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Flashcards in Shock & Resuscitation Deck (42):
1

Shock

Inadequate tissue perfusion. Also called hypoperfusion.

2

Compensatory shock (S&S)

The stage of shock in which a cascade of organ and gland stimulation and hormones occurs to increase the blood pressure, restore arterial wall tension, and maintain a near normal blood
pressure and perfusion of the vital organs. Also called compensated shock.

Signs & Symptoms:
- Normal to anxious mental status
- Increased HR
- Weak peripheral pulses
- Increased RR
- Normal BP
- Pale, cool skin (hypovolemic)
- Warm, dry (distributive)
- Increased cap refill time
- Nausea & vomiting

3

Decompensatory
shock

An advanced stage of shock in which the body's compensatory mechanisms can no longer maintain a blood pressure and perfusion of the vital organs. Late signs of shock develop. Also called decompensated shock or progressive shock.

S&S:
- Decreased mental status
- Significantly Increased HR
- Very weak peripheral pulses
- Increased RR
- Decreased BP
- Severely pale, clammy skin (hypovolemic)
- Cool (distributive)
- Dilated pupils
- Thirst
- Nausea & vomiting

4

Irreversible Shock

When the body cannot maintain perfusion to vital organs. Patient may die of organ failure later, even if vital signs are restored on scene.

S&S:
- Severely decreased mental status (Unresponsive)
- Decreased HR
- Absent peripheral pulses
- Increased RR
- Severely decreased or absent BP
- Cold, cyanotic, mottled
- Dilated pupils

5

Hypovolemic
shock

Shock from the loss of whole blood from the intravascular space. Can result from open wounds (hemorrhagic shock), crush injuries, burns, & dehydration.

6

Cardiogenic
shock

Poor perfusion resulting from an ineffective pump function of the
heart, typically the left ventricle.

7

Metabolic/ Respiratory shock

Dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, off-load at the cell, or be used effectively
by the cell for metabolism.

8

Obstructive shock

A poor perfusion state resulting from a condition that obstructs forward blood flow.

9

Distributive shock

Shock associated with a decrease in intravascular volume caused by massive systemic vasodilation and an increase in the capillary permeability.

10

Anaphylactic
shock

A shock state that results from dilated and leaking blood vessels related to severe allergic reaction.

11

Neurogenic shock

A type of distributive shock that results from massive vasodilation. Also called vasogenic shock. Due to nerve paralysis, often from spinal cord injuries

12

Septic shock

A type of distributive shock caused by an infection that releases bacteria or toxins into the blood.

13

Hemorrhagic shock

Shock from the loss of whole blood from the intravascular space.

14

Nonhemorrhagic
hypovolemic
shock

Shock caused by loss of fluid from the intravascular space with
red blood cells and hemoglobin remaining within the vessels.

15

Burn shock

Shock caused by loss of fluid from the intravascular space with
red blood cells and hemoglobin remaining within the vessels

16

Characteristics of Shock in Pediatric Patients

- May not have developed speech or may be uncomfortable with strangers, which makes it difficult for them to communicate their sickness
- Have less muscle mass, which makes them more susceptible to the cold
- Generally stay in compensated shock for longer periods of time, but can deteriorate quickly from compensated to decompensated shock

17

Characteristics of Shock in Geriatric Patients

- Commonly have multiple medicines that may affect their ability to compensate for shock (medications can also mask effects of shock)
- Have less muscle mass, which makes them more susceptible to the cold
- May be hard of hearing and have difficulty seeing and/or hearing, which makes communication difficult

18

Treatment for Shock

- High flow oxygen
- Lay patient supine or in Trendelenburg
- Control external bleeding, splint injuries if time permits
- Cover patient with blanket to conserve warmth
- Consider PASG application

19

Indications & Contraindications for PASG use

Indications:
-Pelvic fracture in patient w/ hypotension
-Controlling bleeding in lower extremities
-Can help control internal bleeding

Contraindications:
-Any patients with difficulty breathing
-Penetrating chest injury
-Eviscerating abdominal injury
-Pregnancy (inflate legs only)
-Cardiac arrest

20

Cardiac arrest

The cessation of cardiac function with the patient displaying no
pulse, no breathing, and unresponsiveness.

21

Chain of survival

Term used by the AHA for the series of
four interventions that provides the best chance for
successful resuscitation of a cardiac arrest patient.

