shock recognition and management

circulation - consider shock, affects vital organs

neurogenic

septic

toxic

cardiogenic

hypovolemic

haemorrhagic

treat shock before tq replacement

shock - o2 demands of cells aren’t met, leading to hypoxia - most likely to present as hypotension

s + s

  • weak or absent radial pulse major sign

  • pulse assessment (thready, faint, irregular)

  • altered mental state (avpu ever 15 mins) major sign

  • control bleeding, confirm all indications are effective

  • better to prevent shock than treat it - deal with it early. don’t wait for s+s to occur

hypovolemic shock - not enough volume circulating body

  • haemorrhagic

  • d + v

  • diabetic ketoacidosis

  • burns

disruptive shock - not enough perfusion due to maldistribution

  • neurogenic shock

  • anaphylaxis

  • sepsis

obstructive shock - not enough cardiac output due to mechanical obstruction

  • pulmonary embolism

  • tptx

  • cardiac tamponade

  • acute ivc or svc obstruction

cardiogenic - not enough cardiac output due to cardiac failure

  • mi

  • late sepsis

  • overdose

  • heart block

hypothermia - cold, give blanket

coagulopathy - loss of clotting factors in platelets

acidosis - buildup of lactic acid, give fluids (to make up volume, not to replace blood)

refractory shock - fatal manifestation of cardiovascular failure, inadequate response to shock interventions leads to hypotension and organ failure

  • s+s of tptx

  • thoracic trauma

  • resp distress

  • absent breath sounds

  • spo2 <90

if not already treated for tptx, do needle decompression if not responding to fluids