Shock, Resuscitation, and AED

Question 1

What is perfusion? Why is adequate perfusion necessary?

Answer 1

Perfusion is the adequate circulation of oxygenated blood thoughout the body. Adequate perfusion is necessary to maintain homeostasis.

Question 2

What is shock, or hypoperfusion?

Answer 2

Shock, or hypoperfusion, is inadequate tissue perfusion. The cells of the body do not get the oxygen and nutrients they need from the circulatory system.

Question 3

What is compensated shock?

Answer 3

Compensated shock is the early stage of shock. The body is still able to compensate for the hypovolemic state through defense mechanisms, such as increased heart rate and peripheral vasoconstriction.

Question 4

What is decompensated shock?

Answer 4

Decompensated shock is late or “progressive” shock. The body can no longer compensate for the hypovolemic state, and blood pressure starts to fall.

Question 5

What is irreversible shock?

Answer 5

Irreversible shock is the final stage of shock. The patient will not survive once entering irreversible shock.

Question 6

What are three primary causes of shock?

Answer 6

• Heart conditions such as myocardial infarction and cardiac trauma.
• Blood vessel problems such as anaphylaxis, spinal trauma, and infection.
• Blood volume problems such as bleeding, vomiting, and diarrhea.

Question 7

What compensation mechanism does the human body use to protect itself during shock?

Answer 7

• Tachycardia. If there is a loss of circulating blood volume, the body will increase heart rate and cardiac force of contraction to compensate.
• Peripheral vasoconstriction. The body will constrict peripheral blood vessels to try and increase blood pressure and increase perfusion to vital organs.
• The body will increase the respiratory rate to improve oxygenation.

Question 8

What is a late sign of shock?

Answer 8

Falling blood pressure is a late sign of shock. It indicates the body’s defense mechanisms are no longer working. Assume any patient with suspected shock and hypotension is decompensated shock. Treat as a high transport priority. Pediatric patients can maintain their blood pressure until about half of their blood volume has been lost. Do not wait for hypotension to begin treating a pediatric patient for shock.

Question 9

What is cardiogenic shock?

Answer 9

Cardiogenic shock is a pump problem. The heart muscle cannot pump effectively, causing a backup of fluid, pulmonary edema, and hypotension.

Question 10

What is pulmonary edema?

Answer 10

Pulmonary edema is an accumulation of fluid in the lungs.

Question 11

What causes cardiogenic shock?

Answer 11

Cardiogenic shock is caused by low cardiac output due to reduced preload, high afterload, or poor myocardial contractility.

Question 12

What are signs and symptoms of cardiogenic shock?

Answer 12

Signs and symptoms of cardiogenic shock include hypotension, probable cardiac history, chest pain, respiratory distress, pulmonary edema, and altered level of consciousness (LOC).

Question 13

What is obstructive shock?

Answer 13

Obstructive shock is a pump problem caused by mechanical obstruction of the heart muscle.

Question 14

What is cardiac tamponade?

Answer 14

Cardiac tamponade is when fluid accumulates within the pericardial sac and compresses the heart. Also referred to as pericardial tamponade.

Question 15

What are signs and symptoms of a cardiac tamponade?

Answer 15

Signs and symptoms of a cardiac tamponade include jugular venous distention (JVD), which is the filling of jugular veins in the neck, narrowing pulse pressures, which is systolic and diastolic pressures moving closer together, and hypotension.

Question 16

What is a tension pneumothorax?

Answer 16

Tension pneumothorax is when air enters the chest cavity due to lung injury or sucking chest wound. Accumulating pressure compresses the lungs and great vessels.

Question 17

What are signs and symptoms of a tension pneumothorax?

Answer 17

Signs and symtoms of a tension pneumothorax may include jugular venous distention (JVD), respiratory distress, diminished or absent lung sounds, poor compliance during artificial ventilations with bag valve mask (BVM), and tracheal deviation toward the unaffected side. Tracheal deviation is a very late sign.

Question 18

What is distributive shock? What is relative hypovolemia?

