EMT Shock Handout for studying PDF

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Listing of All shocks and stages of shock...

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Shock Handout

EMT

Shock is caused by three major problems that occur within the body: 1. Problems with the heart's functioning: Cardiogenic shock can be caused by any disease, or event, which prevents the heart muscle from pumping strongly and consistently enough to circulate the blood normally. Heart attack, conditions which cause inflammation of the heart muscle (myocarditis), disturbances of the electrical rhythm of the heart, any kind of mass or fluid accumulation and/or blood clot which interferes with flow out of the heart can all significantly affect the heart's ability to adequately pump a normal quantity of blood. 2. The total circulating blood is low: Hypovolemic shock occurs when the total volume of blood in the body falls well below normal. This can occur when there is excess fluid loss, as in dehydration due to severe vomiting or diarrhea, diseases which cause excess urination (diabetes insipidus, diabetes mellitus, and kidney failure), extensive burns, blockage in the intestine, inflammation of the pancreas (pancreatitis), or severe bleeding of any kind. 3. Overwhelming infection, usually caused by bacteria: Septic shock can occur when an infection (usually bacterial) is allowed to progress. Bacteria often produce toxins which can cause injury throughout the body. When large quantities of bacteria/toxins, begin circulating in the bloodstream, every organ is at risk. The most damaging consequences include:- Poor functioning of the heart muscle Widening of the diameter of the blood vessels - Drop in blood pressure - Activation of the blood clotting system, causing blood clots and a risk of uncontrollable bleeding - Damage to the lungs, causing acute respiratory distress syndrome - Liver failure - Kidney failure Coma

Shock Handout

EMT

There are 3 separate stages of shock:  Stage I: Compensated Shock: When low blood flow (perfusion) is first detected by the body. A number of systems are activated in order to maintain/restore perfusion. The heart beats faster, the blood vessels become smaller in diameter, and the kidney works to retain fluid in the circulatory system to maximize blood flow to the most important organ systems of the body. The patient in this stage of shock has very few symptoms, and aggressive treatment may slow or stop progression to stage II shock.  Stage II: Decompensated Shock: When the methods of compensation begin to fail. The systems are unable to maintain perfusion any longer. Oxygen deprivation in the brain causes the patient to become confused and disoriented.  Stage III: Irreversible Shock: The length of time that poor perfusion has existed begins to take a permanent toll on the body's organs and tissues. The heart's functioning continues to spiral downward, and the kidneys usually shut down completely. Cells in organs and tissues throughout the body are injured and dying. The endpoint of Stage III irreversible shock, is patient death. Types of Shock  Hypovolemic shock: decreased blood volume. A type of hypovolemic shock is hemorrhagic shock, which results from blood loss.  Obstructive shock: something blocks perfusion to the heart. For example, pulmonary embolism, tension pneumothorax, or cardiac tamponade.  Distributive shock: abnormal blood distribution that leads to inadequate blood reaching the heart.  Cardiogenic shock: inadequate pumping of the heart. Can be due to heart disease or heart attack.

Shock Handout

EMT

Remember, most types of shock (hypoperfusion) are caused by dysfunction in one or more parts of the perfusion triangler  The pump (the heart)  The pipes, or container (blood vessels)  The fluid, or volume (blood)

Hypovolemic Shock Hypovolemic shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working. Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock. Blood loss (Hemorrhagic Shock) can be caused by:  Bleeding from cuts  Bleeding from other injuries  Internal bleeding, such as in the gastrointestinal tract The amount of circulating blood may drop from the patient losing too much body fluid, which can occur with:    

Burns Diarrhea Excessive perspiration Vomiting

Distributive Shock As in hypovolemic shock there is an insufficient volume of blood. This form of relative hypovolemia is the result of dilation of blood vessels. Examples of this form of shock are:  Septic shock: Caused by overwhelming infection leading to vasodilation. It is treated in hospital by antibiotics, fluid replacement, and vasoconstrictors.  Anaphylactic shock: Caused by allergens that trigger widespread vasodilation and movement of fluid out of the blood into the tissues. This a serious, potentially life-threatening allergic response that is

