1. EMS SERVICES (SHOCK, TISSUE INJURIES, AND SEIZURES)

2. SHOCK Inadequate perfusion(blood flow) leading to inadequate oxygen delivery to tissues

3. PHYSIOLOGY Cell is the basic unit of life Cells get energy needed to stay alive by reacting oxygen with fuel (usually glucose) No oxygen, no energy No energy, no life

4. PERFUSION FAILURE Pump Failure (heart) Pipe Failure (vessels) Loss of Volume (blood)

5. PHASES OF SHOCK Compensated Shock Decompensated Shock Irreversible Shock

6. COMPENSATED SHOCK Body still compensates for blood loss Pulse rate increases Pulse strength decreases Pale, diaphoretic skin Anxiety, restlessness, combativeness Thirst, weakness, eventual air hunger

7. DECOMPENSATED Body compensatory mechanisms fail Unpalpable pulse Precipitous drop in blood pressure Patient becomes unconscious Respirations slow or cease

8. IRREVERSIBLE Lack of circulation causes:  Cellular death  Tissue dysfunction  Organ dysfunction  Patient death

9. SHOCK ETIOLOGY Psychogenic Hypovolemic Distributive Obstructive Cardiogenic Respiratory Neurogenic

10. PSYCHOGENIC SHOCK Simple fainting (syncope) Caused by stress, fright, pain Heart rate slows, vessels dilate Brain becomes hypo-perfused Loss of consciousness occurs Patient usually recovers by self

11. HYPOVOLEMIC SHOCK Loss of volume Causes:  Blood loss from trauma  Plasma loss from burns  Fluid/electrolyte loss from vomiting, diarrhea, sweating, increased urine output, increase respiratory loss  “Third space” fluid shifts

12. HYPOVOLEMIC S/S Anxiety, restlessness, irritability Rapid, weak pulse Change in mental status Signs of inadequate perfusion (diaphoresis, cyanosis, pale/clammy skin) Increased respiratory rate

13. ANAPHYLACTIC SHOCK Results from severe allergic reactions Body responds to allergen by releasing histamine Histamine release causes vessels to dilates and become “leaky

14. S/S Sudden onset Mild itching, rash, uticaria, hives Burning sensation (skin) Hypotension Generalized edema Angiodema, airway compromise Respiratory distress Coma, rapid death May have anxiety and restlessness

15. TREATMENT ABC’s Apply O2, assist ventilations as needed Keep patient in position of comfort Control bleeding, stabilize fractures Prevent loss of body heat Assist with medications Nothing by mouth Calm and reassure

16. TREATMENT Elevate lower extremities 8 to 12 inches in hypovolemic shock Do NOT elevate the lower extremities in cardiogenic shock

17. BLEEDING CONTROL AND TISSUE INJURY DIRECT PRESSURE over injury Elevate: Raise the extr4emity above the level of the heart Apply direct pressure at major artery Closed soft tissue injury- body is struck by a blunt object but does not break the skin.

18. A SEIZURE IS…. A sudden, brief disruption of the normal functioning of neurons in the brain

19. SEIZURE CAN APPEAR AS… A sudden cry and fall, followed by  Convulsive movements of all limbs  Shallow/interrupted breathing - cyanosis  Loss of bowel/bladder control  Slow return to consciousness, post-seizure confusion and/or fatigue  This is a generalized tonic-clonic or “grand mal” seizure.

20. OR MAY APPEAR AS…  Blank staring, chewing, other repetitive purposeless movements  Wandering, confusion, incoherent speech  Crying, screaming, running, flailing  A sudden loss of muscle tone and fall  Picking at clothes, disrobing This is one type of partial seizure known as a complex partial seizure.

21. CAUSES  High fever, especially in infants  Drug use, alcohol withdrawal  Near-drowning or lack of oxygen from another cause  Metabolic disturbances  Head trauma  Brain tumor, infection, stroke  Complication of diabetes or pregnancy

22. A COMMON CAUSE OF SEIZURES IS EPILEPSY Epilepsy (also known as a ‘seizure disorder’) is a chronic neurological disorder characterized by recurring seizures that are not otherwise provoked by an acute injury or health emergency.

23. Epilepsy is not contagious, it is not a mental illness or a cognitive disability. The neurological dysfunction seen in epilepsy can begin at birth, childhood, adolescence, or even in adulthood.

24.  Other neurological conditions  Genetic factors  Stroke  Brain tumor  Brain infection  Past head injury  Metabolic problems

25. In a generalized seizure the electrical disruption involves the entire brain.

26. TONIC-CLONIC SEIZURE -“ GRAND MAL”  Loss of consciousness, fall and stiffening of limbs, followed by rhythmic shaking.  Breathing may stop temporarily - skin, nails, lips may turn blue  Loss of bladder/bowel control may occur  Generally lasts 1 to 3 minutes  Followed by confusion, sleepiness

27. In a partial seizure the electrical disruption involves a limited area of the brain.

28. SIMPLE/PARTIAL SEIZURE Seizure activity in the brain causing: Rhythmic movements - isolated twitching of arms, face, legs Sensory symptoms - tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions Psychic symptoms - déjà vu, hallucinations, feelings of fear or anxiety  Usually last less than one minute  May precede a generalized seizure

29. COMPLEX PARTIAL SEIZURE  Characterized by altered awareness  Confusion, inability to respond  Automatic, purposeless behaviors such as picking at clothes, chewing or mumbling.  Emotional outbursts  May be confused with: Drunkenness or drug use Willful belligerence, aggressiveness

30. EMS TREATMENT  Assure scene safety  If trauma is not suspected, place patient in recovery position  Protect head/limbs from injury  Follow A B C protocol: Maintain airway – suction PRN Administer O 2 Monitor cardio-respiratory status Patients may experience a Postictal phase- time when patient begins to recover and maybe confused, sleepy, and have difficulty thinking. -