2/20/24 Lecture

Question 1

Definition of Shock

Answer 1

Inadequate cellular perfusion

Question 2

Blood loss

Answer 2

When you lose blood, you stop having hemoglobin circulating. Without hemoglobin carrying oxygen, organs start to die

Question 3

Treating a patient with shock

Answer 3

Turn up the heat in the ambulance
Cover patient to keep them warm
Get vital signs - as early as possible. Vital signs can change with the position of the patient

Question 4

Traumatic Shock

Answer 4

Hypovolemic: acute blood (or body fluid) loss
Distributive: neurogenic loss of vascular tone
Cardiogenic: low cardiac output

Can have more than one type of shock

Question 5

Physiological Response to Shock

Answer 5

Cardiovascular Response: increased heart rate and strength of contraction
. . .

Question 6

average blood volume in a 150-lb adult

Answer 6

5 L

Question 7

Class 1 hemorrhage

Answer 7

Up to 750 ml
Slightly anxious, warm, dry, good capillary refill. Normal breathing rate. Normal/slightly elevated heart rate. Radial pulse, equal central and peripheral strength. Normal systolic/diastolic and pulse pressure

Question 8

Class II hemorrhage

Answer 8

Up to 1500 ml
Starting to get into fight or flight response
increasing anxiety, irritability, restlessness. Pale, cool, capillary refill becomes delayed: 2-3 seconds
breathing: increased rate (hypoxia)
Heart Rate: increasing rate
Pulse: normal central pulses; weak peripheral pulses
Blood pressure: normal systolic/diastolic; decreased pulse pressure

May still be in compensated shock at this stage

Question 9

Class III hemorrhage

Answer 9

Up to 2L
Mentation: increasing anxiety, irritability, restlessness. Confusion. May be combative
Skin: pale, cool, diaphoretic; capillary refill: 3-4 seconds
Breathing: increasing rate and depth (30-40 breaths/min in adults)
Heart rate: increasing
Pulse: weak central pulses, absent peripheral pulses
Blood pressure: decreasing systolic/diastolic; decreasing pulse pressure

Question 10

Class IV hemorrhage

Answer 10

Greater than 2000 ml
Mentation: difficult to arouse, progressing to unresponsive
Skin: pale, cool, diaphoretic; capillary refill > 5 seconds
Breathing: increasing rate
Heart rate: increasing rate
Pulse: weak central pulses, absent peripheral pulses
Blood pressure: decreasing systolic/diastolic; decreasing pulse pressure

Question 11

Vital sign frequency

Answer 11

Patient with signs of shock, vital signs every 2-3 min can tell you if they’re compensating or decompensating.
AEMTs will want to see trend.

Question 12

GCS Score

Answer 12

Go through GCS more than once when analyzing a patient. Can show trending status: ex. going talkative to unresponsive.

Question 13

Special Considerations for Blood Loss

Answer 13

Medications
Pacemaker implants
Older adults/geriatric patients
Pediatric patients
Pregnancy
Athletes

Question 14

Heart rate medication

Answer 14

Heart rate medication can cause heart to not speed up as expected. Heart won’t beat over speed it’s medicated to (more or less)

Question 15

HEENT

Answer 15

Head Ears Eyes Nose and Throat

Question 16

Blood loss: external hemorrhage

Answer 16

Direct Hand Pressure -> pressure bandage -> is the bleeding controlled? If yes, hospital, if no, where is the bleeding located? on an extremity, use a turnoquit, then transport. On the trunk, use . . .

Question 17

How to stop internal bleeding

Answer 17

You can’t stop internal bleeding in the field–rapid transport is paramount