Lecture 4/Chapter 13 Flashcards
Shock
In a set of actively dying
Perfusion
Circulation of blood within an organ/tissue in adequate amount to meet cells needs
What does poor perfusion cause?
Cell damage and cell death
What exactly causes cellular damage during poor perfusion?
A buildup of CO2
What can shock be caused by?
Heart attack, severe allergic reactions, MVAs, blunt or penetrating trauma, severe infections, etc.
What are the classic signs of shock caused by?
Increased heart rate, increased force of contraction, peripheral vasoconstriction, increased respiratory rate, and bronchial dilation
What do you always do when someone is showing signs of shock?
Give high flow O2, put patient in proper positioning (not always shock position), and cover the patient with a blanket.
Compensation
The body’s way of trying to recover from going into shock, i.e., Fight or Flight response
Classic Signs of Shock
Agitation, anxiety, restlessness, tachycardia, tachypnea, pale, cool, diaphoretic skin, and dilated pupils
What are the 3 stages of shock?
Compensated, decompensated, and irreversible shock
Compensated Shock
Body compensates to maintain homeostasis
S/S: Agitation, anxiety, restlessness, weak rapid pulse, 2 second cap refill, pale cool moist skin, tachypnea, N/V, and thirst
Decompensated Shock
Body in unable to compensate
S/S: BP drops, deteriorating LOC, labored irregular breathing, ashten mottled cyanotic skin, thready or absent pulse, dull eyes, dilated pupils, and poor urinary output
Irreversible Shock
The terminal stage
Transfusion will not help, extreme acidosis, impossible to know when patient reaches this point, and must be treated aggressively
When should you expect shock to occur?
After multiple severe fractures, abdominal or chest injuries, spinal injuries, major heart attack, severe allergic reactions, and severe infection
Respiratory Insufficiency
Occurs when 3 or more ribs are broken in 2 or more places. Causes paradoxical motion and may cause pulmonary contusion, hemorrhage, and pneumothorax
What are the 4 categories of shock?
Hypovolemic, Cardiogenic, Obstructive, and Distributive Shock
Hypovolemic Shock
Content failure; low volume shock
Hemorrhagic Shock: massive blood loss and internal/external bleeding
Non-Hemorrhagic Shock: vomiting, diarrhea, burns and dehydration
Put patient into shock position
Cardiogenic Shock
Pump failure; damage to part of the heart reduces strike volume which reduces cardiac output
Causes AMI (heart attack); heart can’t maintain sufficient output when cardiogenic shock occurs
Put patient in Semi-Fowlers/Fowlers position
Obstructive Shock
Physical/mechanical obstruction to blood flow
Causes Pericardial Tamponade, Tension Pneumothorax, and Pulmonary Embolism
Pericardial Tamponade
Reduces ventricular filling, causes Beck’s Triad: JVD< muffled heart sounds, and narrowing pulse pressure
Treatment: high flow oxygen and surgery
Tension Pneumothorax
Collapses lung and puts pressure on heart and great vessels
S/S: severe dyspnea, JVD, absent lung sounds, tracheal deviation, and narrowing pulse pressure
Treatment: High flow O2, chest compressions, ALS, support breathing, and rapid transport
Pulmonary Embolism
Blood clot getting lodged in the lung
S/S: dyspnea, pleuritic chest pain, and pink/frothy sputum
Treatment: High flow O2, support breathing and rapid transport
Distributive Shock
Pipe failure and widespread dilation of blood vessels
Includes septic, neurogenic, anaphylactic, and psychogenic shock
Septic Shock
Systemic infections, toxins damage vessels, vessels dilate and leak
Treatment: BSI, high flow O2, ventilators support PRN, blankets, hospital management required
Skin Signs: heat, moist, flushed (non-typical)
Neurogenic Shock
High spinal injuries, vessels dilate, decreases perfusion
Treatment: BSI, establish/maintain open airway, spinal motion restrictions, assist inadequate breathing, conserve body heat, and transport promptly
Skin Signs: Dry and flushed below injury; warm, dry, and flushed (non-typical)
Anaphylactic Shock
Severe allergic reaction, vessels dilate, bronchioles constrict, sever dyspnea, wheezing, flushed skin, and hives/urticaria
Treatment: run primary, high flow O2, ventilators assistance PRN, epinephrine in secondary, and rapid transport ALS
Psychogenic Shock
Sudden blood vessel dilation, reduces blood flow to the brain, causes arrhythmias and brain aneurysm
Treatment: Run assessment, O2 if SpO2, assess for injuries, suspect head injury if neurological deficits remain after return on consciousness, and transport even if patient appears normal
