2 You Are the Emergency Medical Responder Lesson 29: ShockYou Are the Emergency Medical ResponderYour ambulance unit is the first to arrive on an isolated road where an 18-year-old male driver lost control of a motor vehicle and collided with a tree. In the crash, the driver’s legs were broken, and he is pinned in the wreckage. You find the driver conscious, restless and in obvious pain. After a couple of minutes, the patient’s condition has changed. He begins to look ill. You notice he responds only to loud verbal stimuli, is breathing fast and looks pale. His skin is cold and moist and his pulse is rapid and weak.
3 Shock HypoperfusionInadequate supply of oxygenated blood to the vital organsBlood flow reduced to less important tissues so more blood flows to vital organsThree conditions necessary to maintain adequate blood flow:Functioning heartIntact blood vessels with ability to constrict or dilateAdequate amount of circulating blood
4 Why Shock Occurs Severe bleeding or loss of fluid from the body Failure of the heart to pump oxygenated bloodAbnormal dilation of the vesselsImpaired blood flow to the organs and cellsThis mechanism can protect the body over the short term, but if not treated, can lead to deathCompensatedDecompensatedIrreversible
5 Four Major Types of Shock Hypovolemic – lack of blood or fluidHemorrhagic is the most common typeObstructive – some type of obstructionDistributive – inadequate distribution of bloodNeurogenic/vasogenicAnaphylacticSepticCardiogenic – hearts inability to supply adequate blood supply
6 Other Types of Shock Hypoglycemic – low blood glucose levels Metabolic – loss of fluidDiarrhea / vomitingPsychogenic – blood pools away from brainSyncopeRespiratory – failure of the lungs to transfer sufficient oxygen to the blood
7 Learning Log Neurogenic/Vasogenic-Maize & Eli Anaphylactic-Jessami & MauraSeptic-Nathan
8 Shock: Early Signs and Symptoms Shock is progressive, responding to the early signs and symptoms promptly will increase a patient’s chance of survivalChildren compensate very well until its too lateApprehension and anxietySlightly lower body temperatureRapid breathingSlight increase in pulse rateNormal or slightly decreased blood pressurePale, ashen and cool skin
9 Shock: Later Signs and Symptoms ListlessnessConfusionDifficulty speakingIrregular breathingDecreased blood pressure (diastolic blood pressure may reach zero)Rapid yet weak or irregular pulsePale, cold and clammy skinLow body temperatureDilated pupils that are slow to respond to light
10 ActivityYou are providing care to a patient who has fallen off of a 6-foot ladder into a pile of construction debris. He has numerous lacerations on his body with two large open wounds on his thighs that are bleeding profusely. The patient is pale but alert and anxious. His respiratory rate is 28 breaths per minute and his pulse rate is 104 beats per minute. His blood pressure is within his usual range.
11 Shock: Care Preventing is just as important as caring Respond quickly and identify signs/symptomsEnsure an open airwayPerform a primary assessmentProvide emergency oxygen and ventilatory supportControl bleedingLeave patient flat in a face-up position
12 Shock: Care (cont’d)Immobilize any suspected broken bones or dislocated or damaged jointsMaintain normal body temperature - blanketsReassure the patientDo not give any food or drinkTreatment for specific injuries or conditionsTransport as soon as possible
13 You Are the Emergency Medical Responder After extrication teams arrive, they finally free the driver from the vehicle and he is removed from the car. You notice that the patient looks worse. He now responds only to painful physical stimuli. His breathing has become very irregular. You know that the hospital is 20 minutes away.