Illinois EMSC1 Upon completion of this lecture, you will be better able to: n Define shock n Describe key differences between the pediatric and adult circulatory system and how they affect assessment and treatment of shock in children n Explain how to assess for pediatric shock n List appropriate interventions for pediatric shock SHOCK OBJECTIVES

Illinois EMSC2 SHOCK

Illinois EMSC3 SHOCK Insufficient delivery of oxygen and nutrients to the cells due to decreased perfusion or blood flow

Illinois EMSC4 CAUSES OF SHOCK n Hemorrhage n Dehydration n Burns n Heat stroke n Hypoglycemia n Anaphylaxis

Illinois EMSC5 CAUSES OF SHOCK n Drug ingestion or overdose n Sepsis n Congenital heart defects n Traumatic head or spinal injury

Illinois EMSC6 CARDIAC OUTPUT Cardiac Output = Heart Rate x Stroke Volume

Illinois EMSC7 EARLY SHOCK COMPENSATION n SYMPATHETIC NERVOUS SYSTEM – Increased heart rate (one of the first responses to shock) n VASOCONSTRICTION – Maintains perfusion to vital organs n INCREASED RESPIRATORY RATE – Increased oxygen to vital tissues

Illinois EMSC8 LATE SHOCK DECOMPENSATION n Decreased blood pressure (often falls rapidly) n Decreased respiratory rate n Significant alteration in level of consciousness: Stuporous/Coma

Illinois EMSC9 Shock Assessment in Compensated and Decompensated Hypovolemic Shock Compensated Decompensated Pulse Tachycardia Marked tachycardia; can progress to bradycardia Skin White, cool, moist White, “waxy”, cold, marked diaphoresis Blood Pressure Normal range Lowered Level of Consciousness Unaltered Altered, ranging from disoriented to coma Source: Prehospital Trauma Life Support Manual, 3 rd Edition. National Assn of EMT’s, 1994

Illinois EMSC10 BLOOD PRESSURE BY ITSELF IS NOT A GOOD INDICATOR OF THE PRESENCE OF SHOCK!!!!

Illinois EMSC11 DIFFERENCES IN THE PEDIATRIC CIRCULATORY SYSTEM n Healthier circulatory system n Less muscle mass than adults n Higher metabolic rate, increased oxygen demand n Greater circulating blood volume per weight n Greater ability to compensate

Illinois EMSC12 TYPES OF SHOCK n HYPOVOLEMIC – Decrease in circulating blood volume n DISTRIBUTIVE – Massive vasodilatation, causing decreased blood flow to heart n CARDIOGENIC – Inadequate heart muscle function or obstruction of flow

Illinois EMSC13 ASSESSMENT OF THE CHILD IN SHOCK n Across-the-room assessment n Skin – Perfusion – Color – Moisture – Temperature

Illinois EMSC14 CAPILLARY REFILL TIME n Normal equals < 2 seconds n Assess on distal extremity and keep limb level with heart

Illinois EMSC15 VITAL SIGNS n Assess TPR and BP n *Increase in heart rate is the earliest sign of shock n Assess quality of pulses n Blood pressure may not fall until 20% of blood volume is lost!! n Level of consciousness

Illinois EMSC16 AVPU n ALERT n VERBAL n PAIN n UNRESPONSIVE

Illinois EMSC17 PLAN AND INTERVENTIONS n Goal is recognition of shock and restoring student’s perfusion to normal n ABC’s n Keep child warm n Call EMS and parent/guardian

Illinois EMSC18 TRIAGE AND TRANSPORT n Student suspected to be in shock is EMERGENT n Call EMS as soon as shock is suspected!!

Illinois EMSC19 SPECIAL NEEDS STUDENTS n History of previous illness n Congenital defects n Surgery

Illinois EMSC20 PREVENTION n Prevention of injuries n Knowledge of signs and symptoms of shock. Be aware that they may be subtle n Knowledge of local EMS system

Illinois EMSC21 Shock is a life-threatening condition, particularly in children. It is crucial to recognize shock early and initiate appropriate interventions. Students who are experiencing shock may initially look well because of their effective compensatory mechanisms, but their condition can deteriorate rapidly. SUMMARY

Illinois EMSC22 ANY QUESTIONS??