Chapter 10 Shock Shock Shock Causes of Shock The Perfusion Triangle (1 of 2) Causes of Shock The Perfusion Triangle (2 of 2)

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1 Chapter 10 Shock Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow, cannot get rid of metabolic wastes Results in hypoperfusion to cells that causes the organ, then organ systems, to fail Shock Shock can occur because of medical or events: Heart attack Severe reaction Automobile crash, GSW, other major Causes of Shock The Perfusion Triangle (1 of 2) Heart (Pump Function) Damage to the heart by or injury. It cannot move adequately to support perfusion. Blood Vessels (Container Function) If all the vessels at once, the normal amount of blood volume is not enough to fill the system and provide adequate perfusion to the body. Causes of Shock The Perfusion Triangle (2 of 2) Blood (Content Function) 1

2 If blood or is lost, the volume in the container is not enough to support the perfusion needs of the body The Perfusion Triangle Causes of Shock (1 of 3) Causes of Shock (2 of 3) Pump Failure Shock Obstructive Shock Poor Vessel Function (Distributive Shock) Shock Neurogenic Shock Anaphylactic Shock Shock Causes of Shock (3 of 3) Low Fluid Volume ( Shock) Shock Nonhemorrhagic Shock Pump Failure Causes of Shock Cardiogenic Shock failure Inadequate function of the heart or pump failure Causes a backup of blood into the lungs Results in edema Pulmonary edema leads to impaired Obstructive Shock Obstructive shock occurs when conditions that cause 2

3 obstruction of the cardiac muscle also affect the pump function Common examples include cardiac tamponade and pneumothorax. These conditions discussed later in course Distributive Causes of Shock Distributive Shock Results when there is widespread of the small arterioles, small venules, or both Blood volume and perfusion decreases Septic shock, neurogenic shock, anaphylactic shock, and psychogenic shock Septic Shock Results from Combined vessel and content failure Some patients with severe bacterial infections, toxins, or infected tissues contract septic shock. Toxins damage vessel walls, causing and impairing ability to contract. Leads to of vessels and loss of plasma, causing shock. Neurogenic Shock Poor function Damage to the spine may affect control of the size and muscular tone of blood vessels. The vascular system increases Blood in the body cannot fill the 3

4 system Perfusion and Neurogenic Shock Anaphylactic Shock (1 of 2) Severe Reaction Occurs when a person reacts violently to a substance to which he or she has been sensitized means becoming sensitive to a substance that did not initially cause a reaction. Anaphylactic Shock (2 of 2) Each subsequent exposure tends to produce a more reaction. Four categories of common causes: - -Stings -Ingestion - Psychogenic Shock Caused by sudden reaction of the nervous system that produces a, generalized vascular dilation Commonly referred to as fainting or Can be brought on by serious causes: irregular heartbeat, brain aneurysm Can be brought on by causes ranging from or bad news to unpleasant sights Low Fluid Volume Shock Hypovolemic Shock (1 of 2) 4

5 Content failure Results from fluid or blood loss Shock is loss of blood shock is loss of body fluids such as diarrhea and vomiting Blood is lost through external and internal bleeding. Severe thermal cause plasma loss Hypovolemic Shock (2 of 2) can cause or aggravate shock. Very young and are most susceptible to dehydration Dehydration can lead to hypovolemic shock and can lead to death Respiratory Insufficiency Respiratory Insufficiency AKA Shock Patient with a severe chest injury or airway may be unable to breathe adequate amounts of oxygen. Insufficient oxygen in the blood will produce shock. Multiple causes Progression of Shock shock When the body compensates for blood loss shock The late stage of shock when blood pressure is falling and the body cannot compensate shock 5

6 The terminal stage that results in death S/S of Compensated Shock Anxiety Restlessness Feeling of impending doom Altered mental status pulse skin Pallor Shallow, rapid breathing of breath Nausea or vomiting Delayed capillary Marked thirst S/S of Decompensated Shock Falling blood pressure (systolic < mmhg in adults) Labored, irregular breathing Ashen,, cyanotic skin Thready or absent pulse eyes, dilated pupils Poor output S/S of Irreversible Shock This is the stage of shock. A of any type will not be enough to save a patient s life. When to Expect Shock Multiple severe 6

7 Abdominal or chest injuries Spinal injuries Severe Major heart attack General Emergency Care (1 of 2) Make certain patient has open. Keep patient. Control external. Splint any broken bones or joint injuries. General Emergency Care (2 of 2) Always provide. Splint any broken bones or joint injuries Place under and over patient. If there are no broken bones, elevate the legs to. Do not give the patient anything by mouth. Treating Cardiogenic Shock Patient may breathe better in a sitting or -sitting position. Administer high-flow. Assist ventilations as necessary. Have nearby in case the patient vomits. Transport promptly. Treating Obstructive Shock Tension pneumothorax and cardiac tamponade both require procedures 7

8 Tension pneumothorax can be treated by a Cardiac Tamponade must be treated by a ABC s and rapid transport Treating Septic Shock Transport as promptly as possible while giving all support available. Definitive treatment requires complex hospital management including Give high-flow oxygen during transport. Use to conserve body heat. Treating Neurogenic Shock Maintain airway and breathing as needed. Keep patient warm. promptly. Neurogenic shock victims will have skin that is warm and Treating Anaphylactic Shock Administer if indicated Provide prompt transport Provide all possible support assistance Treating Psychogenic Shock It is usually self-. Assess patient for from fall. If patient has difficulties after regaining consciousness, suspect another. 8

9 Treating Hypovolemic Shock Control obvious. any bone or joint injuries. If no fractures, raise legs 6 to 12. Secure and maintain. Give oxygen as soon as you suspect shock. Transport rapidly. Treating Respiratory Shock Secure and support the airway. Clear airway of any. Ventilate if needed with a device. Administer. Transport promptly. Key Points to Remember Agitation, restlessness, and anxiety are normally the signs of shock A falling BP is a sign of shock Some types of shock has no loss Not all shock produces and rapid heart rate (ex: Neurogenic Shock) 9