Answer 18

Distributive shock is a pipe (blood vessel) problem. It occurs due to widespread vasodilation, which causes blood pooling and relative hypovolemia. Relative hypovolemia is low volume relative to the size of the vascular space. Distributive shock expands blood vessels, making the vascular space bigger and the volume inadequate for effective circulation.

Question 19

What is anaphylactic shock?

Answer 19

Anaphylactic shock (also referred to as anaphylaxis) is a life-threatening form of severe allergic reaction due to three factors: massive vasodilation, widespread vessel permeability (fluid leakage), and bronchoconstriction.

Question 20

What causes anaphylactic shock?

Answer 20

Anaphylactic shock can be caused by medications, foods, bites, stings, and environmental allergens.

Question 21

What are the signs and symptoms of anaphylactic shock?

Answer 21

Signs and symptoms of anaphylactic shock include hives, swelling, itching, flushed or cyanotic color to the skin, weak pulses, hypotension, severe dyspnea, wheezing, and respiratory failure.

Question 22

What is neurogenic shock?

Answer 22

Neurogenic shock is damage to the spinal cord, typically in the cervical region. Neurogenic shock interrupts the normal communication pathways between the central nervous system and the peripheral nervous system. This interferes with the body’s normal compensatory mechanisms.

Question 23

What does neurogenic shock lead to?

Answer 23

Neurogenic shock leads to massive, systemic vasodilation below the level of injury. Relative hypovolemia results due to dramatic increase in vascular space. During neurogenic shock the nervous system cannot stimulate peripheral vasoconstriction or tachycardia due to spinal cord injury.

Question 24

What are the signs and symptoms of neurogenic chock?

Answer 24

Signs and symptoms of neurogenic shock include mechanism of injury indicative of cervical spine injury, hypotension, warm skin, heart rate that is not tachycardic, paralysis, respiratory paralysis, and priapism (persistent, painful penile errection). Having warm skin and a heart rate that is not tachycardia is unusual because the skin is normally pale and cool during shock due to increased peripheral vasoconstriction and the heart rate normally increases during shock to compensate for hypovolemia.

Question 25

What is septic shock?

Answer 25

Septic shock is caused by severe infection, which damages blood vessels and increases plasma loss out of the vascular space. Blood vessels do not constrict well during septic shock, diminishing the body’s ability to compensate.

Question 26

Wat does septic shock lead to?

Answer 26

Although primarily a pipe (vessel) problem, septic shock also leads to hypovolemia due to vessel permeability, fever, increased respiratory rate, and often poor fluid intake while ill.

Question 27

What are signs and symptoms of septic shock?

Answer 27

Signs and symptoms of septic shock include fever, chills, weakness, recent illness, infection, surgery, altered level of consciousness, increased respiratory rate, tachycardia, hypotension, pale, cool skin, weak peripheral pulses, and loss of appetite.

Question 28

What is psychogenic shock?

Answer 28

Psychogenic shock is a pseudo-shock caused by sudden temporary vasodilation that leads to syncope (fainting). Psychogenic shock does not typically present a problem because there is not sustained inadequate tissue perfusion. The sudden vasodilation interrupts blood flow to the brain, leading to a syncopal episode.

Question 29

What is hypovolemic shock?

Answer 29

Hypovolemic shock is a fluid problem. Dehydration due to vomiting, diarrhea, or burns can also lead to hypovolemic shock. Hypovolemic shock due to dehydration is common in pediatric and geriatric patients.

Question 30

What is hemorrhagic shock?

Answer 30

Hemorrhagic shock is a form of hypovolemic shock due to loss of whole blood. Note: hemorrhagic shock is always hypovolemic, but not all hypovolemia is due to hemorrhage.

Question 31

What are signs and symptoms of hypovolemic shock?

Answer 31

Signs and symptoms of hypovolemic shock may include trauma (blunt or penetrating), bleeding, altered level of consciousness, nausea, vomiting, diarrhea, tachycardia, pale, cool skin, weak peripheral pulses, and hypotension.

Question 32

In general, what are early signs and symptoms of shock?

