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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
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
shock3
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
dehydration15
Dehydration

Signs

dry mucus membranes

sunken eyes

decreased urination

poor skin turgor

  • note: fontenelles for pediatrics
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