1. Shock: Cycle “A” Refresher Shock Nature’s prelude to death 2008 Cycle “A” OEC Refresher

2. Shock: Cycle “A” Refresher I Can: Goals and Objectives Define shock. List the early and late signs of shock. Describe the treatment for shock.

3. Shock: Cycle “A” Refresher What is Shock? Inadequate perfusion… …What does this mean?  Lack of oxygen, other nutrients to body cells  The body needs oxygen to survive!

4. Shock: Cycle “A” Refresher Blood Pressure What brings oxygen to body tissues?? Blood What supports the delivery of blood?? Blood Pressure

5. Shock: Cycle “A” Refresher Shock What is really happening in shock?? There is not enough blood pressure to adequately get oxygen to body tissues.

6. Shock: Cycle “A” Refresher Compensated Shock  Tachycardia  Tachypnea  A narrowing of the difference between the systolic and diastolic blood pressure (a.k.a - pulse pressure) Shock How do I identify that a patient is in shock??

7. Shock: Cycle “A” Refresher Shock How do I identify that a patient is in shock?? Decompensated Shock  A drop in the systolic blood pressure

8. Shock: Cycle “A” Refresher Shock Once the patient is in decompensated shock body cells begin to die. This is a bad thing!!!! Identify shock early before the patient has decompensated.

9. Shock: Cycle “A” Refresher Types of Shock Hypovolemic: Hypovolemic: not enough volume (e.g., bleeding, dehydration, vomiting, diarrhea) Cardiogenic: Cardiogenic: not enough strength to push the volume some causes of respiratory shock are actually cardiogenic shock (ex. Flash pulmonary edema from congestive heart failure )

10. Shock: Cycle “A” Refresher Types of Shock Neurogenic Neurogenic (a.k.a. - Distributive): loss of tone in the blood vessels (e.g., sepsis, severe infection, anaphylaxis, spinal cord injury, psychogenic) Other reasons for shock: A mechanical obstruction that prevents movement of blood (a.k.a. – Obstructive) some causes of respiratory shock are actually obstructive shock (ex. pulmonary embolism)

11. Shock: Cycle “A” Refresher Hemorrhage  A cause of hypovolemic shock  In trauma, hemorrhage most common cause of shock !!!! Caution: It is not the only reason for shock in trauma, but is definitely the most common reason.

12. Shock: Cycle “A” Refresher Hemorrhage  External  Internal Chest Abdomen Pelvis Where can a patient bleed to death?

13. Shock: Cycle “A” Refresher Don’t Forget to Look for Bleeding! Signs & Symptoms of shock  Shortness of breath  Dizzy  Pain  Nausea  Tachycardia  Tachypnea  Diaphoresis  Pale  Drop in systolic blood pressure (late finding) Signs Symptoms

14. Shock: Cycle “A” Refresher OEC Management of Shock Hemorrhagic Shock Direct pressure Elevation Pressure points Tourniquet (as a last resort) External Bleeding

15. Shock: Cycle “A” Refresher OEC Management of Shock Hemorrhagic Shock Determine if this it occurring Safely and rapidly transport Internal Bleeding (chest, abdomen, pelvis)

16. Shock: Cycle “A” Refresher OEC Management of Shock: all types Diagnose shock early Stop bleeding Give oxygen Keep patient warm (Hypothermia makes shock worse) Transport

17. Shock: Cycle “A” Refresher Remember…  See a drop in BP? You are way behind the eight ball!  Diagnose shock early  Direct pressure to stop bleeding  Give oxygen  Keep patient warm  Transport to definitive care

18. Shock: Cycle “A” Refresher