Transcript Shock

Chapter 10
Shock
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Heart
◦ Four chambers
 Blood
vessels
◦ Arteries – away from the
heart
◦ Veins – toward the heart
 Blood
BRADY
How the Heart Pumps Blood
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
What is Shock?


Failure of the circulatory system to
maintain adequate blood flow to tissues
Leads to inadequate tissue perfusion in
which cells do not receive sufficient O2
& nutrients
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Stages of Shock
 Compensated
shock
 Decompensated shock
 Irreversible shock
 Important
terms:
◦ Tachypnea & tachycardia
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Shock
 Hypovolemic
◦ Results from a critical decrease in
circulating blood volume
 Caused
by a loss of circulating blood
or internal body water
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Shock
 Cardiogenic
◦ Heart cannot adequately pump blood
 The
defect occurs within the heart
itself
 Examples?
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Shock
 Distributive
◦ Blood vessels lose their ability to
constrict appropriately
3
subtypes: septic, anaphylactic,
neurogenic
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Shock
 Septic
◦ Caused by an infection known as sepsis

Anaphylactic
◦ Severe allergic reaction
 Neurogenic
◦ Caused by disruptions of the CNS
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Shock
 Obstructive
shock
◦ Tension pneumothorax
◦ Pericardial tamponade
◦ Pulmonary embolism
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Factors Affecting Shock
 Age
 Concurrent
illness or injury
 Pre-existing medical condition
 Mind-altering substances or
medications
 Prescription or over-the-counter
(OTC) medications
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Patient Assessment
 MOI
◦ Scene size up
◦ Clues; suggestion possible shock
 Classic
◦
◦
◦
◦
◦
BRADY
signs
Tachycardia
Hypotension
Tachypnea
Pale, cool, diaphoretic skin
Altered mental status
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Patient Management
 High
flow oxygen
 Return to homeostasis
 Place in shock position
 Transport in head down position
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 10-1
Shock Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River,
NJ
OEC Skill 10-1 Shock Management (a) Assess scene safety and initiate
Standard Precautions. Copyright Scott Smith
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 10-1 Shock Management (b) Perform a primary assessment.
Assess ABCDs and correct any problems found. Copyright Scott Smith
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 10-1 Shock Management (c) Call for help and arrange for transport
that includes ALS. Copyright Scott Smith
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 10-1 Shock Management (d) Monitor the airway and administer
high-flow oxygen. Copyright Scott Smith
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 10-1 Shock Management (e) To prevent heat loss, keep the patient
warm and dry. Copyright Scott Smith
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 10-1 Shock Management (f) Place the patient with the head lower
than the feet while maintaining spinal integrity. Copyright Scott Smith
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 10-1 Shock Management (g) Provide for rapid transport.
Copyright Selko
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Early recognition!!
 Early
recognition of the potential for
shock is essential in reducing the
number of deaths from this condition.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th
©2012 by Pearson Education, Inc., Upper Saddle River, NJ