1. First Aid and Emergency Nursing (Theory)
University of Tabuk Faculty of Applied Medical Sciences Department of Nursing
First Aid and Emergency Nursing (Theory)
(NUR 410)

2. Curriculum & Course Development Committee
Topics Outline
Definition
CLASSIFICATION OF SHOCK
Causes of Shock
Sign and Symptoms
Medical and Nursing management
Outline Pharmacologic Intervention
Risks
DEPARTMENT OF NURSING
Curriculum & Course Development Committee
Department of Nursing

3. SHOCK
It is a condition in which systemic blood pressure is inadequate to deliver oxygen and nutrients to support vital organs and cellular function.
Is a life threatening condition with variety of underlying causes.
It is characterized by inadequate tissue perfusion that, if untreated results in cell death.

4. CLASSIFICATION OF SHOCK
HYPOVOLEMIC SHOCK
ANAPHYLACTIC SHOCK
Department of Nursing

5. I. Hypovolemic Shock Occurs when there is a decrease in the
intravascular volume. It is the most common type
of shock; it is characterized by a decreased
intravascular volume of 15% to 25%.
This represents a loss of 750 to 1,300 ml of
blood in a 70kg person.

6. Hypovolemic Shock External: Internal: Fluid losses Vomiting Diarrhea
Diuresis
Diabetic Insipidus
Trauma Surgery
Fluid Shifts
Hemorrhage
Burns
Ascites
Peritonitis
Dehydration

7. Categories of Causes of Hypovolemic Shock
Absolute hypovolemia – occurs as a result of external losses of fluid.
Relative hypovolemia – occurs as a result of the internal shifting of fluid between the body’s two compartments, which is known as third spacing.
“Third spacing is when the fluid of the intravascular space relocates to the extra-vascular space, causing edema”

8. Sign and Symptoms per Stage
Compensatory Stage
Occurs with a fluid loss of 15% to 30% or 750 to 1500 ml
The goal of this stage is to restore oxygenation and perfusion to the cells

9. Compensatory Stage Patient may exhibit:
Normal BP reading and narrowed pulse pressure (the difference between the systolic and diastolic BP which is normally 40 mmHg
Tachycardia
Tachypnea
Hypoxia
Decrease Urinary Output
Thirst
Pale
Cool skin
Delayed Capillary refill
Changed in LOC (confusion, restlessness, anxiousness)

10. Sign and Symptoms per Stage
Progressive Stage of Shock
Occurs with the fluid loss of 30% to 40% or 150 to 200 ml
In this stage the compensatory mechanism fail and tissue perfusion becomes ineffective for the body organ to function.

11. Progressive Stage of Shock
Patient may exhibit:
Heart rate continues to increase
Vasoconstriction
Hypotensive
Narrowed pulse pressure
Oliguria worsen
Increasingly lethargic, confused and comatose
During this stage, organs become dysfunctional and all body system is affected. As one organ fails, the others eventually become dysfunctional, leading to multi-organ dysfunction syndrome (MODS)

12. Sign and Symptoms per Stage
Refractory or Irreversible Stage of Shock
The body organ are no longer responsive to treatment and multi-pre organ failure ensures
The compensatory mechanism completely and organ failure occurred

13. Refractory or Irreversible Stage of Shock
The patient exhibit:
Severe tachycardia becomes bradycardia
Continued hypotension
Cardiopulmonary arrest
Unresponsive
Edema
Oliguria at Anuria
Failure of other body system, the patient has 90% to 100% mortality rate when only 3 body system fails

14. GOAL: Restore homeostasis and intra-vascular volume
Medical Management
Treatment of the underlying cause
Fluid and blood replacement
Redistribution of fluid
Pharmacologic therapy

15. Nursing Management
Ensuring safe administration of prescribed fluids and medications
Documenting their administration and effects
Monitoring for signs of complication and side effects of treatment
Reporting signs early in treatment
Administering blood and fluids safely

16. Anaphylactic Reaction
It is also called severe allergic reaction;anaphylaxis; anaphylactic shock. It is an acute systemic hypersensitivity reaction that occurs within seconds or minutes of exposure to various foreign substances, such as medications and other agents such as, insects or foods. Repeated administration of parenteral or oral therapeutic agents may also precipitate an anaphylactic reaction.

17. Anaphylactic reactions range from mild to severe
Anaphylactic reactions range from mild to severe. It can also be sudden or massive. It is a life-threatening situation. If untreated anaphylaxis can be fatal within 5-30 minutes about 60% - 80% of anaphylactic deaths are caused by inability to breathe because swollen airway passages obstruct airflow to the lungs. Another main cause results when blood vessels dilate so blood is deficient in the body.

18. Risk factors: Penicillin sensitivity Transfusion reaction
Insect stings allergy
Latex sensitivity

19. Signs and Symptoms:
*Respiratory signs: • Nasal congestion • Sneezing, coughing or wheezing • Dyspnea • Cyanosis • Chest tightness • Tightness or swelling of the throat

20. *Skin manifestations: • Severe itching, burning, rash or hives on the skin • Swelling of face, tongue and / or mouth *Cardivascular and Neurologic manifestations: • Tachycardia or bradycardia • Pallor • Imperceptible pulse • Decreasing BP • Dizziness • Convulsions • Unconsciousness • Circulatory failure that may lead to death * Gastrointestinal problems: • Nausea and vomiting • Colicky abdominal pains • Diarrhea

21. Management:
1. Do not mistake anaphylaxis for other reactions such as, hyperventilation, anxiety attacks, alcohol intoxication and hypoglycemia. 2. Check ABCs. 3. Maintaining patent airway and ventilation is essential. 4. Seek medical attention immediately. 5. Early endotracheal tube intubation is essential to avoid loss of airway. 6. Oropharyngeal suctioning may be necessary to remove excessive secretions.

22. 7. First aid for seizures may be necessary. 8
7. First aid for seizures may be necessary. 8. Resuscitative measures are used, especially for patients with stridor and progressive pulmonary edema. 9. If glottal edema occurs, a cricothyroidotomy is used to provide airway. 10. Simultaneously, with airway management, epinephrine is administered as prescribed to provide rapid relief of hypersensitivity reaction. 11. Keeping the conscious victim sitting in an upright position may also help breathing.

23. References
Daniel Limmer ,Michael F. O’keefe. Emergency Care .12 th ed, Pearson Education, Inc., ISBN-10: X • ISBN-13:
•Kathleen Sanders Jordan, Emergency Nursing Core Curriculum,5 th ed, Philadelphia, W.B. Saunders company :A division of Harcourt Brace & company,2000.
Department of Nursing