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EMER 113/114 > LO2 Shock and Haemorrhage (Chapter 4/5) > Flashcards

LO2 Shock and Haemorrhage (Chapter 4/5) Flashcards

1
Q

Adequate Perfusion requires 4 components

A

Intact, functioning Vascular system

Adequate Air exchange

A functioning Pump

Adequate Fluid volume in vascular system

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2
Q

Normal perfusion

Relies on two Key Factors:

A

Cardiac Output

• Peripheral Vascular Resistance
The resistance blood has to flow against

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3
Q

How do we preserve perfusion?

A

Control bleeding.
-Look for other bleeding and control it

Maintain airway.

Maintain oxygenation & ventilation.

Maintain circulation

Adequate heart rate & intravascular volume.

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4
Q

Shock

A

a state of tissue hypoxia due to reduced oxygen delivery and or increased oxygen consumption or an adequate oxygen utilization

A condition during which the cardiovascular system fails to perfuse the tissues adequately.

Is a continuum.

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5
Q

three stages of shock

A

compensated decompensated and irreversible

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6
Q

Shock cycle:

A

↓ in Red Blood Cells

Anaerobic process

Hypoxia worsens

Inadequate perfusion: causes of buildup of lactic acid

Catecholamine ↑ : epi and noreepi

Cell death
repeat

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7
Q

Four Distinct kinds of shock

A

hypovolemic

distributive

obstructive

cardiogenic

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8
Q

Hypovolemic shock (absolute hypovolemia) causes

A

External hemmorage- controlled

External hemmorhage- uncontrolled

Internal hemmorahage

Other causes of intravascular volume loss such as diahrea

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9
Q

Distributive shock (high space) causes

A

Neurogenic shock

Medical causes (anaphylaxis, sepis, overdoses)

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10
Q

mechanical shock -Obstructive shock causes

A

Cardiac tamponade

Tension pneumothorax

Massive pulmonary embolism

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11
Q

mechanical shock -Cardiogenic shock

A

Cardiac contusion

MI

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12
Q

catecolmines

A

Epinephrine and Norepinephrine AKA Catecholamines are released due to a decrease in cardiac output.

• This causes:
↑ heart rate & contractility.

↑ systemic vascular resistance.

Blood is redirected from skin, gut and kidneys to the heart & brain.

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13
Q

Compensated Shock (first phase)

A

Loss of 15-25% of the blood volume

Body is compoensating

if not fixed goes to decompensated

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14
Q

Compensated Shock (first phase) signs and symptoms and why

A

Sustained tachycardia (high heart rate): catecholamines

  • Pale (Pallor) & Cool skin: blood is shunted to middle of body
  • Diaphoresis: catecholamines
  • Tachypnea (high breathing rate): catecholamines
  • Weakness/light headedness: caused by decreased blood volume
  • Peripheral pulses weakened: blood is shunted to middle of body
  • Thirst: hypovolemia
  • Urinary output decreased: hypovolemia, hypoxia and circulating catecholamines
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15
Q

Decompensated Shock (second phase)

A

Loss of 30-45% of the blood volume: enough to cause hypotension
Body has failed to compensate

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16
Q

Decompensated Shock (second phase) signs and symptoms and why

A
  • Hypotension: caused by hypovolemia, diminished cardiac output and/or vasodilation
  • Altered metal status: lack of o2 to brain
  • Cardiac arrest: organ failure secondary to blood loss, hypoxia
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17
Q

Capnography (ETCO ) 2

A

Normal range is 35-40 mmHg.

Falling ETCO2 indicates hyperventilation and decreased oxygenation

An ETCO less than <20mmHg means shock is worsening and may indicate circulatory collapse

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18
Q

Tachycardia

A

First sign of shock

100bpm not normal 120 red flag

Some patients in shock may not develop tacahycardia

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19
Q

Relative bradycardia

A

patients with traumatic hypotension

Consider patients meds

Beta blockers or calcium channel blocking medications might prevent them from developing tachycardia

Children in decompensated shock may develop bradycardia

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20
Q

Low volume shock(absolute hypovolemia)

A

is caused by haemorrhage or other major body fluid loss like diarrhea, vomiting and third spacing due to Burns, peritonitis and other causes

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21
Q

High space shock (relative hypovolemia)

A

is caused by spinal injury, vasovagal syncope, sepsis, anaphylaxis and certain drug overdoses that dilate the blood vessels and redistribute blood flow to a larger vascular volume

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22
Q

Mechanical shock (obstructive shock):

A

is caused by conditions preventing the filling of the heart like pericardial Tampanade, tension pneumothorax, or something obstructing blood flow through the lungs like a massive pulmonary embolism

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23
Q

Cardiogenic shock (pump failure):

A

is caused by a damaged heart like myocardial contusion or myocardial infarction

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24
Q

Absolute hypovolemia

• Loss of volume

A

Blood vessels can hold more than actually flows

Catecholamines (sympathetic nervous system) cause vasoconstriction and maintains bp high enough to perfuse vital organs

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25
Q

signs and symptoms of Absolute hypovolemia

A

LOC: possibly decreased

Airway: possibly snoring

Breathing: rapid and shallow

Pulses: rapid and “Thready” pulse: means width of artery shrinks

Skin: pale, cool, clammy

Possibly uncontrolled hemorrhage

Neck veins: flat

Trachea: midline

Chest: may be normal

Possible contusions or penetrations

Breath sounds: normal or unilaterally diminished

Abdomen: possibly tender/rigid/distended

Pelvis: may be unstable or painful

Extremities: possible fractures

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26
Q

TREATMENT Controllable Hemorrhage  

A

Control bleeding w/ direct pressure.  

