3. At the end of this lecture the student will 1-Define shock 2- List Causes of shock 3-Determine signs and symptoms of shock 4-List the mechanisms of shock 5-Identify stages of shock (compensatory progressive and irreversible) 6-State steps to stabilize the shocked victim until help arrives. 7- identify Principles of rescuing Shocked victim

4. What is shock? Shock is an inadequate blood flow to tissues and cells of the body It is caused by decreased in: *1-blood volume*2- cardiac output *3- tissue perfusion

5. Causes of shock Shock may result from *trauma*heatstroke *allergic reactions*severe infection *poisoning*electrical * other causes.

6. Classifications of shock Fluid loss Hypovolemic Pump failure cardiogenic Pipe failure neurogenic Infection septic shock

7. signs and symptoms appear in a person experiencing shock: signs and symptoms appear in a person experiencing shock: The skin is cool and clammy. It may appear pale or gray. The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal. The eyes lack luster and may seem to stare. Sometimes the pupils are dilated. The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious.

8. Recognition of Shock Initially, a flow of adrenaline causes: A rapid pulse. Pale, grey skin, especially inside the lips. If pressure is applied to a fingernail or earlobe, it will not regain its colour immediately. Sweating, and cold, clammy skin (sweat does not evaporate).

9. Recognition of Shock cont. As shock develops, there may be: Weakness and giddiness. Nausea, and sometimes vomiting. Thirst. Rapid, shallow breathing. A weak, ‘thready’ pulse. When the pulse at the wrist disappears, fluid loss may equal half the blood volume.

10. Recognition of Shock cont. As the oxygen supply to the brain weakens: The casualty may become restless, anxious and aggressive. The casualty may yawn and gasp for air (‘air hunger’). The casualty will eventually become unconscious. Finally, the heart will stop.

11. Mechanism of shock Inadequate blood to tissues& cells Inadequate oxygen and nutrition to cell Cellular starvation Cell death Organ dysfunction Organ failure & death

12. Stages of shock The stages of shock include CCompensatory: the client skin is cold and clammy, bowel sounds are hypoactive and decrease in urine output. It can happen when the fluid loss is less than 25% of body blood. (750 to 1300 ml of blood)

13. PProgressive: the client prognosis worsens. There is failure of cardiac pump. The mechanisms that regulate blood pressure can no longer compensate. Pulse is rapid more than 150 beat per minute and respiration is shallow and rapid

14. IIrreversible: in this type of shock, the organ damage is so sever that the patient does not respond to treatment and can not survive. MMultiple organ dysfunction progressing to complete organ failure has occurred and death is imminent

15. First Aid of shock before hospitalization As with all emergency treatment, make sure you remain safe. Follow universal precautions and wear personal protective equipment if you have it. You cannot be helpful to a victim if you allow yourself to be injured in the process.universal precautionspersonal protective equipment

17. First Aid of shock before hospitalization cont. Whenever a first aid is given to shock victim, three Words should come to mind ;position, heat, and fluids Position: supine with elevated lower extremities to an angle of 20 degree, knees are straight, trunk is horizontal and head is slightly elevated except in case of head injury.

18. First Aid of shock before hospitalization cont. If on elevation of feet the person complains of pain, lower the feet If the victim has neck or spinal injury, he should not be moved for any reason If the person has difficulty breathing, elevate the head and chest a unit If the victim is unconscious, place him on the side if there is no spine or neck injury In the event of vomiting, turn the victim’s head a side. If you don’t know, keep victim in flat on his back

19. First Aid of shock before hospitalization cont. Whenever possible, keep the victim in the supine position Assess and provide care as needed for breathing, circulation, and excessive bleeding Nothing per mouth Loosen clothing, avoiding unnecessary or rough handling Call 997 for medical assistance

20. Make sure the victim is breathing. If not, begin rescue breathing.rescue breathing Before any other treatments for shock are done, bleeding must be stopped.bleeding must be stopped

21. First Aid of shock before hospitalization cont. Heat Keep the victim warm (to avoid hypothermia ad death) How can you warm the victim? Remove the victim’s cloths if it is wet Place a blanket, coat or any other light covering over the person using hot water bottle or heated sand covered with protective materials to prevent burning the victim

22. Continue to check on the victim. If the victim stops breathing, begin rescue breathing. If the victim vomits, roll the victim to one side and sweep the vomit from his or her mouth with your fingers.

23. First Aid of shock before hospitalization cont. Fluids:  No fluid to the injured, unconscious, semiconscious, convulsion, vomiting, abdominal or head injuries  No harm of moistening victim’s mouth and lips if requested, moisten a piece of cloth, squeeze it to extract as much water as possible and then hold it to the mouth and lips  If the medical help is delayed, (at least one hour) give small amount of lukewarm water or juice at fifteen minutes intervals if the victim is concsious

24. First Aid of shock before hospitalization cont. Pain reduction: Pain may increase the severity of shock. To reduce pain, use bandage for open wounds, immobilize suspected and recognized fractures, avoid rough handling and excessive movements, loosing tight clothing and other activities according to the situation

25. Principles of rescuing Shocked victim STOP THE CAUSE OF SHOCK BEFORE STARTING YOUR FIRST AID DO NOT let the casualty move unnecessarily, eat, drink, or smoke. DO NOT leave the casualty unattended. Reassure the casualty constantly. Treat any cause of shock which can be remedied (such as external bleeding). Lay the casualty down, keeping the head low. Raise and support the casualty’s legs (be careful if suspecting a fracture). Loosen tight clothing, braces, straps or belts, in order to reduce constriction at the neck, chest and waist. Insulate the casualty from cold, both above and below. Contact the emergency service. Check and record breathing, pulse and level of response. Be prepared to resuscitate the casualty if necessary.