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1、Avoiding the Train Wreck of SHOCKKay Kamish, RN, BSN, EMT-P Tulsa Life FlightOBJECTIVES Define the four types of SHOCK Understand the difference in etiologies Recognize the progression of symptoms Understand the difference in approach to treatmentsTrain Wreck of SHOCKSHOCKThink of the Engine as the
2、Heart. The Tracks as the blood vessels The cars as the RBCs. The Freight as the Oxygen and nutrients.SHOCKg Inadequate tissue perfusiong Inability of the body to keep up with the tissue demand for oxygen and nutrients. Train Wreck of SHOCKTrain Wreck of Shock* FOCUS of INTERVENTION:*Identify the typ
3、e of Shock*Initiate the proper care SHOCKTYPES of SHOCK HypovolemicTrain Wreck of SHOCK Cardiogenic Distributive ObstructiveTrain Wreck of SHOCKHYPOVOLIEMIC SHOCK* Hemorrhage* Vomiting*Diarrhea*Third Spacing*DiuresisSHOCK - HypovolemicLow volume - poor carrying capacity of the cells - not enough fre
4、ight CARDIOGENIC SHOCKOccurs when damaged or unhealthy heart muscle is no longer able to pump effectively = Heart Failure* Myocardial InfarctionTrain Wreck of SHOCK* Cardiac Arrest * Dysrhythmias* CardiomyopathiesSHOCK - CardiogenicHeart Failure - an old and tired EngineSHOCK - Cardiogenic Cardiogen
5、ic Shock - the heart (engine) no longer functions effectivelyDISTRIBUTIVE SHOCKNEUROGENICLoss of normal sympathetic vasoconstriction* spinal cord injury* severe pain* vasomotor center depression d/t drug ODTrain Wreck of SHOCKDISTRIBUTIVE SHOCKTrain Wreck of SHOCKVASOGENICDiminished arterial resista
6、nce and increased venous capacitance* Due to a release of vasodilating substance from the body itself* Anaphylactic Shock* Septic ShockSHOCK - DistributiveVasodilation - too many tracks/ blood vessels to fillOBSTRUCTIVE SHOCKTrain Wreck of SHOCK* Arterial Stenosis* Pulmonary Embolism* Pulmonary Hype
7、rtension* Cardiac Tamponade* Tension PneumothoraxTrain Wreck of SHOCKReview: Four Types of SHOCKHYPOVOLEMICVolume LossCARDIOGENICHeart FailureDISTRIBUTIVEVasodilationOBSTRUCTIVESHOCKYou have the engine (the heart) but no cars (volume) and too many tracks to fill up (excess venous capacitance).Train
8、Wreck of ShockSTAGES of SHOCK* Whatever the type of shock, the signs and symptoms are the result of diminished blood flow* Symptoms follow a predictable path YOUR GOAL: Identify the type of shock and intervene at the earliest stage possibleSTAGES of SHOCKTrain Wreck of Shock Early StagePathophysiolo
9、gy Decrease in MAP Results in reduced or unevenmicrocirculatory blood flowand decreased O2 deliveryto cellsClinical Signs Usually there arefew at this point STAGES of SHOCKTrain Wreck of ShockEarly StagePathophysiologyCompensatory mechanisms can restore MAP to reasonable levels. Clinical SignsTheref
10、ore: There are few clinical signsAND: No disruption of vital organ functionSTAGES of SHOCKTrain Wreck of Shock* Important Point * VITAL ORGAN FUNCTION Now drops 10 -15 mmHg*Compensatory Mechanisms are put in motion Heart rate increases Respirations increaseSTAGES of SHOCK - CompensatoryTrain Wreck o
11、f ShockCardiac OutputCO=Heart rateXStroke volumeNormal CO = 4 to 6 Liters/ minuteNormal SV = 60 to 100 ccNormal HR = 60 to 100 bpmSTAGES of SHOCK - CompensatoryTrain Wreck of ShockCardiac Output Increases WHY ?To perfuse Vital Organs :heart, lungs, brain, kidneysSTAGES of SHOCK - CompensatoryTrain W
12、reck of ShockPathophysiology Renal predominantly a - adrenergic SHOCK - TreatmentTrain Wreck of ShockDistributiveRemember this is due to the loss of sympathetic tone, resulting in pooling of blood in venous and capillary beds. SHOCK - TreatmentTrain Wreck of ShockDistributiveSeptic Shock Most common
13、 form of Distributive Shock 40 % Mortality Rate Seen in bodys inflammatory response to overwhelming systemic infection Produces profound hypotensionSHOCK - TreatmentDistributiveTrain Wreck of ShockSeptic Shock Provide aggressive fluid resuscitation What will you do if blood pressure continues to dro
14、p ? Vasopressors Inotropic drugsSHOCK - TreatmentDistributiveTrain Wreck of ShockNeurogenic Shockh Typically the result of head injury or spinal cord injury Initial Symptoms:T HypotensionT BradycardiaT HypothermiaT Warm, dry skin What symptoms are present here that are opposite to other forms of sho
15、ck ?SHOCK - TreatmentDistributiveTrain Wreck of ShockNeurogenic Shock Treatment is aimed at the cause of cardiovascular instabilityEg: T Bradycardia AtropineT Hypotension Vasopressors Not a volume problem in this caseSHOCK - TreatmentDistributiveTrain Wreck of ShockAnaphylactic Shock Hypersensitivit
16、y to an environmental exposureg Foodg Venomg MedicationsSHOCK - TreatmentDistributiveTrain Wreck of ShockAnaphylactic Shock Causes large release of histamine and other vasoactive substances This in turn causes : massive vasodilation increased capillary permeability profound hypovolemia vascular collapse arrhythmias decreased cardiac contractilit
