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Recognition and Care of Shock

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Presentation on theme: "Recognition and Care of Shock"— Presentation transcript:

1 Recognition and Care of Shock
18 Recognition and Care of Shock

2 Define the following terms:
Objectives Define the following terms: Anaphylactic shock Cardiogenic shock Compensated shock Decompensated shock Hemorrhagic shock Hypoperfusion Hypotension Hypovolemic shock Neurogenic shock Perfusion Psychogenic shock (continued)

3 Define the following terms:
Objectives Define the following terms: Respiratory/metabolic shock Septic shock Shock Explain the pathophysiology of shock. Describe the four categories of shock. List the seven main types of shock and their causes. Describe the signs and symptoms of shock. (continued)

4 Objectives Explain the proper care of a patient presenting with signs and symptoms of shock. Demonstrate the proper techniques for caring for a patient at risk for shock. Value the importance of proper body substance isolation (BSI) precautions when caring for a patient with suspected shock.

5 Media Slide 9 Shock Animation

6 Topics Perfusion and Shock Mechanism of Injury and Shock

7 PERFUSION AND SHOCK

8 Perfusion and Shock Perfusion Shock (hypoperfusion)
Adequate supply of well-oxygenated blood and nutrients to all vital organs Shock (hypoperfusion) Failure of body's circulatory system to provide enough oxygenated blood and nutrients to all vital organs Teaching Tip: Remind students about the meaning of “hypo” and how this relates to the circulatory system not being able to meet the requirements of perfusion.

9 Click here to view an animation on the topic of shock.
BACK TO DIRECTORY

10 Perfusion and Shock Normal Perfusion
Oxygen and carbon dioxide exchanged Nutrients and waste products exchanged Fluid and salt balance maintained between blood and tissues Discussion Question: How might a patient look if they have normal perfusion?

11 Perfusion and Shock Shock develops or occurs in step-by-step progression; can be rapid or come about slowly. Shock can be life-threatening. Care for patients with shock should not be delayed. Critical Thinking: Why is it important to rapidly treat signs and symptoms of shock?

12 If left untreated, blood loss will lead to death.
Talking Point: Blood loss is just one aspect of shock. If left untreated, blood loss will lead to death.

13 Perfusion and Shock The Four Categories of Shock Cardiogenic
Distributive Hypovolemic Obstructive Discussion Question: How are the four main categories of shock the same? How are they different?

14 Perfusion and Shock Cardiogenic shock
Heart is not pumping blood properly or efficiently. Critical Thinking: Which medical conditions could cause a type of shock that would fall under each of these categories?

15 Critical Thinking: How does the early recognition and treatment of heart attack relate to cardiogenic shock? Cardiogenic shock is a pump problem. The heart is not pumping the blood properly or efficiently.

16 Discussion Topic: Discuss how the heart is a muscle and how damage from a heart attack will impact its ability to pump blood. Heart attack as a cause of cardiogenic shock: Damaged heart muscle results in reduced force of contractions and reduced cardiac output.

17 Perfusion and Shock Distributive shock
Vascular tone problem; blood is not allocated properly. Critical Thinking: Which medical conditions could cause a type of shock that would fall under each of these categories?

18 Discussion Topic: Compare and contrast the performance of a normal vessel with that of an over-dilated vessel. Distributive shock is a vascular tone problem. The blood is not allocated properly.

19 Uncontrolled dilation of the blood vessels.
Critical thinking: What real-world examples can you think of as a metaphor for distributive shock? Uncontrolled dilation of the blood vessels.

20 Perfusion and Shock Hypovolemic shock
Related to extreme blood loss or too little volume. Critical Thinking: Which medical conditions could cause a type of shock that would fall under each of these categories?

21 Teaching Tip: To help students remember the meaning of hypovolemic shock; remind them again that “hypo” means too low and “volemic” refers to volume (the amount of blood in the system). Hypovolemic shock is related to extreme blood loss or too little volume.

22 Perfusion and Shock Obstructive shock
Develops when an obstruction of a vessel causes less blood to be pumped by the heart. Critical Thinking: Which medical conditions could cause a type of shock that would fall under each of these categories?