Answer 32

Many of the early signs and symptoms of shock are indications the body is attempting to protect itself. Early signs and symptoms of shock include altered level of consciousness, restlessness, anxiousness, irritability, an indication of hypoxia, tachycardia, pale, cool skin, weak peripheral pulses (due to increased peripheral vasoconstriction), increased respiratory rate, thirst, and delayed capillary refill (over two seconds) in pediatric patients.

Question 33

In general, what are late signs and symptoms of shock?

Answer 33

Late signs and symptoms of shock include failing blood pressure, irregular breathing, mottling or cyanosis, and absent peripheral pulses. The presentation of neurogenic shock is unique due to the interruption in communication between the central and peripheral nervous systems. Skin is typically warm, and heart rate is often normal. Paralysis, including respiratory paralysis, could be immediate.

Question 34

Explain how to manage shock.

Answer 34

1. Control bleeding.
2. Place the patient supine when possible. Note: often those in cardiogenic or obstructive shock will not tolerate being placed supine.
3. Prevent loss of body heat.
4. Initiate rapid transport to appropriate facility. Remember the “Platinum 10 Minutes.”
5. Note: There is no clear evidence that use of the pneumatic anti-shock garment (PASG) is beneficial for treating shock. Consult local protocol. If used, the PASG should not delay patient transport.

Question 35

Describe high-quality chest compressions.

Answer 35

• Rate of compression: 100-120 per minute
• Adult: 2 inches-2.4 inches
• Pediatric: 2 inches
• Infant: 1 1/2 inches
• Single rescuer (any age): 30:2
• Two rescuers with infants and children: 15:2
• Allow full chest recoil between compressions
• Minimum interruption in chest compressions
• CAB sequence, not ABC sequence, is used for unresponsive patients
• Do not delay checking a pulse or initiating chest compressions to look, listen, and feel for respirations
• AED is indicated for infants as well as pediatric and adult patients in cardiac arrest
• Avoid hyperventilation
• Patients with a pulse but inadequate breathing
• Adults: 1 breath every 5 to 6 seconds (10 to 12 breaths per minute)
• Infants and pediatric patients: 1 breath every 3 to 5 seconds (12 to 20 breaths per minute)
• Patients with advanced airway
• 1 breath every 6 seconds (10 breaths per minute)
• No pause in compressions with advanced airway

Question 36

What are two types of AEDs?

Answer 36

• Fully automated external defibrillators. These AEDs do not require the operator to push a button to deliver a shock.
• Semi-automated external defibrillators. These AEDs wil not shock until the operator pushes the shock button.

Question 37

Describe the steps of using an AED.

Answer 37

1. Confirm cardiac arrest and safe conditions for use of the AED.
2. Initiate CPR and obtain an AED.
3. Turn on the AED and follow the prompts.
4. Expose the chest.
5. Remove medication patches and piercings as needed.
6. Dry the chest if wet.
7. Shave excess hair as needed.
8. Apply appropriate pads (sternum/apex position, anterior/posterior position, biaxillary position).
9. Avoid placing pads directly over pacemaker, implanted defibrillator, etc.
10. Deliver shock as indicated.
11. Ensure everyone is clear prior to delivery of shock.
12. Resume CPR immediately.
13. Re-analyze following two minutes of CPR.
14. Initiate transport after third shock or “no-shock” advisory, or per local protocol.

Question 38

Describe special circumstances while using an AED.

Answer 38

• Hypothermic patients should typically be transported after only one shock.
• AEDs cannot typically be used in a moving ambulance.
• For witnessed cardiac arrest, the AED should be utilized as soon as possible.
• For unwitnessed cardiac arrest, it is acceptable to perform two minutes of CPR before utilizing the AED.
• Pediatric AED pads should be used on pediatric patients. However, adult pads should be used if pediatric pads are not available and ALS rescuers are not present with a manual defibrillator.

Question 39

What are the four “Ds” for withholding resuscitation?

Answer 39

• Decapitation
• Dependent lividity: blood pooling in the most gravity-dependent area of the body
• Decomposition
• A Do Not Resuscitate (DNR) order