chp 29 Recognition and Care of the Shock Patient

Question 1

Anaphylactic Shock

Answer 1

Type of shock caused by an overreaction of the immune system when exposed to an allergen.

Question 2

Cardiogenic Shock

Answer 2

Type of shock caused when the heart can no longer pump blood adequately, resulting in a decrease in cardiac output and thus a decrease in perfusion.

Question 3

Compensated Shock

Answer 3

when the patient is developing shock but the body is still able to maintain perfusion.

Question 4

Decompensated Shock

Answer 4

when the body can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure, become evident

Question 5

Hemorrhagic Shock

Answer 5

Type of shock caused by a loss of blood.

Question 6

Hypoperfusion

Answer 6

inadequate perfusion of blood to an organ or organs. Also called shock.

Question 7

Hypovolemic Shock

Answer 7

type of shock caused by a sudden decrease in body fluids (blood or other body fluids)

Question 8

Neurogenic Shock

Answer 8

type of shock caused when the vessels dilate abnormally in response to injury to the spinal cord.

Question 9

Obstructive Shock

Answer 9

a form of shock that blocks the forward movement of blood within the circulatory system.

Question 10

Perfusion

Answer 10

the supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.

Question 11

Psychogenic Shock

Answer 11

type of shock caused by a sudden and temporary dilation of the blood vessels from psychological causes.

Question 12

Respiratory/Metabolic Shock

Answer 12

a form of shock caused by a disruption in the ability of cells to utilize oxygen effectively.

Question 13

Septic Shock

Answer 13

Type of shock caused by severe infections that abnormally dilate the blood vessels.

Question 14

Shock

Answer 14

inadequate perfusion of blood to an organ or organs. Also called hypoperfusion.

Question 15

29-2 Describe the physiology of maintaining adequate perfusion.

Answer 15

Cells require an adequate supply of oxygen and glucose for aerobic metabolism, which ensures production of ATP. In addition to oxygen and glucose, good perfusion requires an adequate volume of blood, a properly functioning heart, and an intact system of blood vessels. Without one of these components, hypoperfusion happens.
S/S of adequate perfusion are:
* Normal Skin Signs
* Normal mental Status
* Normal Vital Signs
S/S of inadequate perfusion are:
* Abnormal skin signs (pale, cool, and moist)
* Altered mental status (agitation, restlessness, sluggishness, confusion, or decreased responsiveness)
* Abnormal vital signs (increased pulse and respiratory rate, decreased blood pressure)

Question 16

29-3 Explain the Pathophysiology of shock (hypoperfusion)

Answer 16

a progressive condition that occurs when a patient does not receive an adequate supply of well oxygenated blood to all organs of the body. It can occur for several reasons, including damage to the heart, loss of blood, and abnormal dilation of the vessels. When enough cells of an organ suffer from inadequate perfusion it malfunctions and shuts down.

Question 17

29-4 Describe how inadequate vascular volume, inadequate heart function, ad decreased peripheral vascular resistance can lead to shock.

Answer 17

Inadequate vascular volume, inadequate heart function, and decreased peripheral vascular resistance can lead to shock.

• Inadequate Volume - by bleeding uncontrollably, or dehydrated, either case results in a decrease in cardiac preload and in turn cause a decreased stroke volume. The heart compensates by increasing heart rate. If that does not work the blood pressure will drop.
• Pump failure - Inability of the heart to pump with enough force to supply blood to the body. This comes from three things.
  
  • Damage to the heart muscle (myocardial infarction.
  • trauma
  • buildup of blood or fluid in the pericaridial sac that surrounds the heart causing compression of the heart (pericardial tamponade)
• Inadequate blood vessel tone - A minimum amount of systemic vascular resistance (SVR) is required to maintain adequate blood pressure. When faced with a failing SVR due to lack of smooth muscle tone, the heart rate increases until it can not keep up output and systolic pressure drops.

Question 18

29-5 Explain the mechanisms and pathophysiology of each of the following categories and types of shock: Cardiogenic, Distributive (anaphylactic, septic, and neurogenic), hypovolemic (hemorrhagic and nonhemorrhagic), metabolic or respiratory, and obstructive.

