Shock

2 Introduction Shock is a state of extremely impaired circulation that reduces the flow of blood and oxygen to body cells. Shock is a life-threatening condition that occurs when the body is not getting enough blood flow as a result of sever hypotension. Shock requires IMMEDIATE medical treatment. If not properly managed the tissue damage becomes irreversible and finally leads to multi-organ failure. Types of Shock Hemorrhagic (hypovolemic) Shock Non-hemorrhagic Shock –Cardiogenic Shock –Neurogenic Shock –Anaphylactic Shock/Vasogenic Shock –Psychogenic Shock –Septic or toxic –Metabolic shock

3 Common causes of Shock Heart attack Severe or sudden blood loss Large drop in body fluids like in burns. Major infections Long exposure to extreme heat or cold

STAGES OF SHOCK Compensated Shock Body works to overcome developing hypotension and hypoperfusion. Uncompensated Shock Defense mechanisms are unable to compensate for the systemic decline caused by poor circulation Irreversible The body is unable to overcome the effects of anaerobic metabolism and the death of vital organs

5 Hemorrhagic Hypovolemic Shock A sudden decrease in the volume of blood, resulting in decreased in blood return. Most common cause is hemorrhage : –Stab wounds –Gunshot wounds –Motor vehicle accidents –Dehydration (excessive vomiting and diarrhea) –Burns.

6 Treatment for Hypovolemic Shock Maintain airway Control bleeding Baseline vital signs Level of consciousness Aims: Increase tissue perfusion and oxygenation status through:

7 Treatment for Hypovolemic Shock Position casualty/ elevate legs (trendelenburg’s position) Keep patient at normal temperature –Prevent hypothermia –Minimize effect of shock Fluid therapy Drug therapy On-going assessment - every minutes

9 Non-Hemorrhagic Shock Cardiogenic Shock Septic Shock Neurogenic Shock Anaphylactic Shock/Vasogenic Shock Psychogenic Shock

10 Cardiogenic Shock Decrease in contractions/contractile ability of the myocardium. The most common cause is myocardial infarction Heart fails to circulate blood efficiently Reduction in cardiac output results in: –Decreased circulating blood supply –Decreased oxygen delivery

11 Treatment for Cardiogenic Shock Place the patient in a comfortable position Oxygen therapy Assist ventilation

12 Neurogenic Shock The failure of nervous system to control the diameter of blood vessels leading to decreased arterial resistance and Peripheral vasodilatation. Causes: –Nerve paralysis (spinal cord or brain injuries). –Severe blows to the abdomen. –Hot bath or hot vapor bath Spinal cord injury Certain drugs

13 Treatment for Neurogenic Shock Keep patient at normal temperature Secure airway/ Assist ventilation Administer oxygen Baseline vital signs Level of consciousness Position casualty

14 Anaphylactic Shock/ Vasogenic Shock An extreme and generalized allergic antigen-antibody reaction, that may bring on vascular collapse. in which widespread histamine release causes swelling, bronchioles constriction, heart and/or failure. It results from exposure to: –Sensitive drugs or other substances (serum, vaccines enzymes, hormones, penicillin and other antibiotics, local anesthestetics, salicylates). –Diagnostic chemicals (radiographic contrast dye). –Food (legumes, nuts, berries, seafood, eggs). –Insect venom (honeybees, mosquitoes, certain spiders.

15 Anaphylactic Shock/ Vasogenic Shock - Onset within 30 minutes of exposure leading to: - Diffuse vasodilatation - Increase size of vascular bed - Blood is trapped in small vessels and viscera - Temporary loss in total circulatory volume

16 Treatment for Anaphylactic Shock Secure airway Terminate exposure to causative agent First-line therapies, during acute stage –Epinephrine –IV fluids –Oxygen Second-line therapies –Antihistamines –Corticosteroids Evacuate

17 Psychogenic Shock - A sudden dilation of the blood vessels takes place in response to an emotional or traumatic situation causing the patient to faint. -Stimulation of the vagus nerve causes the heart to slow down (bradycardia). When the bradycardia is severe enough, insufficient blood flow to the brain results and the patient loses consciousness (faints). Conditions causing psychogenic shock include: –Severely scared. –Severe exhaustion. –Bad news (death or fail in exam)

18 Treatment for Psychogenic Shock Determine duration of unconsciousness Record initial vital signs and mental status If patient is confused or slow to regain consciousness, suspect head injury

Septic or Toxic Shock It is a condition that shows vascular dilatation due to a major infection resulting into a damage to the blood vessels walls which is causing loss of their ability to constrict. Diseases and conditions that predispose a patient to septic shock include: –Liver disease –Immune suppression (AIDS, drug therapy for cancer)

Metabolic shock Change in body chemistry, including: Salt and acid-base balance. Failure of the adrenaline, thyroid and pituitary glands Diabetes mellitus

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Positioning Patients on a Long Backboard Three or more rescuers needed Position long backboard beside patient One rescuer maintains head in line while other rescuers take position On cue from rescuer at patient’s head, other rescuers roll patient toward them as a unit

Positioning Patients on a Long Backboard Continued Slide backboard next to patient On cue from rescuer at head, other rescuers roll patient as a unit Patient is secured to backboard using straps

References Goldman's Cecil Medicine, 24th ed. Core Skills24Treat for Shock