Chapter 13: Shock Flashcards
The Perfusion Triangle
Heart: Can’t pump = no perfusion!
Blood Vessels: If dilate too much, volume of fluid in the body is not enough to perfuse into all parts of body. You want the whole cylinder filled.
Blood: Not enough blood = cylinder can not be filled.
Cardiogenic Shock
Failure of the grand pump (heart).
Signs and Symptoms: Chest pain, irregular pulse, weak pulse, low blood pressure, cyanosis, cool clammy skin, anxiety, crackles, PULMONARY EDEMA
Blood backs up into the pulmonary vessels (rtb) - not everything gets out on time. Excess fluid finds it’s way into the capillaries of the lung like water falling into sand. Leads to pulmonary edema: the spacing out of cells due to large amounts of fluid (path oxygen + redblood cells must travel to cells increases).
Eventually blood begins to encase the alveoli = oxygen can not diffuse. Rapid respirations to compensate (tachypnea).
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Story Varies.
Obstructive Shock
Mechanical obstruction of cardiac muscle = decreased output (low volume).
Tension Pneumothorax, cardiac tamponade, pulmonary embolisim.
Signs and Symptoms: a lot
Distributive Shock
Dilation of the blood vessels. Problem is throughout the body.
4 Common: septic, neurogenic, anaphylactic, and psychogenic
Septic Shock
INFECTION! Small fellas that aren’t cool start breaking down the vessels by carving out little holes = prevents vessels from constricting! Overdilation problem occurs.
Signs and Symptoms: warm skin, fever Temp = 103.3 deg F! , tachycardia, low blood pressure
Neurogenic Shock
Ah fuck! Spinal cord damage = loss of control for autonomic nervous system for rest of body. Constriction of muscles below the spinal injury is no longer possible. Blood dilation occurs. Overdilation = heightened risk for hypothermia.
Signs and Symptoms: Neck Injury, normal skin color and temperature, bradycardia, LBP, loss of control of everything
Hypothermia is also coommon as the body loses it’s ability to control body temperature.
Anaphylactic Shock
Allergic reaction causes widespread vascular dilation and bronchoconstriction. 4 types: injections, stings, ingestion, amd inhalations.
Symptoms: Mild itching or rash, burning skin, vascular dilation, -> generalized edema, coma
Psychogenic Shock
Sudden reaction occurs in nervous system causing a over dilation error in the vascular system. Blood leaves brain = sleep sleep (syncope = fainting).
Psychogenic: Rapid pulse, normal or LBP
Hypovolemic
Not enough fluid. Blood loss = hemorrhage. Vomit, pissing, shitting = dehydration.
Symptoms: Rapid, weak pulse, LBP, change in mental status, cyanosis, cool clammy skin, increased respiratory rate
Tension Pneumothorax
A cause obstructive shock. Air is builds up within the pleural space (tissue that covers the lungs) eventually displacing thoracic entities (heart, other organs, vena cava obstruction occurs. Limits cardiac output due to obstruction.
Changes from a simple to a tension once the air builds up enough to compress the heart. Affects preload and afterload of heart.
Indications: hypoxia, chest wall crepitus, diminished breath sounds, tachypnea, tachycardia, hypotension, tracheal deviation, and the presence of a sucking chest woundallhave been used to help make the diagnosis. (Abscence of sound on one lung but not the other also a clear sign.)
Tracheal deviation is a late stage change.
Cardiac Tamponade
Obstructive shock. Fluid builds up in pericardial sack which prevents the heart from beating effectively. Ventricles no longer fill with blood = poor perfusion = shock.
Signs and Symptoms = Beck’s Triad
1. Jugular Vein Distension
2. Muffled Heart Sounds
3. Narrowing Pulse Pressure
Pulmonary Embolism
Blood clot in the pulmonary (lung) arteries. Right ventricle gets overloaded with nonoxygenated blood = catastrophic.
General Treatment of Shock
- Stop any lifethreatening issues (lots of bleeding)
- Secure Airway
- Provide Oxygen + Assisted Ventilations
- Keep Warm (Shunting occurs)
- Rapid Transport
- ALS if convenient