Answer 18

• Distributive Shock - an over dilation of the blood vessels when exposed to an allergen (anaphylactic), severe infection (septic), in response to injury of the spinal cord (Neurogenic).
• Cardiogenic Shock - the heart can no longer pump blood adequately, resulting in a decrease in cardiac output and thus a decrease in perfusion.
• Hypovolemic Shock - Loss of blood or other fluids such as through severe diarrhea which is dehydration.
• Obstructive Shock - when forward movement of blood flow is obstructed. Conditions such as pulmonary embolism, tension pneumothorax, and pericardial tamponade.
• Respiratory/metabolic shock - caused by a disruption in the ability of cells to utilize oxygen effectively. Certain poisons such as cyanide and carbon monoxide can cause this type of shock.

Question 19

29-6 Differentiate between early (compensated) and late decompensated/irreversible) signs of shock.

Answer 19

Compensated shock is where shock is developing, but the body is still able to compensate for it by releasing adrenaline, raising the heart rate and force of contractions, constricting the capillaries and constricting the blood vessels, increase in respirations.
Decompensated shock is when the body can’t keep producing the adrenaline, The heart continues to try to beat faster but the blood vessels, even constricted, are not full and therefore blood pressure starts failing and their mental status starts failing.
Irreversible is when the heart slows down as it can no longer keep up and the patient’s pulse finally goes away into cardiac arrest.

Question 20

29-7 Explain how compensatory mechanisms to shock are maintained through direct nerve stimulation and release of hormones.

Answer 20

• Direct nerve stimulation happens when the sympathetic nervous system is activated and sends signals to the heart and blood vessels in an attempt to maintain normal BP. These effects are Increased heart rate; Increase in the force of contractions, Constriction of the blood vessels (increased SVR)
• The adrenal glands also release hormones epinephrine and norepinephrine. This produces a more sustained sympathetic effect. epinephrine stimulates both alpha and beta receptors, while norepinephrine affects mostly alpha receptors. The stimulation of the beta receptors affects the heart and causes an increase in strength and constriction. The stimulation on the alpha receptors affects the constriction of the blood vessels.

Question 21

29-8 Describe the progression of shock through the compensated, decompensated (progressive), and irreversible stages.

Answer 21

Early S/S of shock are increased pulse, increased breathing and pale skin. This is in Compensated Shock.
A major sign of entering decompensated shock is is a significant drop in blood pressure, in addition the patient will present with a significant decrease in mental status.
During irreversible shock the patient’s pulse becomes very weak until it finally goes away and they experience cardiac arrest.
Vital signs:
*Compensated
*Increased respirations
*Increased pulse
*Normal to low Systolic
*Normal to high diastolic
*Skin is pale, cool, moist
*Pupils are sluggish but responsive
*Mental Status is slightly altered
*Decompensated
*Decreased Respirations
*Pulse becomes weaker
* Blood Pressure decreasing to absent
*Skin is pale, cool, moist
*Pupils are sluggish to fixed and dilated
*Mental Status is very altered to unresponsive

Question 22

29-9 Explain the influence of age on the assessment and management of patients with shock.

Answer 22

In pediatric patients they can compensate till nearly half of their blood is gone. Their condition deteriorates very quickly and death is sudden. Initiate care and transport as soon as possible.
* In Geriatrics may show signs of shock more easily than young people, Their blood vessels are stiffer and less responsive to sympathetic stimulus. They may also be on beta blockers whick won’t allow their heart to become tachycardic as expected. As a result they may progress to decompensated shock more quickly.

Question 23

29-10 Explain how to identify the patient who is in a shock state and demonstrate the assessment of patients to identify shock

Answer 23

During primary assessment obtain baseline vitals if possible and give oxygen asap. Look for signs of shock at that moment and with future vitals every 5 minutes with unstable medical or Trauma patients with significant MOIs

Question 24

20-11 Discuss the pre-hospital management of patients with shock.

Answer 24

• Conduct an appropriate Scene Size-up and BSI
• Manually stabilize spine as appropriate for MOI
• Perform a primary assessment and initiate supplemental oxygen.
• Control any external bleeding
• Keep the patient supine, If the cause of shock is due to illness, you may elevate the legs 8-12 inches.
• Conserve Body heat by covering the patient with a blanket when appropriate.
• Place the patient on a long backboard as appropriate for the MOI
• Initiate Transport and request an ALS intercept if available
• Perform reassessments as appropriate and be alert for changing vital signs (trending).