1. 5/19/2018
Chapter 10
Shock 1

2. Anatomy and Physiology
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Heart
Four chambers
Blood vessels
Arteries – away from the heart
Veins – toward the heart
Blood
Heart – muscular organ that pumps blood throughout the body via blood vessels
Divided into four chambers – right & left upper chambers called atria/ right and left lower chambers called ventricles
*Right side pumps blood to the lungs & the left pumps blood to the rest of the body
-Veins take oxygen-depleted blood from the tissues & deliver it to the superior and inferior vena cava (largest veins in the body).
-Right atrium receives blood from the venae cave and pumps it through a one-way valve into the right ventricle
-Then blood passes through another one-way valve into the pulmonary arteries and on to the lungs for oxygenation
-The left atrium recieves O2-rich blood from the lungs and delivers it through a valve to the left ventricle
-This 02-rich blood is then pumped into the aorta and then out into the arteries
-Arteries carry oxygenated blood to the tissues
**Capillary – exchange site between blood and tissue
-Heart is regulated by pacemaker cells
How the Heart Pumps Blood

3. What is Shock?
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Failure of the circulatory system to maintain adequate blood flow to tissues
Leads to inadequate tissue perfusion in which cells do not receive sufficient O2 & nutrients
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4. Stages of Shock Compensated shock Decompensated shock
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Compensated shock
Decompensated shock
Irreversible shock
Important terms:
Tachypnea & tachycardia
Discussion Point:
Compare and contrast the three stages of shock
Compensated shock:
The body’s ability to maintain blood perfusion to vital tissues under conditions that, if left uncorrected, would inevitably lead to death
*The body’s ability to do this (compensate for shock) can mask serious conditions & give you a false impression
Evidence: tachycardia (heart rate greater than 100bpm), tachypnea (resp. rate greater than 20 rpm), delayed cap refill, cool skin, altered mental status & normal BP
Decompensated shock:
Perfusion hasn’t been restored, cellular hypoxia will continue, body’s systems begin to fail
Heart rate will continue to rise, systolic BP will begin to fall, respirations may become shallow, skin pale or cyanotic & cool/moist, cap refill issues, LOR decrease, etc.
Irreversible shock
Cells die, tissues die, organs die, organ system failure & death
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5. Types of Shock Hypovolemic
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Hypovolemic
Results from a critical decrease in circulating blood volume
Caused by a loss of circulating blood or internal body water
Water loss can occur with severe burns, dehydrating, excessive vomiting, etc. 5

6. Types of Shock Cardiogenic The defect occurs within the heart itself
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Cardiogenic
Heart cannot adequately pump blood
The defect occurs within the heart itself
Examples?
Examples?
-valve problems, heart attack, slow or fast heart rates, medication, trauma to heart
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7. Types of Shock Distributive
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Distributive
Blood vessels lose their ability to constrict appropriately
3 subtypes: septic, anaphylactic, neurogenic

8. Types of Shock Septic Anaphylactic Neurogenic
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Septic
Caused by an infection known as sepsis
Anaphylactic
Severe allergic reaction
Neurogenic
Caused by disruptions of the CNS
Vasodilation – results in reduced blood pressure & cellular hypoxia 8

9. Types of Shock Obstructive shock Tension pneumothorax
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Obstructive shock
Tension pneumothorax
Pericardial tamponade
Pulmonary embolism
Obstructive Shock
-results when some type of blockage prevents oxygenated blood from reaching vital organs
Tension pneumothorax: air in the pleural space results in the collapse of the lung on the affected side and can compress the heart
Pericardial tamponade: fluid fills the sac around the heart, compressing it and impairing its pumping action
Pulmonary embolism: blood clot in the pulmonary circulation reduces blood flow to lung tissue

10. Factors Affecting Shock
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Age
Concurrent illness or injury
Pre-existing medical condition
Mind-altering substances or medications
Prescription or over-the-counter (OTC) medications
Examples of pertinant drugs:
beta-blockers: limit the heart’s ability to beat faster
Anticoaagulant – blood thinner, prevents blood from clotting

11. Patient Assessment MOI Classic signs Scene size up
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MOI
Scene size up
Clues; suggestion possible shock
Classic signs
Tachycardia
Hypotension
Tachypnea
Pale, cool, diaphoretic skin
Altered mental status
Discussion Point:
List the classic signs and symptoms of shock

12. Patient Management High flow oxygen Return to homeostasis
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High flow oxygen
Return to homeostasis
Place in shock position
Transport in head down position
-Primary assessment/ABCD’s
-Rapid transport, ALS
-High flow 02
-Keep patient warm and dry to prevent heat loss
-Head lower than feet

13. Skill 10-1 Shock Management
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Skill Shock Management 13

14. OEC Skill 10-1 Shock Management (a) Assess scene safety and initiate Standard Precautions. Copyright Scott Smith
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OEC Skill 10-1 Shock Management (a) Assess scene safety and initiate Standard Precautions. Copyright Scott Smith 14

15. OEC Skill 10-1 Shock Management (b) Perform a primary assessment
OEC Skill 10-1 Shock Management (b) Perform a primary assessment. Assess ABCDs and correct any problems found. Copyright Scott Smith
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OEC Skill 10-1 Shock Management (b) Perform a primary assessment. Assess ABCDs and correct any problems found. Copyright Scott Smith 15

16. OEC Skill 10-1 Shock Management (c) Call for help and arrange for transport that includes ALS. Copyright Scott Smith
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OEC Skill 10-1 Shock Management (c) Call for help and arrange for transport that includes ALS. Copyright Scott Smith 16

17. OEC Skill 10-1 Shock Management (d) Monitor the airway and administer high-flow oxygen. Copyright Scott Smith
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OEC Skill 10-1 Shock Management (d) Monitor the airway and administer high-flow oxygen. Copyright Scott Smith 17

18. OEC Skill 10-1 Shock Management (e) To prevent heat loss, keep the patient warm and dry. Copyright Scott Smith
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OEC Skill 10-1 Shock Management (e) To prevent heat loss, keep the patient warm and dry. Copyright Scott Smith 18

19. OEC Skill 10-1 Shock Management (f) Place the patient with the head lower than the feet while maintaining spinal integrity. Copyright Scott Smith
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OEC Skill 10-1 Shock Management (f) Place the patient with the head lower than the feet while maintaining spinal integrity. Copyright Scott Smith 19

20. OEC Skill 10-1 Shock Management (g) Provide for rapid transport
OEC Skill 10-1 Shock Management (g) Provide for rapid transport. Copyright Selko
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OEC Skill 10-1 Shock Management (g) Provide for rapid transport. Copyright Selko 20

21. Early recognition!!
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Early recognition of the potential for shock is essential in reducing the number of deaths from this condition.
continued