1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Recognition and Care of Shock 18

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: a.Anaphylactic shock b.Cardiogenic shock c.Compensated shock d.Decompensated shock e.Hemorrhagic shock f.Hypoperfusion g.Hypotension h.Hypovolemic shock i.Neurogenic shock j.Perfusion k.Psychogenic shock Objectives (continued)

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: l.Respiratory/metabolic shock m.Septic shock n.Shock 2.Explain the pathophysiology of shock. 3.Describe the four categories of shock. 4.List the seven main types of shock and their causes. 5.Describe the signs and symptoms of shock. Objectives (continued)

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 6.Explain the proper care of a patient presenting with signs and symptoms of shock. 7.Demonstrate the proper techniques for caring for a patient at risk for shock. 8.Value the importance of proper body substance isolation (BSI) precautions when caring for a patient with suspected shock. Objectives

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Topics Perfusion and Shock Mechanism of Injury and Shock

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley PERFUSION AND SHOCK

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Perfusion – Adequate supply of well-oxygenated blood and nutrients to all vital organs Shock (hypoperfusion) – Failure of body's circulatory system to provide enough oxygenated blood and nutrients to all vital organs

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Normal Perfusion – Oxygen and carbon dioxide exchanged – Nutrients and waste products exchanged – Fluid and salt balance maintained between blood and tissues

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock When Shock Develops Shock develops or occurs in step-by-step progression; can be rapid or come about slowly. Shock can be life-threatening. Care for patients with shock should not be delayed.

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley If left untreated, blood loss will lead to death.

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock The Four Categories of Shock – Cardiogenic – Distributive – Hypovolemic – Obstructive

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Cardiogenic shock “pump failure” – Heart is not pumping blood properly or efficiently. – Inadequate volume of blood

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Cardiogenic shock is a pump problem. The heart is not pumping the blood properly or efficiently.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Heart attack as a cause of cardiogenic shock: Damaged heart muscle results in reduced force of contractions and reduced cardiac output.

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Distributive shock – Vascular tone problem; blood is not allocated properly.

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Distributive shock is a vascular tone problem. The blood is not allocated properly.

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Uncontrolled dilation of the blood vessels.

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Hypovolemic shock – Related to extreme blood loss or too little volume.

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Hypovolemic shock is related to extreme blood loss or too little volume.

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Obstructive shock – Develops when an obstruction of a vessel causes less blood to be pumped by the heart.

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obstructive shock can develop when an obstruction of a vessel causes less blood to be pumped by the heart.

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Causes of obstructive shock: (A) pulmonary embolism; (B) tension pneumothorax; (C) pericardial tamponade.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Types of Shock – Cardiogenic (also a category) – Neurogenic – Anaphylactic – Psychogenic – Septic – Hemorrhagic – Respiratory/metabolic

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Cardiogenic Category – Cardiogenic shock (type): results when heart is unable to pump enough blood at consistent pressure to all vital organs.

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Distributive Category – Neurogenic shock: caused when spinal cord is damaged and unable to control tone of blood vessels by way of sympathetic nervous system. – Anaphylactic shock: caused when body experiences severe allergic reaction. (continued)

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Distributive Category – Psychogenic shock: results in a sudden, temporary dilation of blood vessels. – Septic shock: caused by widespread infection of the blood.

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Hypovolemic Category – Hemorrhagic shock: occurs when body loses significant amount of whole blood from circulatory the system.

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Respiratory/Metabolic – Disruption of oxygen transfer into the cells or the cells are not able to utilize the available oxygen. – Caused by cyanide, carbon monoxide, or iron poisoning.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock The Body's Response During Shock – Compensated stage – Decompensated stage

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Compensated Shock – Condition in which body is using specific mechanisms (increased pulse rate; increased breathing rate) to compensate for lack of adequate perfusion.

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The patient will experience anxiety and mental status changes. The brain begins to feel the effect of decreased oxygen.

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The patient will have cool, pale, sweaty skin and an increased pulse and respirations. Blood is shunted from the skin the vital areas. Pulse and respirations increase to compensate for shock.

