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

2. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Heart ◦ Four chambers Blood vessels ◦ Arteries – away from the heart ◦ Veins – toward the heart Blood How the Heart Pumps Blood

3. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY What is Shock? Failure of the circulatory system to maintain adequate blood flow to tissues Leads to inadequate tissue perfusion in which cells do not receive sufficient O2 & nutrients continued

4. 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 Important terms: ◦ Tachypnea & tachycardia continued

5. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock Hypovolemic ◦ Results from a critical decrease in circulating blood volume Caused by a loss of circulating blood or internal body water

6. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock continued Cardiogenic ◦ Heart cannot adequately pump blood The defect occurs within the heart itself Examples?

7. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock Distributive ◦ Blood vessels lose their ability to constrict appropriately 3 subtypes: septic, anaphylactic, neurogenic

8. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Shock Septic ◦ Caused by an infection known as sepsis Anaphylactic ◦ Severe allergic reaction Neurogenic ◦ Caused by disruptions of the CNS

9. 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

10. 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

11. 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

12. 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

13. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 10-1 Shock Management

14. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (a) Assess scene safety and initiate Standard Precautions. Copyright Scott Smith

15. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (b) Perform a primary assessment. Assess ABCDs and correct any problems found. Copyright Scott Smith

16. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (c) Call for help and arrange for transport that includes ALS. Copyright Scott Smith

17. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (d) Monitor the airway and administer high-flow oxygen. Copyright Scott Smith

18. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (e) To prevent heat loss, keep the patient warm and dry. Copyright Scott Smith

19. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (f) Place the patient with the head lower than the feet while maintaining spinal integrity. Copyright Scott Smith

20. National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 10-1 Shock Management (g) Provide for rapid transport. Copyright Selko

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