Shock Handout

EMT

marked by swelling, lowered blood pressure, and dilated blood vessels. In severe cases, a person will go into shock. If anaphylactic shock isn't treated immediately, it can be fatal.  Neurogenic shock : Caused by the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. Without this constant stimulation the vessels relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure. The rarest cause of shock is acute spinal cord injury leading to neurogenic shock.  Psychogenic shock: Caused by a sudden reaction of the nervous system that produces a temporary, generalized vascular dilation, resulting in fainting, or syncope. Obstructive Shock Occurs when the normal flow of blood is obstructed. Several conditions result in this form of shock:  Cardiac tamponade - Blood in the pericardium prevents blood from entering the heart (venous return).  Tension Pneumothorax - Increased pressure within the thoracic cavity blocks the normal flow of blood to the heart.  Pulmonary embolism - The result of a blockage (embolus) in the blood vessels of the lungs, blocking the return of blood to the heart. Cardiogenic Shock Cardiogenic shock is literally shock with cardiac origin. It is also the physiologic end point of all other causes of shock. Cardiogenic shock can therefore, regardless of its etiology, be thought of as shock caused by failure of the heart as a forward pump. Modern advances in medical care have made cardiogenic shock less common than it once was, but it is still a life-threatening reality. The most common etiology for cardiogenic shock is a myocardial infarction. Some of the less common causes of cardiogenic shock include infectious cardiac disease processes, such as:  Acute myocarditis or endocarditis  Induced heart failure from drugs/medications (i.e., cocaine, betablockers, tricyclic antidepressants)  Trauma-related; such as a myocardial contusion

Shock Handout

EMT

 Metabolic disorders resulting in cardiac arrhythmia's, such as sustained tachycardia or bradycardia.  Pulmonary embolism may also produce cardiogenic shock by impeding blood flow in the pulmonary vessels. Signs and Symptoms of Shock (Hypoperfusion) Initial symptoms of shock include:  Cold, clammy hands and feet  Pale  Weak, fast pulse rate (tachycardia)  Fast breathing rate (tachypnea)  Low blood pressure (hypotension)  Anxiety (feeling of impending doom) A variety of other symptoms may be present, but they are dependent on the underlying cause of the shock state. 1. Mental states  Restlessness  Anxiety  Altered mental status 2. Peripheral perfusion  Delayed capillary refill greater than 2 seconds in normal ambient air temperature infant and child patients only  Weak, thready or absent peripheral pulses  Pale, cool, clammy skin 3. Vital signs  Decreased blood pressure (late sign)  Increased pulse rate (early sign) - weak and thready  Increased breathing rate (1) Shallow (2) Labored (3) Irregular 4. Other signs and symptoms include

Shock Handout

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EMT

Dilated pupils Thirst Nausea and vomiting Pallor with cyanosis to the lips

NOTE: Infants and children can maintain their blood pressure until their blood volume is more than half gone, so by the time their blood pressure drops they are close to death. The infant or child in shock has less reserve. Treatment Goals for Shock Important goals in the treatment of shock for EMT’s include:      

Quickly diagnosing the patient's state/type of shock Intervening to halt the underlying condition(Stop bleeding, restarting the heart, etc.) Treat the effects of shock(High flow O2, keep pt warm, reassure, etc.) Supporting vital functions(respiration, blood pressure, heart function). Keep the patient warm, with patient lying supine Treat the underlying condition which led to shock.

Shock Management  Take body substance isolation precautions  Maintain an open airway  High concentration oxygen; assist ventilations or administer CPR if indicated

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Control external bleeding Patient in supine position Splint fractures Prevent loss of body heat Transport immediately...