Chapter 13: Shock, Emergency Care and Transportation of the Sick and Injured, 12th Edition

Hypoperfusion

Inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. A life-threatening condition. Also called shock.

Perfusion Triangle

The heart (the pump)

The pipes (blood vessels or arteries)

The contents of container (blood)

When a person is in shock one or more of these will not work properly.

Pulse Pressure

Systolic pressure - diastolic pressure; signifies the amount of force the heart generates with each contraction. Pressure less than 25 may be seen in patients with shock.

Cardiogenic Shock

Caused by inadequate function of the heart, or pump failure.

Preload

Volume of blood in ventricles at end of diastole.

Afterload

The force or resistance against which the heart pumps. How much resistance in the vascular system the heart has to pump against.

Edema

The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area.

Pump Failure

Cardiogenic, Obstructive.

Poor Vessel Function

Distributive shock (septic shock, neurogenic shock, anaphylactic shock, psychogenic shock)

Low Fluid Volume

Hypovolemic shock (hemorrhagic shock, non-hemorrhagic shock)

Embolism

Obstruction of a blood vessel by a clot of blood or foreign substance.

Obstructive Shock

Caused by a mechanical obstruction which prevents an adequate volume of blood to fill the heart chambers.

Pulmonary Embolism

A blood clot that occurs in the pulmonary circulation and blocks the flow of blood through the pulmonary vessels.

Tension Pneumothorax

A pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels.

Cardiac Tamponade

Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.

Becks Triad

Hypotension, JVD, muffled heart sounds; cardiac tamponade.

Distributive Shock

Results when there is widespread dilation of the small arterioles, small venules, or both.

Septic Shock

Shock caused by severe infection, usually a bacterial infection.

Neurogenic Shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.

Anaphylactic Shock

A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Characterized by bronchoconstriction, labored breathing, widespread vasodilation, circulatory shock, and sometimes sudden death.

Psychogenic Shock

Shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting (syncope).

Hypovolemic Shock

Result of an inadequate amount of fluid or volume in the circulatory system.

Deep Vein Thrombosis (DVT)

Blood clot (thrombus) forms in a large vein, usually in a lower limb.

Compensated Shock

Early stage of shock, while the body can still compensate for blood loss.

Decompensated Shock

The late stage of shock when blood pressure is falling.

Erticaria

Hives

<90 systolic

A measure of decompensate shock.

Progression of Shock

Any PT showing signs and symptoms of shock gets 15ml of oxygen via non-rebreather at a minimum, and should be laying supine. Elevate feet if no injury and cover with a blanket.

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Cariogenic Shock Signs

Low blood pressure

A weak, irregular pulse

Cyanosis around the lips and underneath the fingernails

Anxiety

Nausea

Cardiac Tamponade Treatment

Increasing cardiac output should be the priority.

Apply high-flow oxygen.

The only definitive treatment for cardiac tamponade is surgery.

Tension Pneumothorax Treatment

Administer high-flow oxygen via nonrebreathing mask early.

The only action that can prevent death from a tension pneumothorax is decompression, an ALS skill.

Septic Shock Treatment

Standard precautions. Requires complex hospital management. Transport promptly. High flow O2 and/or ventilation support. Use blanket to conserve heat.

Neurogenic Shock Treatment

Obtaining and maintaining a proper airway

Providing spinal stabilization

Assisting inadequate breathing as needed

Conserving body heat

Ensuring the most effective circulation possible.

Anaphylactic Shock Treatment

Administer epi.

Prompt transport.

High flow O2.

Consider ALS backup.

Psychogenic Shock Treatment

Transport patient promptly. Check for injuries.

Hypovolemic Shock Treatment

Control obvious bleeding.

Keep warm.

Maintain airway.

High flow O2

Watch for aspiration.

Transport ASAP.