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Shock

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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  1. Shock • Definition - widespread inadequate tissue perfusion • Caused by state of collapse and failure of the cardiovascular system

  2. Compensatory Mechanisms • tachycardia • vasoconstriction • increased respiratory rate & depth • decreased urine production

  3. Shock • 4 major categories of shock • hypovolemic • cardiogenic • obstructive • distributive

  4. hypovolemic shock inadequate blood / fluid volume • trauma • hemorrhage • burns • dehydration

  5. 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

  6. Obstructive shock Physical obstruction of blood flow • tension pnuemothorax • cardiac tamponade • pulmonary embolus • dissecting aortic aneurysm

  7. Distributive shock widespread reduction of blood vessel tone (vasodilation) • neurogenic (spinal cord trauma) • Sepsis – see dehdration • anaphylaxis • drugs/ overdose • psychogenic

  8. Shock Early Signs (compensated) • Pale, cool, moist skin** • Tachycardia • delayed capillary refill • Tachypnea • Agitation/anxiety/restlessness • ALOC** • Nausea/Vomiting • Marked thirst

  9. 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

  10. When to Expect Shock • Multiple severe fractures • Abdominal or chest injuries • Spinal injuries • Severe infection • Major heart attack • Anaphylaxis

  11. treatment for shock Treatment does not vary with type of shock

  12. 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

  13. ALS Considerations • IV Fluid “challenges” (hypovolemic) • Medications (cardiogenic / distributive) • MAST- Medical Anti Shock Trousers (not used in California)

  14. Dehydration History of: • nausea • vomiting • exertion • diarrhea

  15. Dehydration Signs dry mucus membranes sunken eyes decreased urination poor skin turgor • note: fontenelles for pediatrics

  16. what is Blood pressure? BP = CO x PVR

  17. Cardiac Output (CO) • the amount of blood pumped by the left ventricle over 1 minute • CO = Stroke volume x BPM (beats per minute)

  18. Stroke Volume • the amount of blood pumped by the left ventricle in one contraction

  19. 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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