Shock position  

High‐flow oxygen  

Rapid safe transport  

Large‐bore IV access  

Fluid bolus 500‐1000 ml for adult or 20 ml/kg for pediatrics
—Only restore perfusion 

Monitor patient’s ECG, SPO2 and ETCO2.  

27
Q

treatment Uncontrollable Hemorrhage (external)

A

Control bleeding quickly and aggressively  

Shock position 

High‐flow oxygen 

Rapid safe transport  

Large‐bore IV access 

Fluid administration 

TXA Administration 

Monitor patient’s ECG, SPO2 and ETC  

28
Q

treatment Uncontrollable Hemorrhage (internal)

A

Rapid safe transport

  • Shock position 
  • High-flow oxygen 
  • Large-bore IV access
  • Fluid administration  
  • TXA Administration 
  • Monitor patient’s ECG, SPO2 and ETCO2.  
29
Q

Low-volume Shock – Burns

A

Cutaneous injury as a result of thermal (heat, flame or scald) or non thermal (chemical or electrical).

May be associated with smoke inhalation injury or other traumatic injuries.

Severity of a burn is determined by:

  • -Age, medical history of the patient.
  • -Body area involved
  • -Size and depth of burn.
30
Q

Major burns

A

Burns greater than 20% total body surface area (TBSA) are considered
Major Burns.

result in the loss of or the evaporation of:

Plasma or water.

Large amounts of electrolytes.

They can cause generalized edema and hypovolemia.

31
Q 
TREATMENT 
Burn treatment (<20 TBSA)  
A
  • Cool the burn 
  • Analgesia 
  • Apply moist sterile dressing
  • Fluid administration 
  • Safe transport  
32
Q 
TREATMENT 
Burn treatment (>20 TBSA)  
A 
Cool the burn  
• Airway support  
• High-flow oxygen  
• Apply sterile dry dressings  
• Large-bore IV access  
• Analgesia  
• Fluid administration  
• Rapid safe transport  
• Monitor patient’s ECG, SPO2 and ETCO2  
• Monitor patient for hypothermia  
33
Q

Distributive Shock

Relative hypovolemia

A

“Vasodilatory shock”

Large intact vascular space

Interruption of sympathetic nervous system

Loss of normal vasoconstriction; vascular space becomes much “too large”

Clinical presentation
Varies dependent on type of high-space shock

34
Q

Distributive shock – Neurogenic Shock

A

Neurogenic shock typically occurs after an injury to the spinal cord (C6 and above).
Injury prevents additional catecholamine release.

35
Q

Neurogenic Shock signs and symptoms

A

oHypotension

oHeart rate normal or slow

oSkin warm, dry, pink à not pale because catecholmines are not released

oParalysis or deficit

oNo chest movement, simple diaphragmatic

36
Q

Neurogenic Shock treatment  

A 
Treat symptomatically  
• Spinal motion restriction   
• Rapid safe transport  
• High-flow oxygen  
• Large-bore IV access   
• Fluid administration  
• Monitor patient’s ECG, SPO2 and ETCO2.  
37
Q

Distributive shock – Sepsis shock

A

Septic shock has a high mortality rate.

An infectious processes initiates it.

Bacteria, endotoxins and exotoxins initiate the inflammatory process which initiates widespread vasodilation.

38
Q

Common sites of infection are:

A

i. Lungs
ii. Bloodstream
iii. Intravascular catheter
iv. Urinary tract
v. Surgical wound

39
Q

signs and symptoms of septic shock

A 
Tachycardia 
• Tachypnea 
• Temperature instability  
• Altered mental status  
• ↓ renal function 
• Clotting abnormalities
40
Q

• There are phases of Sepsis not every patient is in shock.

A

Sepsis
SIRS with signs of infection

Severe sepsis
Involvement of 1 or more organ system dysfunctions

Septic shock
Development of hypotension

41
Q

Systemic inflammatory response syndrome (SIRS)

A

Temp: >38°C or <36°C; Pulse: >90; R/R: >20/min

42
Q

Sepsis Treatment  

A
  • Identify the source of infection  
  • Large-bore IV access  

• Fluid replacement - 20 mL/kg with the intent to repeat following a reassessment  
–Start pts with crackles at 250ml if not 500ml and reassess  

  • Oxygen administration 
  • Rapid safe transport 
  • Temperature management 
  • Monitor patient’s ECG, SPO2 and ETCO2
  • Inotropic support (ALS ONLY) 
  • IV antibiotic administration (ALS ONLY)  
43
Q

Distributive shock – Anaphylaxis

A

This response typically involves 2 body systems and causes massive vasodilation.

