Ch. 12 - Shock (Knowledge Objectives)

Knowledge Objectives 1) Pathophysiology of Hypoperfusion Circulation of blood is inadequate to provide cells and tissues needs for oxygen, nutrients, and waste removal With poor perfusion, cells begin to die, and body systems begin to lose their function Oxygen is carried to tissues attached to hemoglobin Carbon Dioxide is transported in the blood from tissues back to the lungs in three ways: Dissolved into the Plasma Combined with Water in the form of Bicarbonate Attached to Hemoglobin Platelets assist in forming blood clots; Blood Clots can form depending on: Retention of Blood due to Blockage in Circulation (blood stasis) Changes in the Vessel Wall (Such as Wound) Blood’s Ability to Clot (Result of a Disease or Medication) “Perfusion Triangle” A Pump (Heart) Damage to the heart by disease or injury decreases ability for heart to function as a pump; cannot move blood through the body (perfusion) A Set of Pipes (Blood Vessels/Arteries serving as a Container) If all vessels dilate rapidly, blood volume is not enough to fill the system and provide adequate perfusion to the body Contents of the Container (Blood) If there is enough blood or plasma loss, volume of fluid is not enough to support perfusion needs Autonomic Nervous System – Regulates Involuntary Functions (Sweating and Digestion) Circulatory Sphincters Constrict and Dilate to Regulate Blood Flow Inadequate Oxygen Exchange; Adequate Ventilation and Oxygenation Primary Concern Oxygen Exchange in the Lungs, Nutrients in the form of Glucose in the Blood, Adequate Waste Removal primarily through the Lungs 2) Identify Causes of Shock Pump Failure Heart is damaged by disease, injury, or obstruction, preventing proper function Heart may not generate enough energy to move blood through the system Causes: Heart Attack Trauma to the Heart Obstructive causes (Large Pulmonary Embolus) Poor Vessel Function Blood vessels dilate excessively, even with normal volume, inadequate to fill system and provide efficient perfusion Causes: Infection Narcotic Overdose Spinal Cord Injury Anaphylaxis Low Fluid Volume Low Fluid Volume, bleeding or illness, leading to inadequate perfusion Causes: Trauma to Vessels or Tissues (Excessive Bleeding) Fluid Loss from GI Tract (Vomiting/Diarrhea) 3) Types of Shock Cardiogenic Inadequate function of the Heart (Pump Failure) Edema is the presence of large amounts of fluid between cells in tissues causing swelling of the affected area Pulmonary Edema leads to impaired respiration; Increased Respiratory Rate, Abnormal Lung Sounds Cardiac Output (Volume of blood the heart pumps per minute) not maintained Obstructive Mechanical obstruction preventing adequate blood volume to heart chambers Tension Pneumothorax Caused by damage to lung tissue; air escapes into chest cavity Accumulation applies pressure to structures in Mediastinum Pressure pushing mediastinum to other side; Vena Cava becomes compressed, reduced blood return to right side of heart Cardiac Tamponade (Pericardial Tamponade) Collection of fluid between Pericardial Sac and Myocardium (Pericardial Effusion) Large Effusions prevent ventricles from filling with blood Can be seen in patients with cancer or autoimmune diseases Pulmonary Embolism Blood clot that forms in the Pulmonary Circulation and blocks the flow of blood through the pulmonary vessels Prevents blood from being pumped from right side of heart to left side, backup of blood in Right Ventricle resulting in Pump Failure Distributive Septic Severe Infections, usually bacterial; Toxins damage vessel walls Insufficient Volume of fluid in the container when plasma leaks (hypovolemia) Leaked fluid collects in respiratory system, interfering with respiration Vasodilation cannot sustain volume of intravascular fluid Neurogenic Damage to spinal cord, usually cervical; Brain conditions, tumors, pressure on spinal cord, spina bifida Muscles in blood vessel walls are cut off from Sympathetic nervous system and Nerve Impulses cause them to Contract Anaphylactic Severe Allergic Reaction; develops in minutes or seconds after exposure Second phase reaction can occur 1-8 hours after initial reaction Widespread vasodilation, increased permeability and Bronchoconstriction; Cyanosis is late sign of anaphylactic shock Psychogenic Temporary, generalized vascular dilation resulting in fainting or syncope Life-threatening syncope causes: Irregular Heartbeat or Brain Aneurysm Hypovolemic Inadequate amount of fluid or volume in circulatory system Hemorrhagic Injuries involving bleeding Non-hemorrhagic Vomiting and Diarrhea can cause massive fluid loss Severe Burns – intravascular plasma loss from leaking into burned tissues Dehydration – loss of water or fluid from body tissues 4) Signs and Symptoms of Compensated and Decompensated Shock Compensated Agitation, Anxiety, Restlessness, Feeling of Impending Doom Weak, Rapid (thready), or Absent pulse Clammy (pale, cool, moist) skin Pallor with Cyanosis of the lips Shallow, Rapid breathing Nausea/Vomiting, Shortness of Breath Cap Refill Longer than 2 seconds Narrowing Pulse Pressure Decompensated Falling Blood Pressure (<90 systolic) Altered Mental Status Labored or Irregular breathing Ashen, Mottled, Cyanotic skin Thready or Absent Peripheral pulses Dull Eyes, Dilated Pupils Poor Urinary Output Mechanisms Leading to Shock: Multiple Severe Fractures Abdominal or Chest Injuries Spinal Injury Severe Infection Major Heart Attack Anaphylaxis 5) Key components of patient assessment for shock Rapid Exam to determine Level of Consciousness (LOC) Identify and manage Life Threats as they are Found Massive Hemorrhage may require Tourniquet High Flow Oxygen to assist with Perfusion Do Not Delay seriously injured transport with treatment on scene (splinting) If Adult patient has Radial pulse (Systolic >90); Femoral pulse (Systolic >80); Carotid pulse (Systolic >70); We check carotid because it is the Last to Go If simple MOI, focus assessment on area affected, treat life threats first Unstable conditions reassess vitals every 5 minutes, stable patients 10-15 minutes 6) Steps to follow in emergency care of patient in various types of shock Immediately treat shock as soon as you realize the condition may exist Dry, sterile dressings over bleeding sites and secure with bandages Comfort, Calm, and Reassure patient while maintaining in Supine position If Spinal Immobilization is indicated, splint patient on backboard Provide Oxygen and Assist with Ventilations Place Blankets over patient to Prevent Loss of Body Heat 23495042672000Transport Immediately 29210051752500027940000082061904035550 469900000