Shock (صدمة)

Objectives At the end of this session, each student should be able to: Define shock. Identify general signs and symptoms of shock. Identify types of shock. Identify care management for shock.

Definition of Shock Shock is a state of inadequate delivery of blood (perfusion) to the cells. Shock requires IMMEDIATE (فوري) medical treatment. If not properly managed, the tissue damage becomes irreversible, and finally leads to multi-organ failure. في حال لم يتم معالجة الصدمة، سيحصل ضرر دائم بالأنسجة، وقد يتبعه فشل في عدة أعضاء عن العمل. The body cells most sensitive to lack of oxygen are in the heart, brain, and lungs. أكثر خلايا الجسم تأثرا بنقص الأكسجين هي خلايا القلب، الدماغ، والرئتين.

Shock’s General Signs and Symptoms علامات وأعراض عامة للصدمة Lusterless بدون لمعان وبريق جلد باهت وقاتم اللون

Types of Shock أنواع الصدمة Hemorrhagic Shock صدمة بسبب النزيف (نزفية) Also called: Hypovolemic Shock صدمة نقص حجم الدم Non-Hemorrhagic Shock Cardiogenic Shock صدمة قلبية المنشأ Septic Shock صدمة إنتانية (تسممية) Neurogenic Shock صدمة عصبية المنشأ (بالجهاز العصبي) Anaphylactic Shock صدمة تحسسية /Vasogenic Shock صدمة وعائية Psychogenic Shock صدمة نفسية المنشأ Metabolic Shock صدمة أيضية

Hemorrhagic (Hypovolemic) Shock صدمة بسبب النزيف (نزفية) (صدمة نقص حجم الدم) A sudden decrease in the volume of blood. Most common cause is hemorrhage (نزيف) due to: (1) stab wounds جروح ناتجة عن طعنات, (2) gunshot wounds جروح ناتجة عن طلقات الأسلحة, and (3) motor vehicle accidentsحوادث السير . Other causes for hypovolemic shock are: (1) dehydration الجفاف(caused by: excessive vomiting التقيؤand diarrheaإسهال ), and (2) burnsحروق .

Without sufficient blood or fluid replacement, hemorrhagic/hypovolemic shock may lead to: (1) irreversible cerebral and renal damage (ضرر دماغي وكلوي دائم), (2) cardiac arrest (توقف في عضلة القلب), and (3) death (الوفاة).

Non-Hemorrhagic Shocks الصدمات غير الناتجة عن نزيف Cardiogenic Shock صدمة قلبية المنشأ Neurogenic Shock صدمة عصبية المنشأ (بالجهاز العصبي) Anaphylactic Shock صدمة تحسسية Also called: Vasogenic Shock صدمة وعائية Septic Shock صدمة إنتانية (تسممية) Psychogenic Shock صدمة نفسية المنشأ Metabolic Shock صدمة أيضية

1. Cardiogenic Shock صدمة قلبية المنشأ It is a shock due to a decrease in the contraction ability of the heart muscle (myocardium) (هي صدمة ناتجة عن نقص في قدرة عضلات القلب على الانقباض). The most common cause is myocardial infarction (احتشاء عضلة القلب (موتها with greater than 40 percent muscle necrosis (موت خلايا بنسبة تتعدى 40% من مجموع خلايا القلب), in which the heart fails to circulate blood efficiently. Reduction in cardiac output ((نقص حجم الدم الخارج من القلب results in: (1) decreased circulating blood supply, and (2) decreased oxygen delivery.

2. Neurogenic Shock صدمة عصبية المنشأ (بالجهاز العصبي) It is a shock that results due to the failure of nervous system to control the diameter of blood vessels leading to peripheral vasodilatation.   Common causes are: (1) nerve paralysis (spinal cord or brain injuries), (2) severe blows ضربات شديدة to the abdomen, (3) hot bath or hot vapor bath, (4) certain drugs, and (5) hypoglycemia causing vasomotor center depression (تردي عمل المركز الحركي الخاص بالأوعية).

