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EMT Key Points > Ch13: Shock > Flashcards

Ch13: Shock Flashcards

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1
Q

what is shock

A

inadequate cellular perfusion

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2
Q

perfusion

A

the circulation of blood to tissues to meet the cells’ needs and remove waste

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3
Q

perfusion triangle

A

heart
vessels
blood

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4
Q

how does the body compensate for hypoperfusion?

A

it redirects blood flow from organs that can withstand more time without oxygen such as skin and intestines

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5
Q

how to calculate pulse pressure

A

systolic – diastolic pressure

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6
Q

what does a wide pulse pressure tell us?

A

the heart is working harder, arteries have become less flexible or both. very high pulse pressures may indicate heart disease

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7
Q

what are sphincters in the capillary bed controlled by?

A

autonomic nervous system

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8
Q

factors affecting adequate perfusion

A

1) adequate blood flow
2) adequate gas exchange and oxygenation of the blood
3) adequate glucose level
4) adequate removal of waste

(think ab aerobic respiration)

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9
Q

which part of the nervous system controls the flight or flight response?

A

sympathetic (part of autonomic peripheral NS)

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10
Q

3 causes of shock (hint: perfusion triangle)

A
  1. pump failure - cardiogenic shock, and obstructive shock (like pulmonary embolism, cardiac tamponade, tension pneumothorax)
  2. poor vessel function + excessive vasodilation - distributive shock like sepsis, anaphylactic shock, neurogenic shock, psychogenic shock)
  3. low fluid volume - hypovolemic shock (including hemorrhagic and non-hemorrhagic shock)
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11
Q

4 types of shock

A

cardiogenic
obstructive
distributive (sepsis, anaphylactic, neurogenic, psychogenic)
hypovolemic (hemorrhagic and non-hemorrhagic)

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12
Q

how does cardiogenic shock –> pulmonary edema

A

cardiogenic shock damages heart muscle so it does not pump as well. because of the less efficient pumping, blood is backed into the pulmonary vessels. this pressure pushes fluid into the alveoli, causing pulmonary edema and inefficient oxygenation (tachypnea, crackles, rales).

*note: edema = excessive fluid build up

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13
Q

myocardial contractibility

A

ability of the heart to contract

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14
Q

preload

A

the pressure increase as blood fills the heart during diastole

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15
Q

blood enter the heart in diastole –> stretch walls + preload –> ? myocardial contractibility

A

increases myocardial contractibility

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16
Q

afterload

A

the pressure/force of the heart when pumping out the blood (systole)

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17
Q

consequences of increased afterload

A

heart overworks –> heart failure in the long term (similar to the idea of wide pulse pressure)

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18
Q

factors that lead to cardiogenic shock

A

low cardiac output (stroke volume x HR)
high preload
low preload
poor myocardial contractility

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19
Q

pericardial effusion

A

fluid going into pericardial sac

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20
Q

pericardial tamponade / cardial tamponad

A

excessive build up of fluid in pericardial sac, preventing blood from filling up ventricles

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21
Q

signs and symptoms of cardiac tamponade

A

BECK TRIAD
1) jugular vein distention
2) muffled heart soudns
3) narrowing pulse pressure (why? because heart cannot pump properly in systole and and there is A LOT of preload pressure during diastole because of resistance from fluid in pericardial sac when blood tries to flow into the ventricles)

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22
Q

pulmonary embolism

A

fluid bulid up

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23
Q

signs of neurogenic shock

A

no sweat below injury site
hypothermia
hypotension
skin pink, warm and normal

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24
Q

signs of anaphylactic shock

A

skin:
- flushed, itchy or burning sensation on face and upper part of face
- pallor
- cyanosis
- hives
- edema on face, lips

circulatory system:
- vasodilation
- drop in BP
- BP barely palpable

respiratory system:
- stridor
- itching or sneezing in nasal passages
- tightness in chest with dry cough
- dyspnea
- bronchi constriction
- secretion of mucus into lower airway
- cessation of breathing

other:
- abdominal cramping
- nausea
- vomiting
- altered mental status
- dizziness
- fainting and coma

25
Q

Compensated shock

A

early stages of shock where the body’s homeostasis is still able to compensate for changes

26
Q

signs of compensated shock

A

anxiety
restlessness
feeling of impending doom
weak, thready pulse
clammy skin
pallor
cyanosis at lips
shallow, rapid breathing
nausea or vomiting
CRT > 2 seconds
marked thirst
narrowing pulse pressure

