 + liter loss – irreversible. Death imminent.

Hypovolemia in Context

Body part blood content:• Femur or Pelvic fracture: 1.5+ L blood loss• Abdominal cavity capacity: up to 6 L• Spleens exist

Cardiogenic Shock

• Heart ceases to function. • More on this in Ch 15

Distributive shock

• Vessel abnormality leads to dangerously low blood pressure

Distributive Shock

• Septic- systemic inflammatory response to infection

• Anyphylactic- systemic vasodialation in response to allergen. Leads to respiratory arrest.

• Nuerogenic- injury to CNS leads to circulatory failure

Obstructive Shock

• (oxygenated) blood is prevented from reaching body tissues

Obstructive Shock

• Tension pnuemothorax- lung puncture leaks air into chest cavity, lung collapses and pressure is put upon heart

• Pericardial tamponade- fluid fills sac around heart and pressure causes right side of heart to collapse

• Pulmonary embolism- blood clot blocks pulmonary artery and blood flow to lungs

Stages of Shock

Compensated- body is compensating for decreased perfusion by increasing oxygen intake, increasing heart output, and pulling blood to vital organs.• Tachycardia• Tachypnea• Elevated vitals, normal blood pressure• Pale, cool skin, delayed cap refill• Altered mental status

Stages of Shock

Decompensated- compensatory measures can no longer deliver enough oxygen to organs.• cyanotic, cold skin• No cap refill• Failing respiration• HIGHER heart rate• VERY decreased responsivenessIf not treated immediately, patient will die

Stages of Shock

Irreversible shock- All compensating mechanisms have failed. Death is imminent.

Case study

“While mountain biking, you find a middle aged French Canadian at the side of the trail. His bike frame is broken in two and it is obvious he collide with a 12 inch diameter Balsam fir. He is holding his lower right arm across his chest and screaming, but compliant. Jacque is screaming so airway is fine, has sustained no spinal injury and his fresh white kit is not stained with blood, so you proceed to secondary assessment.The patient soon begins to be less responsive. Suspicions?”

Suspect shock with:

Audience participation!• Massive external, or suspected internal

bleeding• Multiple severe fractures• Abdominal or chest injury• Any major trauma• A severe infection• A major heart attack• Allergic reactions

Special Considerations:

• Infection• Allergies• Blood thinners or Beta-Blockers• Dehydration

Treatment

• ABCDs• Give high flow O2. Always.• Elevate legs for blood flow to heart• Keep warm• RAPID TRANSPORT