23 Obstructive shock can develop when an obstruction of a vessel causes less blood to be pumped by the heart.

24 Teaching Tip: Compare and contrast hemorrhagic and nonhemorrhagic hypovolemia; discuss causes.
(A) Hemorrhagic hypovolemia: loss of whole blood; (B) nonhemorrhagic hypovolemia: loss of plasma.

25 Discussion Topic: Obstructive shock can develop when an obstruction of a vessel causes less blood to be pumped by the heart. Review the causes of obstructive shock in detail: trauma, pulmonary embolism; tension pneumothorax; pericardial tamponade. Causes of obstructive shock: (A) pulmonary embolism; (B) tension pneumothorax; (C) pericardial tamponade.

26 Perfusion and Shock Types of Shock Cardiogenic (also a category)
Neurogenic Anaphylactic Psychogenic Septic Hemorrhagic Respiratory/metabolic Discussion Question: What are the similarities and differences between the various types of shock?

27 Perfusion and Shock Cardiogenic Category
Cardiogenic shock (type): results when heart is unable to pump enough blood at consistent pressure to all vital organs. Critical Thinking: Are there other ways in which the cardiovascular system might fail?

28 Perfusion and Shock Distributive Category
Neurogenic shock: caused when spinal cord is damaged and unable to control tone of blood vessels by way of sympathetic nervous system. Anaphylactic shock: caused when body experiences severe allergic reaction. Critical Thinking: Why is it important to readily recognize the signs of neurogenic shock in victims of trauma? Critical Thinking: What signs and symptoms might the EMR see in a patient suffering a severe allergic reaction that would indicate anaphylactic shock? (continued)

29 Perfusion and Shock Distributive Category
Psychogenic shock: results in a sudden, temporary dilation of blood vessels. Septic shock: caused by widespread infection of the blood. Critical Thinking: In what cases might someone experience psychogenic shock? Why should it be taken seriously? Critical Thinking: What signs and symptoms might the EMR see in a patient suffering from septic shock?

30 Perfusion and Shock Hypovolemic Category
Hemorrhagic shock: occurs when body loses significant amount of whole blood from circulatory the system. Critical Thinking: What are some causes (both traumatic and medical) that could lead to hemorrhagic shock?

31 Perfusion and Shock Respiratory/Metabolic
Disruption of oxygen transfer into the cells or the cells are not able to utilize the available oxygen. Caused by cyanide, carbon monoxide, or iron poisoning. Talking Point: Respiratory/Metabolic shock does not fall into a specific category of shock, but relates most closely to the definition of shock as being in a state of “cellular dysoxia” (not enough oxygen at the cellular level).

32 Perfusion and Shock The Body's Response During Shock Compensated stage
Decompensated stage Discussion Topic: The main focus for the EMR is to prevent the patient from entering the decompensated stage of shock.

33 Perfusion and Shock Compensated Shock
Condition in which body is using specific mechanisms (increased pulse rate; increased breathing rate) to compensate for lack of adequate perfusion. Critical Thinking: Why does the body respond with increased pulse and breathing rates? Why is it important for the EMR to recognize these changes?

34 The patient will experience anxiety and mental status changes
The patient will experience anxiety and mental status changes. The brain begins to feel the effect of decreased oxygen.

35 The patient will have cool, pale, sweaty skin and an increased pulse and respirations. Blood is shunted from the skin the vital areas. Pulse and respirations increase to compensate for shock.

36 In addition to sweating, the patient also may experience nausea and vomiting as blood is shunted from the abdomen to more vital areas.

37 Late signs of shock include a drop in blood pressure.

38 Perfusion and Shock Decompensated Shock
Condition in which body is no longer able to compensate for lack of adequate perfusion. Critical Thinking: Why are the signs of decompensated shock ominous?

39 Perfusion and Shock Early Signs and Symptoms of Shock Restlessness
Altered mental status Increased heart rate Normal to slight low blood pressure Mildly increased breathing rate Skin that is pale, cool, and moist Sluggish pupils Nausea and vomiting Critical Thinking: How might you manage a patient in shock with altered mental status who insists on refusing care?