27
Q

signs of decompensated shock

A

BP falling
declining mental status
labored, irregular breathing
ashen, cyanotic skin
thready or absent peripheral pulse
dull eyes, dilated pupils
poor urinary output

28
Q

how to deal with a patient with suspected shock

A

1) primary assesment
2) history taking - more abt chief complaint
3) secondary assessment
4) reassessment

*same as patient assessment without scene size-up

29
Q

primary assessment of patient with suspected shock

A
  1. scan for bleeding
  2. assess LOC
  3. airway
  4. breathing
  5. circulation - both distal & central pulses, mental status, CRT
30
Q

what to look for in history taking

A

SAMPLE
signs & symptoms (chief complaint)
allergies
meds
past med history (e.g. anticoagulants?)
last oral intake
events leading up to injury

31
Q

what is secondary assessment for

A

uncover injuries that were not found in primary assessment

32
Q

general emergency medical care for shock patients

A
  1. check for bleeding; manage by applying pressure and tourniquet if needed
  2. ABCs
  3. spinal motion restriction if there is possibility of spinal injury
  4. if there is enough time, splint any fractures or broken bones
  5. consider calling ALS backup
  6. reassessment every 5 mins for unstable patients
33
Q

potential causes of cardiogenic shock

A

inadequate heart function
something abnormal with electrical impulses
disease of muscle tissue
disease/injury

34
Q

signs and symptoms of cardiogenic shock

A

chest pain
cyanosis
cool clammy skin
weak pulse
BP low
pulmonary edema
anxiety
crackles

35
Q

how to treat cardiogenic shock

A

administer high-flow oxygen (e.g. NR mask)
assist ventilations if needed
position comfortably
consider ALS

36
Q

causes of obstructive shock

A

obstruction of cardiac muscle leading to decreased CO:
pulmonary embolism
pericardial tamponade
tension pneumothorax

36
Q

how to treat obstructive shock

A

administer oxygen
ALS assist, rapid transport

for pericardial tamponade: the only thing can be done is provide oxygen to prevent hypoxia. blood needs to be drained from pericardial sac but that is an ALS skill so CONSIDER ALS ASSIST

37
Q

symptoms of obstructive shock

A

dyspnea
cyanosis
rapid, weak pulse
rapid, shallow respirations
decreased lung compliance
jugular vein distention
cyanosis
Beck triad (cardial tamponade): muffled heart sounds, narrowing pulse pressure, JVD

37
Q

cause of septic shock

A

severe infection

37
Q

symptoms of sepsis

A

fever
tachycardia
low BP

37
Q

how to treat septic shock

A

it is a complex condition to take care of because it needs antibiotics so what an EMT can do is ADMINISTER OXYGEN!!
assist ventilations
keep patient warm
consider ALS

38
Q

what causes neurogenic shock

A

damaged cervical spine that causes excessive vasodilation

39
Q

symptoms of neurogenic shock

A

bradycardia
low BP
no sweating below site of injury
signs of neck injury

40
Q

how to treat neurogenic shock

A

secure airway
administer oxygen
consider ALS
preserve body heat
rapid transport
*the most important thing is maintaining good blood flow bc neurogenic shock patients usually have enough blood but extreme vasodilation

41
Q

what is anaphylactic shock

A

shock caused by life-threatening allergic reaction

42
Q

symptoms of anaphylactic shock

A

burning, itching skin
constriction of airways
vascular dilation
edema
coma
rapid death

43
Q

how to treat anaphylactic shock

A

administer oxygen
identify cause
assist with epinephrine injection
consider ALS

44
Q

what is psychogenic shock?

A

lack of blood flow to brain causing syncope/fainting

45
Q

treatment for psychogenic shock

A

determine duration of unconsciousness
patient supine position
record vital signs and initial mental status
transport promptly
assess and observe for any sign of head injury

45
Q

symptoms of psychogenic shock

A

normal or low BP
rapid pulse

45
Q

what causes hypovolemic shock

A

loss of blood volume = 1) fluid in blood or 2) the whole blood

45
Q

signs of hypovolemic shock

A

low BP
rapid, weak pulse
increased RR
change in mental status
cyanosis
cool, clammy skin

46
Q

treatment for hypovolemic shock

A

control external bleeding
secure airway
assist with breathing
administer oyxgen
rapid transport
consider ALS

46
Q
A
46
Q

nitroglycerin is usually administered for chest pain because it dilates the arteries. should it be given for cardiogenic shock?

A

NO. blood pressure is already low, nitroglycerin will exacerbate it

47
Q
A
48
Q
A
49
Q
A
50
Q
A

EMT Key Points (21 decks)

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