Shock
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Shock. Definition - widespread inadequate tissue perfusion Caused by state of collapse and failure of the cardiovascular system. Compensatory Mechanisms. tachycardia vasoconstriction increased respiratory rate & depth decreased urine production. Shock. 4 major categories of shock

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Shock

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Shock

Shock

  • Definition - widespread inadequate tissue perfusion

  • Caused by state of collapse and failure of the cardiovascular system


Compensatory mechanisms

Compensatory Mechanisms

  • tachycardia

  • vasoconstriction

  • increased respiratory rate & depth

  • decreased urine production


Shock1

Shock

  • 4 major categories of shock

    • hypovolemic

    • cardiogenic

    • obstructive

    • distributive


Hypovolemic shock

hypovolemic shock

inadequate blood / fluid volume

  • trauma

  • hemorrhage

  • burns

  • dehydration


Cardiogenic shock

Cardiogenic shock

  • Pump failure - Heart lacks power to force blood through the circulatory system

    • Basically, CHF that is out of control

  • Onset may be immediate or not apparent for 24 hours after AMI

  • Can also be caused by Dysrhythmias


Obstructive shock

Obstructive shock

Physical obstruction of blood flow

  • tension pnuemothorax

  • cardiac tamponade

  • pulmonary embolus

  • dissecting aortic aneurysm


Distributive shock

Distributive shock

widespread reduction of blood vessel tone (vasodilation)

  • neurogenic (spinal cord trauma)

  • Sepsis – see dehdration

  • anaphylaxis

  • drugs/ overdose

  • psychogenic


Shock early signs compensated

Shock Early Signs (compensated)

  • Pale, cool, moist skin**

  • Tachycardia

  • delayed capillary refill

  • Tachypnea

  • Agitation/anxiety/restlessness

  • ALOC**

  • Nausea/Vomiting

  • Marked thirst


Shock late signs decompensated

Shock Late signs (decompensated)

  • Early signs PLUS

  • Hypotension

  • Labored irregular breathing

  • Ashen, mottled, cyanotic skin

  • Thready or absent peripheral pulses

  • Dilated pupils

  • Poor urinary output


When to expect shock

When to Expect Shock

  • Multiple severe fractures

  • Abdominal or chest injuries

  • Spinal injuries

  • Severe infection

  • Major heart attack

  • Anaphylaxis


Treatment for shock

treatment for shock

Treatment does not vary with type of shock


Tx for shock

TX for shock

  • Maintain airway

  • Control external bleeding

  • Shock position

  • High flow oxygen

  • Rapid transport

  • Keep warm

  • Do not give the patient anything by mouth


Als considerations

ALS Considerations

  • IV Fluid “challenges”(hypovolemic)

  • Medications (cardiogenic / distributive)

  • MAST- Medical Anti Shock Trousers

    (not used in California)


Dehydration

Dehydration

History of:

  • nausea

  • vomiting

  • exertion

  • diarrhea


Dehydration1

Dehydration

Signs

dry mucus membranes

sunken eyes

decreased urination

poor skin turgor

  • note: fontenelles for pediatrics


What is blood pressure

what is Blood pressure?

BP = CO x PVR


Cardiac output co

Cardiac Output (CO)

  • the amount of blood pumped by the left ventricle over 1 minute

  • CO = Stroke volume x BPM (beats per minute)


Stroke volume

Stroke Volume

  • the amount of blood pumped by the left ventricle in one contraction


Peripheral vascular resistance

Peripheral Vascular Resistance

  • the force against which the heart has to beat.

  • partially determined by the size of the blood vessels

  • AKA PVR


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