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley In addition to sweating, the patient also may experience nausea and vomiting as blood is shunted from the abdomen to more vital areas.

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Late signs of shock include a drop in blood pressure.

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Decompensated Shock – Condition in which body is no longer able to compensate for lack of adequate perfusion. – If condition is not met, it will lead to irreversible shock and patient will die. – What is Shock? What is Shock?

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Early Signs and Symptoms of Shock – Restlessness – Altered mental status – Increased heart rate – Normal to slight low blood pressure – Mildly increased breathing rate – Skin that is pale, cool, and moist – Sluggish pupils – Nausea and vomiting

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Later Signs and Symptoms of Shock – Unresponsiveness – Decreasing heart rate – Very low blood pressure – Slow and shallow respirations – Skin that is pale, cool, and moist – Dilated, sluggish pupils – Respiratory and cardiac arrest can develop

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Perfusion and Shock Signs and symptoms of shock worsen with time. Look for these patterns: – Increased pulse rate – Increased breathing rate – Restlessness or combativeness – Pale, cool, moist skin – Changes in mental status

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to an apartment and find a pale 66-year-old male lying on a sofa. He is weak and dizzy. He states that he has vomited twice and shows you a bucket with a large amount of blood. His pulse is 142, and his blood pressure is 80/50. What do you suspect? How will you proceed?

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley MECHANISM OF INJURY AND SHOCK

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Mechanism of Injury and Shock Do not wait for signs and symptoms to develop before caring for shock. In cases of trauma or injury, examine and consider mechanism of injury. If patient suffered blunt trauma to head, chest, abdomen, or pelvis, suspect internal bleeding and provide care accordingly.

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Mechanism of Injury and Shock Caring for Shock 1.Perform primary assessment; ensure ABCs are properly supported. 2.Control external bleeding. 3.Administer oxygen per local protocol. 4.Keep patient in supine position. 5.Calm and reassure patient; maintain normal body temperature. (continued)

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Mechanism of Injury and Shock Caring for Shock 6.Monitor and support the ABCs. 7.Do not give patient anything by mouth. 8.Monitor patient's vital signs.

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Algorithm for emergency care of patients with developing shock.

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Mechanism of Injury and Shock Fainting (Syncope): self-correcting form of mild shock – Examine patient for injury if patient fell. – Keep patient lying down and at rest for several minutes. – Always recommend that patient see physician. – Fainting may be pyschogenic, or due to more serious conditions such as brain tumor, heart disease or diabetes.

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to a motorcycle collision. You find a 19-year-old male 50 feet from his sport race bike which is significantly mangled. You find your patient conscious and wearing a helmet, but in only shorts and tank top. He is bleeding profusely. What are your concerns? How do you proceed?

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SUMMARY

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Perfusion – Adequate supply of well-oxygenated blood and removal of waste products from body's tissues, especially vital organs. Shock (hypoperfusion) – Failure of body's circulatory system to provide enough oxygenated blood and nutrients to all vital organs.

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Signs and Symptoms of Shock – Increased pulse – Increased breathing rate – Restlessness or combativeness – Pale, cool and moist skin – Thirst – Weakness – Nausea and vomiting – Loss of responsiveness

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Categories of Shock – Cardiogenic – Hypovolemic – Distributive – Obstructive Begin caring for shock if MOI suggests internal injury or bleeding.

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Do not wait for signs and symptoms to appear before caring for shock. Care for Shock – Support the ABCs; keep patient lying flat – Control all external bleeding – Administer oxygen if allowed – Maintain normal body temperature – Expedite transport

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley REVIEW QUESTIONS

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.How would you explain the pathophysiology of shock? 2.How would you describe the four categories of shock? 3.What are the seven main types of shock and their causes? 4.What are the signs and symptoms of shock? 5.How would you proceed to care of a patient presenting with signs and symptoms of shock? Review Questions

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Please visit www.bradybooks.com and follow the Resource Central links to access content for this text. www.bradybooks.com