- Early access
- Early cardiopulmonary resuscitation (CPR)
- Early defibrillation
- Early advanced cardiac life support (ACLS)

22

Defibrillation

Electrical shock or current delivered to the heart through the
patient's chest wall or internally from an implanted device to help
the heart restore a normal rhythm.

23

Automated
external
defibrillator (AED)

A device that can analyze the electrical activity or rhythm of a
patient's heart and deliver an electrical shock (defibrillation) if
appropriate.

24

Resuscitation

An attempt to restore normal or adequate physiologic function.

25

Electrical Phase

The electrical phase begins with the onset of cardiac arrest and lasts to approximately the 4-minute mark
- Heart and brain still have enough oxygen, glucose, and other nutrients to survive without any cellular death.
- Primary focus is restoring the electrical rhythm of the heart
- Heart is receptive and readily respondent to defibrillation

26

Circulatory Phase

- The circulatory phase follows the electrical phase (4-10 min)
- Glucose & oxygen stores in heart & brain are low - Without these stores, it is not prepared or readily receptive to defibrillation
- 2 min CPR before delivering any defibrillation attempts with the AED. These two minutes of CPR will circulate the blood and add the necessary levels of oxygen and glucose the heart needs to respond to the defibrillation
- Survival rates drop, sustaining damage to heart/body is more likely

27

Metabolic Phase

The metabolic phase begins immediately after the circulatory phase ends (10+ min)
- Heart is starved of oxygen and glucose
- Severely toxic build-up of acid and waste products is found in the blood, cell death begins to occur--> then organ death, then brain death
- If resuscitation does occur, the patients die later due to irreversible organ death.

28

Reasons for Withholding CPR

- Presence of a Do Not Resuscitate (DNR) form
- Presence of a Physician Orders for Life-Sustaining Treatment (POLST) form
- Presence of a Medical Orders for Life-Sustaining Treatment (MOLST) form
- Decapitations or other mortal wounds that are not compatible with life
- Presence of rigormortis, decomposition, or other obvious signs of death

29

Ventricular
fibrillation (V-Fib)

A continuous, uncoordinated, chaotic rhythm that does not produce pulses.

30

Ventricular
tachycardia (VT or
V-Tach)

A very rapid heart rhythm that may or may not produce a pulse and is generally too fast to adequately perfuse the body's organs.

31

Return of
spontaneous
circulation
(ROSC)

A return of a spontaneous pulse during the cardiac resuscitation.

32

Asystole

A heart rhythm indicating absence of any electrical activity in the
heart. Also known as flatline.

33

Downtime

The time from when the patient goes into cardiac arrest until
CPR is effectively being performed.

34

Pulseless
electrical activity
(PEA)

A condition in which the heart generates relatively normal electrical rhythms but fails to perfuse the body adequately because of a decreased or absent cardiac output from cardiac muscle failure or blood loss.

35

Sudden death

Death of a patient within one hour of the onset of signs and
symptoms.

36

Total downtime

The total time from when a patient goes into cardiac arrest until
he is delivered to the emergency department.

37

Placement of AED Pads (Traditional & Alternative)

Traditional:
- Sternum pad (-) on the upper-right border of the sternum just below the clavicle
- Apex pad (+) over the lower-left ribs at the anterior axillary line

Alternative:
- Posterior electrode (-) near the center of the back, one or two inches above the anterior pad
- Anterior electrode (+) over the apex of the heart

38

Before shocking a patient w/ AED, EMT should...

- Remove medication patches
- Look for pacemakers or similar devices and avoid placing pads over these areas
- Ensure that no one, including the operator, is touching the patient or a conducting object
- SAY: “I'm clear; you’re clear. Everyone is clear.”
before shocking
- If cardiac arrest has been going on for less than four minutes, apply AED immediately.
- If cardiac arrest has been going on for more than 4 minutes, do 5 cycles of 30:2 CPR (2 min of CPR)

39

Impedance Threshold Device

An impedance threshold device, such as the ResQPOD, augments blood flow back to the heart by maintaining the intrathoracic pressure within the chest
- This improves perfusion during CPR, which improves the outcome of the patient during cardiac arrest.
- Attaches to ETT or b/w blind insertion device and bag valve device

40

Effectiveness of CPR compared to normal heart

20-30% as effective as heart beating normally when performed perfectly

41

CPR Compressions per breath (adult & pedi)

- 30:2 for adult CPR regardless of whether one or two people are performing the CPR
- 30:2 for child/infant CPR for one person
- 15:2 for child/infant CPR for two people

42

CPR compressions per minute

100