shock and CPR

Cardiogenic shock (pump failure)

Where the heart muscle cannot generate sufficient cardiac output

Obstructive shock

Caused by mechanical obstruction that physically prevents blood from returning to the heart, filling the ventricles or being pumped out to the body

Obstructive Shock sub categories

Cardiac tamponade

Tension phuemothorax

Pulmonary embolism

Disruptive shock

Occurs when there is widespread dilation of small arterioles and venules

Disruptive shock sub categories

Septic shock

Neurogenic Shock

Anaphylactic shock

Psychogenic shock

Hypovolemic shock

Caused by an inadequate volume of fluid or blood within the circulatory system

Hypovolemic Shock sub categories

Hemorrhagic shock (blood loss)

Non hemorrhagic shock (fluid loss from dehydration or severe burns)

The 3 basic causes of Shock (the perfusion triangle)

The pump (heart)

The container (blood vessels)

The content (blood/fluid volume)

Define psychogenic shock

A sudden temporary vascular dilation caused by a reaction of the nervous system leading to temporary fainting (syncope) due to reduced blood flow to the brain

Capillary refill meaning and normal value

Assesses skin perfusion (see blood return within 2 seconds)

Define shunting blood flow

To protect vital organs from hypoperfusion the body automatically redirects bloodflow away from the organs that tolerate low flow well and directs it to vital organs that cannot tolerate low flow

What are the stages in the progression of Shock

Compensated shock

Decompensated shock

Irreversible shock

Define compensated shock

The early stage where the body's compensatory mechanisms (ans) successfully maintain blood pressure and vital organ perfusion

Define decompensated shock

The late stage when compensatory mechanisms fail, leading to an evident drop in blood pressure

Define Irreversible shock

The final terminal stage where severe cellular damage leads to tissue death and organ failure

Define cardiac tamponade

Fluid or blood accumulates in the pericardial sac, compressing the heart walls

Define tension pneumothorax

Air builds up in the chest cavity collapsing the lung and exerting high pressure on the heart and great vessels

Define pulmonary embolism

A blood clot blocks the pulmonary artery, stopping blood flow through the lungs and backing up blood into the right side of the heart

Define septic shock

Severe bacteria infection where bacterial toxin increase vessel dilation and capillary permeability, causing plasma leakage and hypovolemia

Define neurogenic shock

High spinel cord injury severing sympathetic nerve control, causing vessels below the injury to dilate widely and pool blood

Define anaphylactic shock

Severe allergic reaction caused by rapid massive vasodilation and airway obstruction

Define hypovolemia

Blood/fluid loss

Define psychogenic shock

Sudden, temporary vascular dilation causing syncope

General shock treatment includes all or some of the following

Stabilizing spinal injury, keep warm with blankets, bleeding control, high flow oxygen, rapid transport, epi ( anaphylaxis ), supine

Shock associated with fever signs

Fever combined with hypotension, tachycardia, mottled skin

(Treated as septic Shock)

Common complications in neurogenic shock

Absence of compensatory tachycardia (presents normal or slow heart rate due to loss of sympathetic tone)

Absence of peripheral vasoconstriction ( causes hypotension and warm skin initially below the injury level

Loss of body heat / hypothermia

Which shock type causes pulmonary edema

Cardiogenic shock: fluid backs up into pulmonary vessels and leaks into the alveoli (pulmonary edema), preventing oxygen diffusion across the lungs

3 specific most common causes of hypovolemic shock

Severe traumatic hemorrhage (internal or external blood loss)

Severe thermal burns

Severe dehydration

Apnea or cardiac arrest times and effects

0-4 minutes: brain damage is not likely

4-6 minutes: brain damage is possible

6-10 minutes: permanent brain damage is very likely

More Than 10 minutes: irreversible brain damage

Define mild obstruction signs

Can exchange air, talk, cough (may present with wheezing or stridor)

Encourage to cough and monitor

Which Shocks require ALS

Sepsis (iv antibiotics)

Tension pneumothora (needle decompression)

Burns (iv hydration)

Complete severe obstruction signs

Patient cannot speak, cough, or breathe becomes cyanotic (requires immediate physical intervention

Treatment For responsive patients over a year old with an airway obstruction

Perform alternating back slaps and abdominal thrusts (use chest thrusts for pregnant or obese patients)

Treatment For responsive patients under a year old with an airway obstruction

Perform 5 back slaps followed by 5 chest thrusts ( do not use abdominal thrusts)

Switch compressor roles every _ minutes

2

What are the two shockable rhythms

V fib

V Tach

What are the two non shockable rhythms

aSystole

PEA

When do compressions switch to a 15:2 compression to ventilation ratio

Infants and children on a 2 person rescue

Compression to ventilation ratio on adults

30:2

Compression rate per minute

100 to 120/min

Adult CPR depth

2 inches (5cm)

Infant CPR depth

1/3 chest depth (1.5 in)

Adult breath rate

1 breath every 5-6 seconds

Infant and child breath rate

1 Breath every 2-3 seconds