Shock - Progression & Emergency Care Flashcards
The early stage of shock, while the body can still compensate for blood loss
Compensated shock
The late stage of sock, when BP is falling and the mental status is declining
Decompensated shock
When shock progresses too far, it becomes ___
Irreversible
Conditioned defined by the inability to successfully achieve resuscitation regardless of the methods employed
Irreversible shock
BP may be the ___ measurable factor to change in shock
Last
Infants and children can maintain their BP until they have sustained blood loss equivalent to more than ___
One-half their blood volume
Expect shock if the patient has ___
- Massive external or internal bleeding
- Multiple severe fractures
- Abdominal or chest injury
- Spinal injury
- Severe infection
- Major heart attack
- Anaphylaxis
If shock is suspected ___
Expedite transport and begin treatment for shock immediately
Signs and symptoms of compensated shock
- Agitation
- Anxiety
- Restlessness
- Feeling of impending doom
- Weak, rapid (thready) pulse
- Clammy skin
- Pallor
- with cyanosis about the lips
- Shallow, rapid breathing
- Nausea or vomiting
- Capillary refill of longer than 2 seconds in infants and children
- Marked thirst
- Narrowing pulse pressure
Signs and symptoms of decompensated shock
- Falling BP (systolic 90 mg/Hg or lower in an adult)
- Declining mental status, altered LOC
- Labored or irregular breathing
- Ashen, mottled, or cyanotic skin
- Thready or absent peripheral pulses
- Dull eyes, dilated pupils
- Poor urinary output
The primary assessment for a patient with suspected shock should include ___
A rapid exam to look for evidence of severe or exsanguinating hemorrhage, determine LOC, ID and manage life-threatening concerns as they are found, and determine priority of the patient and transport
When treating a patient in shock, provide ___
High-flow oxygen to assist in perfusion of damaged tissues
If the patient has bled out, saturating the red blood cells they have left will help ___
Prevent hypoxia
If the patient has signs of hypoperfusion, ___
Treat aggressively and provide rapid transport to the hospital
If your patient is ___ perform a secondary assessment of the entire body
- Trauma patient with a significant MOI or multiple injuries
- Patient gives a poor general impression
- You found problems in the primary assessment
- Patient has a medical problem but is not responsive
If your patient has a simple MOI, ___
Focus your examination on the specific area affected
Treat for shock early by ___
Providing oxygen and keeping the patient warm
How can external heat sources harm a patient in shock?
Cause vasodilation and decrease BP even more
When transporting a patient in shock, consider ___ rendezvous, and consider ___ transport
- ALS
- Aeromedical
On-scene time before transport to the hospital is started for a patient in shock should be ___
10 minutes or less
A patient with chronic lung disease will often be able to breath better in a ___ position
Sitting or semi-sitting
Usually patients with cariogenic shock do not have an ___, but they may be having ___
- Injury
- Chest pain
A patient in cardiogenic shock may have taken ___ before your arrival
Nitroglycerin
Signs and symptoms of cardiogenic shock
- Chest pain
- Irregular pulse
- Weak pulse
- Low BP
- Cyanosis (lips, under nails)
- Cool, clammy skin
- Anxiety
- Crackles (rales)
- Pulmonary edema
Treatment for cardiogenic shock
- Position comfortably
- Administer high-flow oxygen
- Assist ventilation
- Transport promptly
- Consider ALS
Signs and symptoms of obstructive shock
Dependent on cause
1. Dyspnea
2. Rapid, weak pulse
3. Rapid, shallow breaths
4. Decreased lung compliance
5. Unilateral, decreased, or absent breath sounds
6. Decreased BP
7. Jugular vein distention
8. Subcutaneous emphysema
9. Cyanosis
10. Brachial deviation toward unaffected side
11. Beck triad (cardiac tamponade)
Signs and symptoms of septic shock
- Warm skin or fever
- Tachycardia
- Low BP
Treatment of obstructive shock
Dependent on cause
1. ALS assist and/or rapid transport
2. Administerhigh-flow oxygen
Treatment of septic shock
- Transport promptly
- Administer high-flow oxygen
- Assist ventilations
- Keep patient warm
- Consider ALS
Signs and symptoms of neurogenic shock
- Bradycardia
- Low BP
- Signs of neck injury
Treatment of neurogenic shock
- Secure airway
- Spinal immobilization
- Assist ventilations
- Administer high-flow oxygen
- Preserve body heat
- Transport promptly
- Consider ALS
Signs and symptoms of anaphylactic shock
Can develop within seconds
1. Mild itching or rash
2. Burning skin
3. Vascular dilation
4. Generalized edema
5. Coma
6. Rapid death
Treatment of anaphylactic shock
- Manage the airway
- Assist ventilations
- Administer high-flow oxygen
- Determine cause
- Assist with administration of epinephrine
- Transport promptly
- Consider ALS
Signs and symptoms of psychogenic shock
- Rapid pulse
- Normal or low BP
Treatment of psychogenic shock
- Determine duration of unconsciousness
- Position the patient supine
- Record initial vital signs and mental status
- Suspect head injury if patient is confused or slow to regain consciousness
- Transport promptly
Signs and symptoms of hypovolemic shock
- Rapid, weak pulse
- Low BP
- Change in mental status
- Cyanosis (lips, under nails)
- Cool, clammy skin
- Increased respiratory rate
___ should be the priority is treating cardiac tamponade
Increasing cardiac output
The only definitive treatment for cardiac tamponade
Surgery
Involves penetrating the pericardium with a needle to withdraw the accumulated blood from the pericardial sac
Pericardiocentesis
When treating cardiac tamponade, the ___ must be increased because the increasing pressure in the pericardium is squeezing the heart
Preload
The only action that can prevent eventual death from a tension pneumothorax
Decompression of the injured side of the chest
Proper treatment of septic shock involves ___
Complex hospital management, including expeditions administration of antibiotics
Shock that accompanies spinal cord injury is best treated by a ___
Combination of all known supportive measures
The most effective emergency treatment of anaphylactic shock is to ___
Administer epinephrine by way of intramuscular injection
The emergency treatment of hypovolemic shock includes ___
The control of all obvious external bleeding
Signs of normal aging with geriatric patients in regards to shock (central nervous system)
CNS has a delayed response; tachypnea and vasoconstriction may be slower to respond to shock
Signs of normal aging with geriatric patients in regards to shock (cardiovascular system)
Variety of changes that result in a decrease in efficiency in the system. On assessment, be alert for higher resting HR and irregular pulse rates
Signs of normal aging with geriatric patients in regards to shock (respiratory system)
Elasticity of the lungs and their size and strength decrease. Ons assessment, be alert for higher respiratory rates, lower tidal volume, and a decreased gag reflex. Cervical arthritis may be present and dentures may cause an airway obstruction
Signs of normal aging with geriatric patients in regards to shock (skin)
Becomes thinner, drier, less elastic, and more fragile, providing less protection and thermal regulation
Signs of normal aging with geriatric patients in regards to shock (renal system)
Decreases in function and may not respond well to unusual demands such as illness or dehydration
Signs of normal aging with geriatric patients in regards to shock (gastrointestinal system)
Sustains changes in gastric motility that may lead to slower gastric emptying
