1. 19
Recognition and Care of Shock

2. Objectives Key terms Pathophysiology of shock.
Four categories of shock.
Seven main types of
Signs and symptoms of shock.
Care of a patient presenting with
shock.

3. Perfusion and Shock Perfusion (Homeostasis)
Adequate supply of well-oxygenated blood and nutrients to all vital organs
Oxygen and carbon dioxide exchange
Nutrients and waste products exchange
Fluid and salt balance maintained between blood and tissues
Discussion Question: How might a patient look if they have normal perfusion?

4. Perfusion and Shock Hypoperfusion (Shock)
Failure of body's circulatory system to provide enough oxygenated blood and nutrients to all vital organs
Inadequate oxygen and carbon dioxide exchange
Inadequate nutrient and waste product exchange
Fluid and salt imbalance
Teaching Tip: Remind students about the meaning of "hypo" and how this relates to the circulatory system not being able to meet the requirements of perfusion.

5. Perfusion and Shock Shock can be life-threatening.
The progression of shock can occur rapidly or over several hours to days.
Care for patients with shock should not be delayed.
Critical Thinking: Why is it important to rapidly treat signs and symptoms of shock?

6. If left untreated, blood loss will lead to shock and eventually death.

7. Perfusion and Shock Shock Categories Cardiogenic Distributive
Neurogenic
Anaphylactic
Psychogenic
Septic
Hypovolemic
Hemorrhagic
Obstructive
Respiratory/
metabolic
Discussion Question: How are the four main categories of shock the same? How are they different?
Critical Thinking: Which medical conditions could cause a type of shock that would fall under each of these categories?

8. Cardiogenic Shock Cardiogenic Category Cardiogenic shock (type)
The heart is unable to pump enough blood at consistent pressure to all vital organs.
Critical Thinking: Are there other ways in which the cardiovascular system might fail?

9. Cardiogenic shock, aka pump failure, occurs when the heart is not able to pump blood efficiently to maintain adequate perfusion.

10. Heart attack as a cause of cardiogenic shock: Damaged heart muscle results in reduced force of contractions and reduced cardiac output.

11. Distributive Shock Neurogenic shock Anaphylactic shock
Occurs when spinal cord is damaged and unable to control tone of blood vessels by way of sympathetic nervous system
Anaphylactic shock
Occurs when body experiences severe allergic reaction
Critical Thinking: Why is it important to readily recognize the signs of neurogenic shock in victims of trauma?
Critical Thinking: What signs and symptoms might the EMR see in a patient suffering a severe allergic reaction that would indicate anaphylactic shock?
continued on next slide

12. Distributive shock is caused by abnormal changes in blood vessel size
Distributive shock is caused by abnormal changes in blood vessel size. This can occur with severe allergic reaction or spinal-cord injury.

13. Shock can be caused by an uncontrolled dilation of the blood vessels.

14. Distributive Shock Distributive Category Psychogenic shock
Results in a sudden, temporary dilation of blood vessels
Septic shock
Widespread infection of the blood
Critical Thinking: In what cases might someone experience psychogenic shock? Why should it be taken seriously?
Critical Thinking: What signs and symptoms might the EMR see in a patient suffering from septic shock?

15. Hypovolemic Shock Hypovolemic Category Hemorrhagic shock
Occurs when body loses significant amount of whole blood from circulatory the system
Critical Thinking: What are some causes (both traumatic and medical) that could lead to hemorrhagic shock?

16. Hypovolemic shock occurs when there is an inadequate amount of fluid in the body, either blood or other fluids such as water and plasma.

17. (A) Hemorrhagic hypovolemia: loss of blood
(A) Hemorrhagic hypovolemia: loss of blood. (B) Nonhemorrhagic hypovolemia: loss of plasma and other fluids.

18. Obstructive Shock Pulmonary Embolism Tension Pneumothorax
When the heart is unable to pump effectively due to a restriction.
Pulmonary Embolism
Tension Pneumothorax
Pericardial tamponade

19. Causes of obstructive shock: (A) pulmonary embolism, (B) tension pneumothorax, (C) pericardial tamponade.

20. Perfusion and Shock Respiratory/Metabolic
Disruption of oxygen transfer into the cells or cells unable to utilize the available oxygen
Caused by cyanide, carbon monoxide, or iron poisoning
Talking Point: Respiratory/Metabolic shock does not fall into a specific category of shock, but relates most closely to the definition of shock as being in a state of "cellular dysoxia" (not enough oxygen at the cellular level).

