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Flashcards in Shock Deck (15)
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1

Shock - Definitiion

Inadequate blood flow resulting in tissue hypoxia

2

Goal of Care

Rapid transport to hospital. Fluid resuscitation where appropriate

3

Overview

pts in shock from any cause are critically ill and survival is dependent upon rapid appropriate therapy specific to the cause

Shock is a clinical diagnosis: signs include inadequate perfusion of the skin - cold, clammy, cyanotic
inadequate perfusion of the CNS - agitation, confusion, lethargy and coma

BP of 90 systolic is commonly used as a cut off to define shock but this is not universal and depends on the pts usual pressure

4

Stages of Shock - Compensated

is associated w/ some decreased tissue perfusion but the bodys compensatory responses are sufficient to overcome the decreas in available fluid.

An increase in catecholamine production maintains cardiac output and a normal systolic blood pressure. Perfusion to vital organs is maintained by moving blood flow from the non-vital organs (eg skin) causing the initial symptoms of cold and clammy skin

5

Stages of Shock - Uncompensated Shock

occurs when the body is no longer able to maintain blood pressure. As the bodys compensatory mechanisms begin to fail, systolic pressure drops and signs of vital organ ischemia appear

6

Categories of Shock

- Hypovolemic

- Distributive

- Obstructive

- Cardiogenic

7

Hypovolemic Shock

Critical decrease in intravascular volume

- Hemorrhagic
- Vomiting/diarrhea
- Burns

8

Distributive Shock

Inadequate intravascular volume due to vasodilation

Increased capacity for blood to pool in the vascular bed

- Anaphylaxis
- Sepsis
- Neurogenic associated w/ brain or spinal cord injury

9

Obstructive Shock

Reduction in cardiac output usually associated w/ obstruction (mechanical or pressure) in the cardiopulmonary circuit

- Cardiac tamponade
- Tension pneumothorax
- Pulmonary embolus

10

Cardiogenic Shock

Inability of the heart to pump efficiently

- AMI
- Arrhythmia
- Valve failure
- Ruptured cardiac septum

11

Guiding Principles

Causes of shock requiring specific treatment in the field:

Anaphylaxis - EPI

Hypovolemia - Fluid

Tension pneumothorax - Chest decompression

Arrhythmia - Cardioversion

12

Special Note

IV fluids should be used judiciously in pts w/ cardiogenic shock. Discuss the case w/ an EP if possible prior to administering a fluid challenge to theses pts

13

Intervention Guidelines EMR/PCP

EMR
- Keep pt at rest
- Supp O2
- Position pt
- Consider possibility of anaphylaxis
- Facilitate rapid transport
- Provide warmth
- Assess for likely cause of shock

PCP
All above, plus:
- IV during transport
Correct hypoperfusion - hypotension BP <90
- Fluid challenge if no pulmonary edema
NS upto 2L - reassess BP and lungs every 500cc - target 90 systolic

14

Intervention Guidelines - ACP

- Consider Arrhythmia
- Tension pneumothorax

15

Further Care

- Fluid resuscitation including blood products and colloid solutions
- Central line
- Blood gas. Lab monitoring
- Sepsis management
- Steroids
- Radiology diagnostics
- Pressor support
- Surgery