Shock: Cycle “A” Refresher

ShockNature’s prelude to death

2008 Cycle “A” OEC Refresher

Shock: Cycle “A” Refresher

I Can:I Can:

Goals and ObjectivesGoals and Objectives

Define shock.

List the early and late signs of shock.

Describe the treatment for shock.

Shock: Cycle “A” Refresher

What is Shock?What is Shock?

Inadequate perfusion…

…What does this mean?

Lack of oxygen, other nutrients to body cells

The body needs oxygen to survive!

Shock: Cycle “A” Refresher

Blood PressureBlood Pressure

What brings oxygen to body tissues??Blood

What supports the delivery of blood??Blood Pressure

Shock: Cycle “A” Refresher

ShockShock

What is really happening in shock??

There is not enough blood pressure to adequately get oxygen to body tissues.

Shock: Cycle “A” Refresher

Compensated ShockTachycardiaTachypneaA narrowing of the difference between

the systolic and diastolic blood pressure (a.k.a - pulse pressure)

ShockShock

How do I identify that a patient is in shock??

Shock: Cycle “A” Refresher

ShockShock

How do I identify that a patient is in shock??

Decompensated ShockA drop in the systolic blood

pressure

Shock: Cycle “A” Refresher

ShockShock

Once the patient is in decompensated shock body cells begin to die.

This is a bad thing!!!!

Identify shock early before the patient has decompensated.

Shock: Cycle “A” Refresher

Types of ShockTypes of Shock

Hypovolemic:Hypovolemic: not enough volume

(e.g., bleeding, dehydration, vomiting, diarrhea)

Cardiogenic:Cardiogenic: not enough strength to push the volume

some causes of respiratory shock are actually cardiogenic shock (ex. Flash pulmonary edema from congestive heart failure)

Shock: Cycle “A” Refresher

Types of ShockTypes of Shock

NeurogenicNeurogenic (a.k.a. - Distributive): loss of tone in the blood vessels

(e.g., sepsis, severe infection, anaphylaxis, spinal cord injury, psychogenic)

Other reasons for shock:Other reasons for shock:A mechanical obstruction that prevents movement of blood (a.k.a. – Obstructive)

some causes of respiratory shock are actually obstructive shock (ex. pulmonary embolism)

Shock: Cycle “A” Refresher

HemorrhageHemorrhage

A cause of hypovolemic shock

In trauma, hemorrhage most common cause of shock !!!!

Caution: It is not the only reason for shock in trauma, but is definitely the most common reason.

Shock: Cycle “A” Refresher

HemorrhageHemorrhage

ExternalInternal

ChestAbdomenPelvis

Where can a patient bleed to death?

Shock: Cycle “A” Refresher

Don’t Forget to Look for Bleeding!

Signs & Symptoms of shockSigns & Symptoms of shock

Shortness of breathDizzyPainNausea

TachycardiaTachypneaDiaphoresisPaleDrop in systolic blood pressure (late finding)

Signs Symptoms

Shock: Cycle “A” Refresher

OEC Management of ShockOEC Management of Shock

Hemorrhagic Shock

Direct pressure Elevation Pressure points Tourniquet

(as a last resort)

External Bleeding

Shock: Cycle “A” Refresher

OEC Management of ShockOEC Management of Shock

Hemorrhagic Shock

Determine if this it occurring

Safely and rapidly transport

Internal Bleeding (chest, abdomen, pelvis)

Shock: Cycle “A” Refresher

OEC Management of Shock: all typesOEC Management of Shock: all types

Diagnose shock early

Stop bleeding

Give oxygen

Keep patient warm(Hypothermia makes

shock worse)

Transport

Shock: Cycle “A” Refresher

Remember…Remember…

See a drop in BP? You are way behind the eight ball!

Diagnose shock earlyDirect pressure to stop bleedingGive oxygenKeep patient warmTransport to definitive care

Shock: Cycle “A” Refresher