21. Perfusion and Shock The Body's Response During Shock Compensated Shock
Compensated stage
Decompensated stage
Compensated Shock
Condition in which body is using specific mechanisms to compensate for lack of adequate perfusion
Discussion Topic: The main focus for the EMR is to prevent the patient from entering the decompensated stage of shock.

22. Perfusion and Shock Restlessness Altered mental status
Early Signs/Symptoms of Compensated Shock
Restlessness
Altered mental status
Increased heart rate
Normal to decreasing blood pressure
Mildly increased breathing rate
Skin that is pale, cool, and moist
Sluggish pupils
Thirst then nausea and vomiting
Critical Thinking: How might you manage a patient in shock with altered mental status who insists on refusing care?

23. Perfusion and Shock Decompensated Shock
Condition in which body is no longer able to compensate for lack of adequate perfusion
Critical Thinking: Why are the signs of decompensated shock ominous?

24. Perfusion and Shock Signs and Symptoms Unresponsiveness
Decreasing heart rate
Very low blood pressure
Slow and shallow respirations
Skin that is pale, cool, and moist
Dilated, sluggish pupils
Respiratory and cardiac arrest can develop
Critical Thinking: What happens if the cause of shock is not treated and the patient continues to decline in the decompensated stage?

25. Shock
Do not wait for signs and symptoms to develop before caring for shock.
In cases of trauma or injury, examine and consider mechanism of injury.
If patient suffered blunt trauma to head, chest, abdomen, or pelvis, suspect internal bleeding and provide care accordingly.
Discussion Question: Early recognition of shock signs and symptoms is essential. Why is ongoing monitoring essential?

26. Shock Caring for Shock Perform primary assessment.
Ensure ABCs are properly supported.
Control external bleeding.
Administer oxygen via NRB.
Keep patient in supine position.
Calm and reassure patient.
Maintain normal body temperature.
Critical Thinking: Why should you keep the patient in the supine position?
continued on next slide

27. Shock Caring for Shock Monitor and support the ABCs.
Do not give patient anything by mouth.
Monitor patient's vital signs.
Class Activity: Divide the class into small groups. Provide each with an index card upon which a significant trauma is written. Direct students to work together to describe the care they would give in the order they would provide it. Have each group present their injury and treatment to the rest of the class.

28. Psychogenic Shock Fainting (Syncope)
Self-correcting form of mild shock
Examine patient for injury if patient fell.
Keep patient lying down and at rest for several minutes.
Discussion Topic: All episodes of syncope should be evaluated by a physician to ensure the episode was not caused by a serious condition.
continued on next slide

29. Psychogenic Shock Fainting (Syncope)
Always recommend that patient see a physician.
Fainting may be psychogenic or due to more serious conditions such as brain tumor, heart disease, or diabetes.
Discussion Topic: All episodes of syncope should be evaluated by a physician to ensure the episode was not caused by a serious condition.

30. Think About It
You respond to a motorcycle collision. You find a 19-year-old male 50 feet from his sport race bike which is significantly mangled. You find your patient conscious and wearing a helmet, but in only shorts and tank top. He is bleeding profusely.
What are your concerns?
How do you proceed?

31. Summary Perfusion (Homeostasis) Hypoperfusion (Shock)
Adequate supply of well-oxygenated blood and removal of waste products from body's tissues, especially vital organs
Hypoperfusion (Shock)
Failure of body's circulatory system to provide enough oxygenated blood and nutrients to all vital organs

32. Summary
Types of Shock
Cardiogenic
Hypovolemic
Distributive
Obstructive
Begin caring for shock if MOI suggests internal injury or bleeding.

33. Summary Signs and Symptoms of Shock Increased pulse and breathing rate
Increased Restlessness or combativeness
Pale, cool, and moist skin
Thirst
Weakness
Nausea and vomiting
Loss of responsiveness
Decreasing Blood Pressure (decompensation)
NYS – late sign of shock

34. Summary
Do not wait for signs and symptoms to appear before caring for shock.
Care for Shock
Support the ABCs.
Keep patient lying flat.
Control all external bleeding.
Administer oxygen if allowed.
Maintain normal body temperature.
Expedite transport.