Chapter 13 EMT Basic

hypothermia

general cooling of the body -> internal body temperature is concerningly low - prolonged exposure to cool or freezing temperature

how is CO2 carried

plasma, hemoglobin, bicarbonate

shock

hypoperfusion affecting the entire body

organs and tissues receive inadequate supply of blood and oxygen

inadequate central or periphral circulation in whole body

low blood volume can lead to cellular injury or death

pulmonary edema

buildup of pulmonary fluid prevents gas exchange

homeostasis

balance of body

bicarbonate

becomes higher when carbon dioxide is produced and lower when exhaled

CO2 mixes with water

in cases of poor perfusion

- transportation of CO2 out of tissues is impaired - results in excessive waste -> cellular damage

what are some patrs of the body that can tolerate shock better than other organs

skin and intestines

perfusion triangle

need pump, container, and content function to all work in the heart for adequate perfusion

pulse pressure

- difference between systolic and diastolic pressures - signifies the amount of force the heart generates with each contraction

pulse pressure less than ___ mmHg may be seen in patients with shock

25

what regulates blood flow through capillary beds

capillary sphincters

capillary sphincters

circular walls that constrict and dilate -> also respond to other stimuli such as heat, cold, need for oxygen or waste removal

peripheral vasoconstruction

reducing blood flow to skin and sends to more important organs

what does hormone increase

heart rate, strength of cardiac contractions, peripheral vasoconstriction

three basic causes of shocks

- pump failure - poor vessel function - low fluid volume

major effect of cardiogenic shock

backup of blood into pulmonary vessels -> forces fluid out of capillary beds -> leads to pulmonary edema

edema

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

what does edema lead to

tachypnea, crackles, rales

what does the heart need to pump blood

• adequate pressure for muscular contraction

• adequate # of heartbeats

what does cardiac output depend on adequate

- low myocardial contractility - low preload - high afterload

preload

amount of blood to pump

myocardial contractility

contractility of heart muscles

afterload

resistance to flow in peripheral circulation

what happens as preload increases

volume of blood within ventricles increases -> causes muscles to stretch -> myocardial contractility and cardiac output increases

high afterload

lower cardiac output -> heart overworks to maintain cardiac output

obstructive shock

mechanical obstruction that prevents blood filling into heart chambers

most common examples of obstructive shock

• cardiac tamponade

• tension pneumothorax

• pulmonary embolism

signs and symptoms related to cardiac tamponade

beck triad

cardiac tamponade aka

pericardial tamponade

beck triad

JVD, muffled heart sounds, narrow pulse pressure

narrow pulse pressure

systolic and diastolic blood pressures start to merge (become similar)

massive pulmonary embolism

- complete backup of blood in right ventricle - leads to catastrophic obstructive shock and complete pump failure

four most common types of distributive shock

• septic

• neurogenic

• anaphylactic

• psychogenic

distributive shock

- results from widespread dilation of small arterioles, small venules, or both - circulating blood volume pools in expanded vascular beds - tissue perfusion decreases

septic shock

• occurs as a result of severe infections in which toxins are generated by bacteria or be infected body tissues

• toxins damage vessel walls, causing increased cellular permability

• vessel walls leak and are unable to contract well

• widespread dilation fo vessels, in combination with plasma loss through vessel walls, results in shock

• capillaries leak and volume from the blood vessels move into interstitial space

• less blood returning to heart to pump

neurogenic shock

• usually result of high spinal cord injury

• nerve impulses to blood vessels below the level of the injury are blocked

• all vessels cut off from nerve impulses will dilate, causing blood to pool

• change of vascular system led to shock

what causes neurogenic shock

- brain conditions - tumors - spinal cord pressure - spina bifida

signs and symptoms of neurogenic shock

• absence of sweating below injury

• normal and low heart rate during hypotension, normal, warm skin

• hypothermia

• can't control body temperature

what is the only type of shock that does not have pale, cool, skin

neurogenic shock

four categories of exposure for anaphylactic shock

- injections - stings - ingestion - inhalation

injections

tetanos antitoxin, penicillin

stings

wasps, bees, hornets, ants

ingestion

fish, shellfish, nuts, eggs, etc

inhalation

dust, pollen, mold

late sign of anaphylactic shock

cyanosis

anaphylactic shock

• occurs when a person reacts violently to a substance to which he or she has been sensitized

• each subsequent exposure tends to produce a more severe reaction

sensitization

means becoming sensitive to a substance that did not initially cause a reaction

psychogenic shock

• caused by a sudden reaction of the nervous system

• produces temporary, generalized vascular dilation

• syncope

life threatening psychogenic shock

irregular heartbeat and brain aneurysm

nonlife threatening events psychogenic shock

receipt of bad news or experiencing fear or unpleasant sights such as blood

dehydration common factor

insufficient volume of fluid within vascular system for circulation

when does hypovolemic shock occur

- severe thermal burns - dehydration

crushing injuries hypovolemic shock

blood and plasma loss from damaged vessels into injured tissues -> excessive swelling

stages in the progession of shock

• compensated shock

• decompensated shock

• irreversible shock

compensated shock

early stage when body can still compensate for blood loss

decompensated shock

late stage when blood pressure is falling

irreversible shock

inability to successuflly achieve resuscitation regardless of methods employed

last measurable factor to change in shock

blood pressure

blood pressure during shock

• when blood pressure drops, shock is well developed especially in infants and children -> close to death

• infants and children can maintain blood pressure drop until 1/2 blood volume lost

other conditions where you should expect shock

• severe fractures

• abdominal or chest injury

• spinal injury

• severe infection

• major heart attack

• anaphylaxis

• hemorrhage

signs and symptoms of cardiogenic shock

• chest pain

• low blood pressure

• weak, irregular pulse

• cyanosis

• anxiety

• nausea

• cclawn

treating cardiogenic shock

• no nitroglycerin as hypotenesive

• oxygen, ventilations, ALS, transport

what is the most definitive treatment for cardiac tamponade

surgery

pericardiocentesis

penetrating pericardium with enedle to withdraw accumulated blood from pericardial sac

treating septic shock

• need hospital management

• standard precautions and transport

• oxygen

• ventilations

• blankets

• sepsis team

what to do at hospital for treating septic shock

expeditious administration of antibiotics

treating neurogenic shock

• ABC

• spinal immobilization

• conserve body heat

• transport

treating anaphylactic shock

• transport

• oxygen, ventilation

• can worsen

• ALS

• determine what agent caused the reaction and how it was received

how can anaphylactic shock was received

mouth, inhalation, injection

best way to administer anaphylactic shock

epinephrine

treating psychogenic shock

• can worsen

• check for injuries if fall

• transport to ED even if LOC is normal

treating hypovolemic shock

• control bleeding

• warmth

• ABC

• transport

treating shock in older patients

• more esrious complications

• same as treating shock in general