1. Shock & Resuscitation

2. Shock Inadequate perfusion to cells, tissues, & organsInadequate perfusion to cells, tissues, & organs AKA hypoperfusionAKA hypoperfusion Includes oxygen & glucoseIncludes oxygen & glucose

3. Review Pathophysiology Aerobic MetabolismAerobic Metabolism Breaking glucose into energyBreaking glucose into energy EnergyEnergy Needed for sodium/potassium pumpNeeded for sodium/potassium pump

4. Oxygen Delivery Pt breathing adequatelyPt breathing adequately Alveoli diffusing properlyAlveoli diffusing properly Oxygen capable carrying cellsOxygen capable carrying cells Adequate volume of bloodAdequate volume of blood Oxygen must break bond from cellOxygen must break bond from cell

5. Etiologies of Shock Inadequate VolumeInadequate Volume Inadequate Pump FunctionInadequate Pump Function Inadequate Vessel ToneInadequate Vessel Tone

6. Inadequate Volume Causes:Causes: Loss of whole bloodLoss of whole blood Loss of plasmaLoss of plasma Pt Needs:Pt Needs: Increase in blood volumeIncrease in blood volume Blood transfusion (blood loss)Blood transfusion (blood loss) IV fluids (dehydration)IV fluids (dehydration)

7. Inadequate Pump Causes:Causes: Injury to heartInjury to heart MI, CHF, Heart valve disease, arrhythmiasMI, CHF, Heart valve disease, arrhythmias Pt needs:Pt needs: Not fluid-may make things worst Not fluid-may make things worst Improve pump functionImprove pump function

8. Inadequate Vessel Tone Causes:Causes: Relates to size of vesselRelates to size of vessel Vasodilation,Vasodilation, Not a fluid problemNot a fluid problem Pt needs:Pt needs: ALS supportALS support Improve pressure, perfusion, cellular oxygenation & delivery of glucoseImprove pressure, perfusion, cellular oxygenation & delivery of glucose

9. REMEMBER!!!! Does not matter what caused the shock, pt needs rapid transport to nearest facilityDoes not matter what caused the shock, pt needs rapid transport to nearest facility

10. Categories of Shock HypovolemicHypovolemic DistributiveDistributive CardiogenicCardiogenic ObstructiveObstructive Metabolic/RespiratoryMetabolic/Respiratory

12. Hypovolemic Low blood volumeLow blood volume Most commonMost common HemorrhagicHemorrhagic Blood lossBlood loss NonhemorrhagicNonhemorrhagic Volume/dehydratio nVolume/dehydratio n

13. Distributive Decrease in intravascular volumeDecrease in intravascular volume Caused by vasodilation/increase capillary permeabilityCaused by vasodilation/increase capillary permeability Usually not fluid problemUsually not fluid problem Caused because vessel large enough not enough volume to fill itCaused because vessel large enough not enough volume to fill it Capillaries can also become permeable & leak fluid into interstitial spaceCapillaries can also become permeable & leak fluid into interstitial space

14. Cardiogenic ineffective pump function ineffective pump function Has adequate volume & toneHas adequate volume & tone >40% loss of pump function>40% loss of pump function

15. Obstructive Blocks blood flowBlocks blood flow Pump, vessel, & volume adequatePump, vessel, & volume adequate Pulmonary EmbolismPulmonary Embolism Cardiac TamponadeCardiac Tamponade Tension PnuemothoraxTension Pnuemothorax

16. Metabolic/Respiratory Inability for O2 to diffuse into blood, be carried by hemoglobin, leave the RBC, or tissue unable to use O2Inability for O2 to diffuse into blood, be carried by hemoglobin, leave the RBC, or tissue unable to use O2 Examples:Examples: Carbon monoxide poisoningCarbon monoxide poisoning Cyanide poisoningCyanide poisoning

17. Types of Shock Remember RANCHPMS R espiratory R espiratory A naphylactic A naphylactic N eurogenic N eurogenic C ardiogenic C ardiogenic H ypovolemic H ypovolemic P sychogenic P sychogenic M etabolic M etabolic S eptic S eptic These each fall under a category of shockThese each fall under a category of shock Some named as the same as the categorySome named as the same as the category Most common types of shockMost common types of shock

18. Regardless of the type of shock: Cells are starved for oxygen-rich blood Without adequate oxygen: Cells begin to break down Waste products build up Death may follow unless adequate perfusion is quickly restored

20. Body Response Fight or FlightFight or Flight Sympathetic nervous systemSympathetic nervous system Direct nerve stimulationDirect nerve stimulation Increase heart rateIncrease heart rate Increase force of contractionIncrease force of contraction VasoconstrictionVasoconstriction Release epinephrine & norepinephrineRelease epinephrine & norepinephrine Release of HormonesRelease of Hormones Stimulate Alpha & BetaStimulate Alpha & Beta Others released which decrease urine outputOthers released which decrease urine output

22. Stages of Shock CompensatoryCompensatory DecompesatoryDecompesatory IrreversibleIrreversible

24. Shock & Resusciation Day 2

25. Review What is shock?What is shock? What are the categories of shock?What are the categories of shock? What are the different types of shock?What are the different types of shock? What are the etiologies of shock?What are the etiologies of shock? What are the types of shock and what is happening with the body in each phase?What are the types of shock and what is happening with the body in each phase?

