Chapter 13: Shock and Resuscitation Flashcards
Shock/Perfusion Triangle
State of collapse and failure of cardiovascular system
pipeing: Vessels
pump: Heart
fluid: Blood
Perfusion
Circulation of blood to tissues in adequate amounts to meet cell’s demands
Pulse pressure
Difference between systolic and diastolic
Capillary Sphincters
-Controlled by autonomic NS
-Regulate involuntary functions such as sweating and digestion
Types of Shock
Pump Failure
Cardiogenic shock (inadequate function)
-Leads to edema (backup)
-High afterload, low preload, poor contractility
Obstructive shock (obstruction prevents blood distribution)
-Tension pneumothorax
-Cardiac tamponade
-Pulmonary embolism
Poor Vessel Function
Distributive shock
-Septic shock
-Neurogenic shock
-Anaphylactic shock
-Psychogenic shock
Low Fluid Volume
-Hemorrhagic shock
-Nonhemorrhagic
Preload
Blood coming into heart
Afterload
Force against the heart pump (resistance)
Pulmonary embolism vs thrombus
Thrombus is static
Embolism- Blood clot that occurs in the pulmonary arteires
Obstructive Shock
Tension pneumothorax
-Damaged to lung tissue
-Lung collapses
-Shifting of chest organs in mediastinum (JVD, tracheal deviation)
Cardiac Tamponade
-Collection of fluid in pericardial sac and myocardium
-Prevent arteries from filling up with blood
Pulmonary Embolism
-Blockage from a previous blocked area
Treatment
-O2
-Comfort
-Assist ventilations
-Consider ALS
-Transport
Distributive shock
Results from widespread dilation of small arteries and venules
Septic
-Infection and fever
Neurogenic
-Spinal cord injury
-Nerve impulses to blood vessels are blocked
-All vessels dilate (loss of sympathetic tone)
Anaphylactic
-Exposed person reacts violently
-Sensitization; becoming sesnitive to something and increasingly worsen
Signs and symptoms
-Puritis (itching)
-Palor (pale)
-Respiratory issues (stridor, tightness)
-GI issues
-Uticaria (hives)
Treatment: Epi (adrenaline)
Psychogenic Shock
-Syncopal episodes
-Vasodilation
-Lack of blood to brain
-Non lifethreatining
Hypovolemic Shock
-Inadequate amount of fluid or volume in circulatory system
-Hemorrhagic shock
Blood loss
-Non hemorrhagic shock
O2 availability does not meet the pt demands
-Thermal burns, emesis, GI
-Loss of salts, heat
Treatment
-Pressure
-Tourniquet
Progression of Shock
Compensated shock
-Agitation
-Feeling of impending doom
-Pulse is weak, rapid, thready
-Pallor and cyanosis
-Cap refill no longer than 2 secs
-Narrowing pulse pressure
Decompensated shock
-Falling BP below 90 systolic
-Labored or irregular breathing
-Ashen, mottled and cyanotic shock
-Dilated pupils
-Poor urinary output
*BP is a poor measure for change in shock
Irreversible Shock
-Inability to achieve resuscitation regardless of method
Shock Conditions
-Multiple severe fractures
-Abdominal or chest injury
-Spinal injury
-Severe infection
-Major MI
-Anaphylaxis
Secondary Assessments
Revisit:
-General impression
-CC
-ABCs
-Vitals
-Interventions
-Priority changes
EMS care for Shock
-Standard precautions
-Control bleeds
-Airway
-C spine precautions
-Comforting and calm
-Provide O2 and monitor Pt breathing