This vasodilation causes fluid to shift from the intravascular space to the extravascular space

44
Q

Distributive shock – Anaphylaxis signs and symptoms

A
  • Anxiety/altered mental status
  • Dyspnea
  • Edema
  • Hypotension
  • Gastrointestinal (GI) cramps
  • Hives (urticaria)
  • Sensations of burning or itching of the skin
  • Fever
45
Q

Anaphylaxis treatment  

A 
Epinephrine administration  
• Bronchodilator administration  
• Oxygen administration  
• Rapid safe transport  
• Large-bore IV access  
• Fluid administration  
• Monitor patient’s ECG, SPO2 and ETCO2. 
46
Q

Mechanical Shock – Cardiogenic

A

Impairment of the pump.

This is typically caused by a myocardial
infarction (MI).

Leads to decreased cardiac output.

Cardiac contusions: right ventricle most common place

Arrythmias

Stiffness/decrease contraction

47
Q

Mechanical Shock – Cardiogenic signs and symptoms

A 
Tachycardia, 
tachypnea, 
hypotension, 
JVD, 
dysrhythmia    
Chest pain  
Dyspnea  
Faintness  
Feelings of impending doom
48
Q

Cardiogenic shock treatment  

A

ASA administration 
• STEMI/NSTEMI, dysrhythmia identification & treatment. 
 • IV access 
• Monitor patient’s ECG, SPO2 and ETCO2. 
• Nitroglycerin administration 
• Rapid safe transport  

49
Q

Mechanical Shock – Obstructive (outside of the heart somewhere)

A

Is inadequate cardiac output caused by an impediment to blood flow to or from the heart into the pulmonary or systemic circulation.

50
Q

Obstructive shock treatment  

A
  • Identify & treat cause. 
  • Chest decompression (ALS)  
  • Rapid safe transport  
  • High-flow oxygen 
  • Large-bore IV access  
  • Fluid administration  
  • Monitor patient’s ECG, SPO2 and ETCO2.  
51
Q

Mechanical Shock – Obstructive (outside of the heart somewhere) causes

A

Tension pneumothorax
Cardiac tamponade
pulmonary embolism

52
Q

Tension pneumothorax

A

High Air tension that may develop in plural space due to lung or chest wall injury

Blood returns to the chest largely because of negative pressure that results when individuals inhales in the absence of this negative pressure blood return will be decreased oh preventing the return of venous blood to the heart resulting in a back up of blood

Increased venous return results in lower cardiac output in the development of shock

53
Q

Tension pneumothorax s/s

A

decreased or absent breath sounds on the affected side, JVD, deviated trachea, cyanosis and a decreased LOC

54
Q

Cardiac tamponade

A

Occurs when blood feels the potential space between the heart and the pericardium squeezing the heart and preventing the heart from filling

This decreased feeling the heart causes cardiac output to fall resulting in development of shock

May occur in more than 75% of cases of penetrating cardiac injury

55
Q

Cardiac tamponade s/s

A

Signs and symptoms have been labelled Becks triad

JVD, muffled heart tones and pulses paradoxus (hypotension)

56
Q

shock in children

Most common type and causes

A

• Hypovolemic

  • Dehydration
  • Trauma
57
Q

shock in children

Second most common type and causes

A

Relative hypovolemia

  • Burns
  • Sepsis
  • “Third spacing” – fluid leaks from inside veins to outside
58
Q

Manifestations of Shock in children

A

Vitals are not always indicative

59
Q

Manifestations of Shock in children

consciousness and responsiveness

A

Extremely irritable

Lethargy: Severe deterioration of consciousness

Decreased response to painful stimulation (usually indicates severe cardiorespiratory or neurologic compromise)

60
Q

Manifestations of Shock in children

breathing

A

Extremely rapid respiratory rate: Tachypnea

Increased depth of respirations: Hyperpnea

Evidence of increased respiratory effort: Retractions (breath in really deep and everything retracts), grunting, nasal flaring

Apnea or inadequate respiratory rate or effort

61
Q

Manifestations of Shock in children

skin color

A

Mottling – marbleized or blotchy appearance to the skin (may come from a cold environment)

Pallor – poor perfusion

Flushed, bright red skin – sepsis

62
Q

Manifestations of Shock in children

cap refill

A

Capillary refill:
• Compromise in systemic perfusion
• Prolonged capillary refill time (>2 seconds)
• Subjective interpretation – reliable?

63
Q

Manifestations of Shock in children

bradycardia

A

Possible cause or a symptom of deterioration

Most common cause: Hypoxia

Often indicates impending cardiovascular collapse

Most common terminal cardiac rhythm observed in children

Pt is detreating

64
Q

Manifestations of Shock in children

blood pressure

A

Shock may be present despite a systolic blood pressure within the normal range for the age of the child

If systolic hypotension develops or the mean arterial pressure fallsàindicates hypotensive shock

10mL/kg of fluid

EMER 113/114 (11 decks)

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