National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Shock Chapter 10

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 10.1 Define shock Describe the basic components of the cardiovascular system: a.blood b.heart c.blood vessels 10.3 Describe the key components of blood Define cardiac output. continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 10.5 Compare and contrast the three stages of shock List the four types of shock Describe how the body compensates for shock List the classic signs and symptoms of shock Describe and demonstrate the management of shock.

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Types of Shock Factors Affecting Shock Patient Assessment Patient Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You notice an older man leaning on his ski poles near the edge of a run. You find that he was just “run over” by a hit-and-run skiier. He says that the impact “knocked the air out of me” but states that he is feeling better and “just wants to rest awhile.” You identify yourself and ask if you can examine him. As you gently touch his left upper abdomen and chest, he winces slightly. Your friends are calling for you. The man repeats that he is fine and tells you to “go on, I’m just going to stand here a little longer.”

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Heart Blood vessels Blood

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Stages of Shock Compensated shock Decompensated shock Irreversible shock continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Stages of Shock Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock Hypovolemic shock Cardiogenic shock Distributive shock ◦ Septic shock ◦ Anaphylactic shock ◦ Neurogenic shock continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock Obstructive shock ◦ Tension pneumothorax ◦ Pericardial tamponade ◦ Pulmonary embolism

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You suspect the patient may be injured and tell your friends ski without you while you evaluate the man. You sit the gentleman down and secure the area by placing both his and your skis in an “X” several yards above your location where they can be seen by people traveling downhill. You obtain a more complete history and assess the man. He states that he was recently prescribed a “blood thinner” to prevent clots and that he is taking a “beta blocker” for high blood pressure.

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update As you are talking with him, the man appears slightly confused and states, “I don’t feel very well.” Soon after, two members of your patrol arrive.

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Factors Affecting Shock Age Concurrent illness or injury Pre-existing medical condition Mind-altering substances or medications Prescription or over-the-counter (OTC) medications

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment MOI ◦ Scene size up ◦ Clues; suggestion possible shock Classic signs ◦ Tachycardia ◦ Hypotension ◦ Tachypnea ◦ Pale, cool, diaphoretic skin ◦ Altered mental status

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Management High flow oxygen Return to homeostasis Place in shock position Transport in head down position

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Management Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You inform the other patrollers that the patient is suffering from hypovolemic shock due to internal injuries made worse by a prescribed anticoagulant. Working with the other patrollers, you administer high-flow oxygen and place the man on a backboard with his feet elevated 8 to 12 inches. You ski down and help them move the patient into the first aid hut. Soon after, a helicopter arrives and transports the patient to a local trauma center.

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Chapter Summary Early recognition of the potential for shock is essential in reducing the number of deaths from this condition.

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Chapter Summary While recognizing the classic signs of shock is important, careful examination of the mechanism of injury combined with subtle changes in the patient’s level of consciousness or pulse pressure often provide early clues that the body is unable to meet its metabolic needs.

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary With few exceptions, treatment priorities focus on correcting problems affecting the ABCDs, delivering high- flow oxygen, and rapidly transporting the patient to a definitive care facility. By following this stratagem, OEC Technicians will significantly help reduce the number of shock-related deaths in the outdoor setting. continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Shock is caused by inadequate tissue oxygenation from poor blood circulation. There are four types of shock: hypovolemic, cardiogenic, distributive, and obstructive. Shock is a life-threatening condition. continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The longer shock goes uncorrected, the worse the chances for recovery. Early shock may be subtle due to physiological compensation. A “normal” blood pressure does not exclude early shock. The very young and very old do not compensate well for shock. continued

National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Maintain a high index of suspicion for shock.