Shock Remember Perfusion …. Shock is inadequate perfusion (aka Hypoperfusion) The organs and tissues of the body do not get enough oxygen and nutrients.

Shock It can occur with either traumatic injuries or serious medical conditions

What causes Shock? Shock is the result of a malfunction of at least 1 of 3 systems Pump (Heart) Tubing (Blood Vessels) Fluid (Blood) The cardiovascular system is made up of three key elements: a Pump (heart), Tubing (vessels) and Blood (vehicle for carrying O2/nutrients and ridding waste products). Blood moves as a result of a pressure gradient generated with each heart contraction and is affected by dilating and constricting blood vessels. Pressure is controlled by the body so there is always sufficient circulation or perfusion in the various tissues and organs. (colors have significance)

What are the types of shock? Remember MASHNCPR Metabolic Excessive loss of fluid & electrolytes with non-hemorrhagic cause 1. GI: vomiting/diarrhea/ urination, 2. burns 3. drugs 4. hyperglycemia 5. heat stroke Anaphylactic Systemic allergic reaction causing widespread vasodilation and generalized edema ; has an upper respiratory component 1. insect sting or bite 2. ingestion (eg legumes), 3. Rx (eg penicillin PCN) 4. inhalants (pollen, dust) Septic Systemic infection, usually bacterial, damages vessel walls resulting in leakage and vasodilation; 1. untreated wound, 2. surgery, 3. trauma (peritonitis); 4. disease (pericarditis), or 5. contagion (meningitis, pneumonia)

Hypovolemic Neurogenic Cardiogenic Loss of fluid volume (blood) with hemorrhagic cause (eg trauma); could be external or internal Bleeding due to 1. Blunt trauma to solid abdominal organ, 2. great vessel tear, 3. major bleed from laceration or fx Neurogenic Sudden loss of the control by CNS of nerves & muscles, causing vasodilation & muscle paralysis 1. brain => Increased Intercranial pressure due to trauma, tumor, bleeding 2. spinal cord => due to fx, vertebral bleeding, or tumor Cardiogenic Heart muscle can no longer generate enough pressure to circulate blood to all organs; leads to pulmonary edema 1. Myocardial Infarction 2. Disease (CHF, pericarditis), 3. Electrical, 4. Trauma (Pericardial tamponade) 5. Valve dysfunction, Psychogenic fainting resulting from temporary vascular dilation (loss of blood pressure) and lack of blood to brain Shock to senses, strong emotional response, or psychotic crisis Respiratory Insufficiency Inability to oxygenate the blood at level required 1. Disease (Asthma, COPD) 2. Trauma (pneumothorax, flail chest) 3. obstruction

Progression of Shock: Compensated Shock When the body’s systems work to maintain perfusion by going into “overdrive”

Progression of Shock: What do you see Compensated Shock – Brain = anxiety, restlessness, ALOC Heart = weak rapid pulse, OK to  BP Respiration = rapid, shallow TV, noise Skin Sx = pale, cool, clammy Cap Refill = > 2 secs Other: nausea or vomiting; decrease in body temp

Progression of Shock: Decompensated Shock Body’s efforts to maintain perfusion fail. Children can compensate longer than adults, but crash quickly Falling BP is the key sign.

Progression of Shock: What do you see Decompensated Shock Brain = ALOC -> unconsciousness Heart = thready or irr or absent, BP Respiration = labored Skin Sx = ashen, cyanotic, diaphoretic Cap Refill = > 2 secs Other: nausea or vomiting; decrease in body temp; dull eyes; dilated pupils

What can you do? --- BSI, ABCs - Open airway, Control Bleeding - Provide high flow O2; assist respirations Place patient supine with legs elevated 6” to 12” above heart; If spinal injury elevate backboard May use other position of comfort for heart patient, breathing distress, etc Keep patient warm (easy hypothermia)

What can you do? --- Emergency evacuation Record vitals every 5 minutes Splint bone or joint injuries Give nothing by mouth; have suction ready Emergency evacuation

Anticipate Shock!! Plan Ahead Always anticipate shock when a suitable mechanism of injury or illness exists Early anticipation and care can prevent or delay decompensated shock

Transport Head up or down? Normally, for shock, head down (want feet elevated) BUT, what if head injury and signs of shock? Judgment call – head (brain swelling) would be priority

Anaphylactic Shock – What can you do? --- The only truly effective treatment is EPINEPHRINE (opens airway) followed by ANTIHISTAMINE (reduces bronchial swelling) Many people with known serious allergic reactions carry epipens