26. Shock Assessment Identify quicklyIdentify quickly Obtain HistoryObtain History Physical examPhysical exam Signs & SymptomsSigns & Symptoms Altered mental statusAltered mental status Pale, cool, clammy skinPale, cool, clammy skin Delayed capillary refillDelayed capillary refill Decreased urine outputDecreased urine output Weak or absent peripheral pulsesWeak or absent peripheral pulses

28. Assessment Continued Vital SignsVital Signs Blood pressureBlood pressure Heart rateHeart rate Pulse characterPulse character Respiratory rate and tidal volumeRespiratory rate and tidal volume Skin color, temperature, and conditionSkin color, temperature, and condition Pulse oximetery readingPulse oximetery reading

29. Age Consideration Normal systolic for a child less than 10Normal systolic for a child less than 10 Times age by 2 & add to 70Times age by 2 & add to 70 Hypotension is a late finding in childrenHypotension is a late finding in children Geriatrics do not compensate wellGeriatrics do not compensate well Medications may prevent some signs and symptomsMedications may prevent some signs and symptoms

30. Treatment Improve oxygenationImprove oxygenation Secure & maintain airwaySecure & maintain airway Ventilate-do not hyperventilateVentilate-do not hyperventilate Stop bleedingStop bleeding Splint fracturesSplint fractures Do not remove FBDo not remove FB Keep in supine positionKeep in supine position Apply PASG if suspected pelvic fractureApply PASG if suspected pelvic fracture Maintain body temperatureMaintain body temperature Remove wet clothingRemove wet clothing Rapid transportRapid transport

31. Cardiac Arrest Ventricles are not contractingVentricles are not contracting Brain cells begin to die within 4-6 minutes without oxygenBrain cells begin to die within 4-6 minutes without oxygen

32. ELECTRICAL PHASE Phases of Cardiac Arrest

33. Begins immediatelyBegins immediately Ends 4 minutes after the arrest has startedEnds 4 minutes after the arrest has started Heart still has good O2 & glucose reservesHeart still has good O2 & glucose reserves Ultimate goal is get ventricles beatingUltimate goal is get ventricles beating

34. Circulatory Phase Begins at 4 minutes & ends at 10 minutesBegins at 4 minutes & ends at 10 minutes Oxygen stores depletedOxygen stores depleted If in this phase must do chest compressions to help rebuild the supplies to the tissuesIf in this phase must do chest compressions to help rebuild the supplies to the tissues

35. Metabolic Phase Begins after 10 minutesBegins after 10 minutes Starved of oxygen & glucoseStarved of oxygen & glucose Tissue ischemicTissue ischemic

36. Vocabulary DowntimeDowntime Total downtimeTotal downtime Return of spontaneous circulation (ROSC)Return of spontaneous circulation (ROSC) SurvivalSurvival Witnessed cardiac arrestWitnessed cardiac arrest Unwitnessed cardiac arrestUnwitnessed cardiac arrest

37. Withholding Resuscitation DNRDNR POLSTPOLST MOLSTMOLST DecapitationDecapitation Rigor mortisRigor mortis

38. Chain of Survival 1. Early access Recognition of emergencyRecognition of emergency Calling 9-1-1Calling 9-1-1 22-38

39. Chain of Survival 2. Early CPR 22-39

40. Chain of Survival 3. Early defibrillation 22-40

41. Chain of Survival 4. Early advanced care 22-41

42. 22-42 Chain of Survival Integrated post-cardiac arrest careIntegrated post-cardiac arrest care

43. AED & CPR Early interventionEarly intervention Push hard & Push fast compressionsPush hard & Push fast compressions Early defibrillationEarly defibrillation

44. Types of Defibrillators ManualManual semiautomatedsemiautomated AutomatedAutomated Fully automatedFully automated AdvantagesAdvantages

45. Ventricular Fibrillation: Shockable!

46. Ventricular Tachycardia: Shockable!

47. Asystole: NOT Shockable!

48. Pulseless Electrical Activity: NOT Shockable! Organized electrical activity with no pulse

49. NEVER touch the patient, AED, or cables when the AED is analyzing a rhythm. ! Back to Objectives

50. To Be or Not to Be Do Not Use in children less than 1Do Not Use in children less than 1 Children 1-8-adult pads can be usedChildren 1-8-adult pads can be used Use in non-traumatic patientsUse in non-traumatic patients

52. Assessment Scene size up and primary assessmentScene size up and primary assessment Secondary assessmentSecondary assessment Emergency Medical CareEmergency Medical Care ReassessmentReassessment

53. Transport If the following occur:If the following occur: Gains a pulseGains a pulse Total of three shocks have been deliveredTotal of three shocks have been delivered AED has said no shock X2AED has said no shock X2 Local ProtocolLocal Protocol

55. Things to watch for WaterWater MetalMetal Transdermal patchesTransdermal patches Implanted deviceImplanted device Hairy chestHairy chest

56. Energy LevelsEnergy Levels PacemakersPacemakers AICDAICD