3. Anaphylactic/Vasogenic Shock صدمة تحسسية / صدمة وعائية It is a shock that results from an extreme and generalized allergic antigen-antibody reaction (تفاعل ضد مستضد) that may bring on vascular collapse due to dilatation (يؤدي إلى انهيار عمل الأوعية نتيجة التوسع). The allergic antigen-antibody reaction causes widespread histamine release, which results in (1) swelling of the lips and tongue, (2) bronchioles constriction (تضيق قصيبات هوائية) (causing wheezingصفير , stridor), (3) decreased cardiac output and hypoxiaنقص أكسجين بالخلايا , (4) flushing, and (5) pruritus (حكة).

Common causes are: exposure to sensitive drugs or other substances (serum, vaccines enzymes, hormones, penicillin and other antibiotics, local anesthestetics, salicylates), exposure to diagnostic chemicals (radiographic contrast dye), sensitivity to certain food (legumes, nuts, berries, seafood, eggs), and exposure to insect venom سم (honeybees, mosquitoes, certain spiders).

4. Septic or Toxic Shock صدمة إنتانية (تسممية) It is a condition that shows vascular dilatation due to a major infection. The biochemical mediators (such as cytokines) cause a damage to the blood vessels walls, which lose their ability to constrict. Diseases and conditions that predispose a patient to septic shock include: liver disease, and immune suppression (AIDS, drug therapy for cancer).

5. Psychogenic Shock صدمة نفسية المنشأ It is a shock that results from a sudden dilation of the blood vessels takes place in response to an emotional or traumatic situation causing the patient to faint (يصاب بالإغماء).   Stimulation of the vagus nerve (العصب الحائر) causes the heart to slow down (bradycardia). When the bradycardia is severe enough, insufficient blood flow to the brain results and the patient loses consciousness (faints).

Several conditions may cause psychogenic shock including: severely scared situationsمواقف مخيفة بشكل مفزع , severe exhaustion (إعياء شديد), and hearing bad news (e.g.: death of someone, failure in an exam).

6. Metabolic Shock صدمة أيضية This shock occurs due to a change in the blood chemistry. The change in the chemistry might be due to: salt and acid-base imbalance, failure of the: adrenaline (هرمون الأدرينالين – هرمون للغدة الكظرية), thyroid glands (غدد درقية), pituitary glands (غدد نخامية), and diabetes mellitus (داء السكري).

Management of Shock Check Responsiveness. Activate the EMS immediately. Check the person's circulation, airway, and breathing. If necessary, begin cardiopulmonary resuscitation (CPR) to prevent irreversible organ damage and death.

Place the victim in a comfortable position. If the victim DOES NOT have an injury to the head, neck, or spine عمود فقري: elevate the victim legs 30 cm (Trendelenburg’s position), with the head turned to one side.

Careful 1 Do NOT reposition the victim if there is a possibility of spinal or neck injuries.

Careful 2 In Cardiogenic Shock: Place the victim flat. BUT لكن If cardiogenic shock victim complains of difficulty breathing, place the victim in semi-Fowler’s position إذا اشتكى من مصاب الصدمة القلبية من ضيق تنفس، ضع المصاب بوضعية شبه جلوس.

Give appropriate first aid for any wounds, injuries, or illnesses. Keep the victim warm (but not hot). Prevent hypothermia. Minimize effect of shock. Loosen tight clothing. Provide oxygen therapy, if available.

Treatment Hints Fluid therapy and drug therapy should be provided as soon as possible by trained health professionals.

Careful 3 In Anaphylactic/Vasogenic Shock: More attention should be paid to: Securing the airway. Assessing for dyspnea (ضيق تنفس), respiratory difficulty, cyanosis, wheezing (الصفير خلال التنفس) (can be life-threatening). Observing for vertigo (دوار), decreased blood pressure, and increased pulse. Terminating the exposure to causative agent.

Careful 4 In Anaphylactic/Vasogenic Shock: First-line therapies, during acute stage include: (1) epinephrine, (2) IV fluids, and (3) oxygen. Second-line therapies, after acute stage include: (1) antihistamines, and (2) corticosteroids.