1. Shock Remember Perfusion ….
Shock is inadequate perfusion (aka Hypoperfusion)
The organs and tissues of the body do not get enough oxygen and nutrients.

2. Shock
It can occur with either traumatic injuries or serious medical conditions

3. What causes Shock?
Shock is the result of a malfunction of at least 1 of 3 systems
Pump (Heart)
Tubing (Blood Vessels)
Fluid (Blood)
The cardiovascular system is made up of three key elements: a Pump (heart), Tubing (vessels) and Blood (vehicle for carrying O2/nutrients and ridding waste products).
Blood moves as a result of a pressure gradient generated with each heart contraction and is affected by dilating and constricting blood vessels. Pressure is controlled by the body so there is always sufficient circulation or perfusion in the various tissues and organs.
(colors have significance)

4. What are the types of shock?
Remember MASHNCPR
Metabolic
Excessive loss of fluid & electrolytes with non-hemorrhagic cause
1. GI: vomiting/diarrhea/ urination,
2. burns
3. drugs
4. hyperglycemia
5. heat stroke
Anaphylactic
Systemic allergic reaction causing widespread vasodilation and generalized edema ; has an upper respiratory component
1. insect sting or bite
2. ingestion (eg legumes),
3. Rx (eg penicillin PCN)
4. inhalants (pollen, dust)
Septic
Systemic infection, usually bacterial, damages vessel walls resulting in leakage and vasodilation;
1. untreated wound,
2. surgery,
3. trauma (peritonitis);
4. disease (pericarditis), or
5. contagion (meningitis,
pneumonia)

5. Hypovolemic Neurogenic Cardiogenic
Loss of fluid volume (blood) with hemorrhagic cause (eg trauma); could be external or internal
Bleeding due to
1. Blunt trauma to solid abdominal organ,
2. great vessel tear,
3. major bleed from laceration or fx
Neurogenic
Sudden loss of the control by CNS of nerves & muscles, causing vasodilation & muscle paralysis
1. brain => Increased Intercranial pressure due to trauma, tumor, bleeding
2. spinal cord => due to fx, vertebral bleeding, or tumor
Cardiogenic
Heart muscle can no longer generate enough pressure to circulate blood to all organs; leads to pulmonary edema
1. Myocardial Infarction
2. Disease (CHF, pericarditis),
3. Electrical,
4. Trauma (Pericardial tamponade)
5. Valve dysfunction,
Psychogenic
fainting resulting from temporary vascular dilation (loss of blood pressure) and lack of blood to brain
Shock to senses, strong emotional response, or psychotic crisis
Respiratory Insufficiency
Inability to oxygenate the blood at level required
1. Disease (Asthma, COPD)
2. Trauma (pneumothorax, flail chest)
3. obstruction

6. Progression of Shock: Compensated Shock
When the body’s systems work to maintain perfusion by going into “overdrive”

7. Progression of Shock: What do you see
Compensated Shock –
Brain = anxiety, restlessness, ALOC
Heart = weak rapid pulse, OK to  BP
Respiration = rapid, shallow TV, noise
Skin Sx = pale, cool, clammy
Cap Refill = > 2 secs
Other: nausea or vomiting; decrease in body temp

8. Progression of Shock: Decompensated Shock
Body’s efforts to maintain perfusion fail.
Children can compensate longer than adults, but crash quickly
Falling BP is the key sign.

9. Progression of Shock: What do you see
Decompensated Shock
Brain = ALOC -> unconsciousness
Heart = thready or irr or absent, BP
Respiration = labored
Skin Sx = ashen, cyanotic, diaphoretic
Cap Refill = > 2 secs
Other: nausea or vomiting; decrease in body temp; dull eyes; dilated pupils

10. What can you do? --- BSI, ABCs
- Open airway, Control Bleeding
- Provide high flow O2; assist respirations
Place patient supine with legs elevated 6” to 12” above heart; If spinal injury elevate backboard
May use other position of comfort for heart patient, breathing distress, etc
Keep patient warm (easy hypothermia)

11. What can you do? --- Emergency evacuation
Record vitals every 5 minutes
Splint bone or joint injuries
Give nothing by mouth; have suction ready
Emergency evacuation

12. Anticipate Shock!!
Plan Ahead
Always anticipate shock when a suitable mechanism of injury or illness exists
Early anticipation and care can prevent or delay decompensated shock

13. Transport Head up or down?
Normally, for shock, head down (want feet elevated)
BUT, what if head injury and signs of shock? Judgment call – head (brain swelling) would be priority

14. Anaphylactic Shock – What can you do? ---
The only truly effective treatment is EPINEPHRINE (opens airway) followed by ANTIHISTAMINE (reduces bronchial swelling)
Many people with known serious allergic reactions carry epipens