40 Perfusion and Shock Later Signs and Symptoms of Shock Unresponsiveness
Decreasing heart rate Very low blood pressure Slow and shallow respirations Skin that is pale, cool, and moist Dilated, sluggish pupils Respiratory and cardiac arrest can develop Critical Thinking: What happens if the cause of shock is not treated and the patient continues to decline in the decompensated stage?

41 Perfusion and Shock Signs and symptoms of shock worsen with time. Look for these patterns: Increased pulse rate Increased breathing rate Restlessness or combativeness Pale, cool, moist skin Changes in mental status Critical Thinking: Why does oxygen help patients who are experiencing shock?

42 Think About It You respond to an apartment and find a pale 66-year-old male lying on a sofa. He is weak and dizzy. He states that he has vomited twice and shows you a bucket with a large amount of blood. His pulse is 142, and his blood pressure is 80/50. What do you suspect? How will you proceed?

43 MECHANISM OF INJURY AND SHOCK

44 Mechanism of Injury and Shock
Do not wait for signs and symptoms to develop before caring for shock. In cases of trauma or injury, examine and consider mechanism of injury. If patient suffered blunt trauma to head, chest, abdomen, or pelvis, suspect internal bleeding and provide care accordingly. Discussion Question: Early recognition of shock signs and symptoms is essential. Why is ongoing monitoring essential?

45 Mechanism of Injury and Shock
Caring for Shock Perform primary assessment; ensure ABCs are properly supported. Control external bleeding. Administer oxygen per local protocol. Keep patient in supine position. Calm and reassure patient; maintain normal body temperature. Critical Thinking: Why should you keep the patient in the supine position? (continued)

46 Mechanism of Injury and Shock
Caring for Shock Monitor and support the ABCs. Do not give patient anything by mouth. Monitor patient's vital signs. Class Activity: Divide the class into small groups. Provide each with an index card upon which a significant trauma is written. Direct students to work together to describe the care they would give in the order they would provide it. Have each group present their injury and treatment to the rest of the class.

47 Algorithm for emergency care of patients with developing shock.

48 Mechanism of Injury and Shock
Fainting (Syncope): self-correcting form of mild shock Examine patient for injury if patient fell. Keep patient lying down and at rest for several minutes. Always recommend that patient see physician. Fainting may be pyschogenic, or due to more serious conditions such as brain tumor, heart disease or diabetes. Discussion Topic: All episodes of syncope should be evaluated by a physician to ensure the episode was not caused by a serious condition.

49 Think About It You respond to a motorcycle collision. You find a 19-year-old male 50 feet from his sport race bike which is significantly mangled. You find your patient conscious and wearing a helmet, but in only shorts and tank top. He is bleeding profusely. What are your concerns? How do you proceed?

50 SUMMARY

51 Summary Perfusion Shock (hypoperfusion)
Adequate supply of well-oxygenated blood and removal of waste products from body's tissues, especially vital organs. Shock (hypoperfusion) Failure of body's circulatory system to provide enough oxygenated blood and nutrients to all vital organs.

52 Summary Signs and Symptoms of Shock Increased pulse
Increased breathing rate Restlessness or combativeness Pale, cool and moist skin Thirst Weakness Nausea and vomiting Loss of responsiveness

53 Summary Types of Shock Cardiogenic Hypovolemic Distributive Obstructive Begin caring for shock if MOI suggests internal injury or bleeding.

54 Summary Do not wait for signs and symptoms to appear before caring for shock. Care for Shock Support the ABCs; keep patient lying flat Control all external bleeding Administer oxygen if allowed Maintain normal body temperature Expedite transport

55 REVIEW QUESTIONS

56 How would you explain the pathophysiology of shock?
Review Questions How would you explain the pathophysiology of shock? How would you describe the four categories of shock? What are the seven main types of shock and their causes? What are the signs and symptoms of shock? How would you proceed to care of a patient presenting with signs and symptoms of shock?

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