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1、Avoiding the Train Wreck of SHOCK,Kay Kamish, RN, BSN, EMT-P Tulsa Life Flight,OBJECTIVES,Define the four types of SHOCKUnderstand the difference in etiologies Recognize the progression of symptomsUnderstand the difference in approach to treatments,Train Wreck of SHOCK,SHOCK,Think of the Engine as t
2、he Heart. The Tracks as the blood vessels The cars as the RBCs. The Freight as the Oxygen and nutrients.,SHOCK,Inadequate tissue perfusion,Inability of the body to keep up with the tissue demand for oxygen and nutrients.,Train Wreck of SHOCK,Train Wreck of Shock,FOCUS of INTERVENTION:Identify the ty
3、pe of ShockInitiate the proper care,SHOCK,TYPES of SHOCK,Hypovolemic,Train Wreck of SHOCK,Cardiogenic,Distributive,Obstructive,Train Wreck of SHOCK,HYPOVOLIEMIC SHOCK,* Hemorrhage,* Vomiting,* Diarrhea,* Third Spacing,* Diuresis,SHOCK - Hypovolemic,Low volume - poor carrying capacity of the cells -
4、not enough freight,CARDIOGENIC SHOCK,Occurs when damaged or unhealthy heart muscle is no longer able to pump effectively = Heart Failure,* Myocardial Infarction,Train Wreck of SHOCK,* Cardiac Arrest,* Dysrhythmias,* Cardiomyopathies,SHOCK - Cardiogenic,Heart Failure - an old and tired Engine,SHOCK -
5、 Cardiogenic,Cardiogenic Shock - the heart (engine) no longer functions effectively,DISTRIBUTIVE SHOCK,NEUROGENIC,Loss of normal sympathetic vasoconstriction,* spinal cord injury,* severe pain,* vasomotor center depression d/t drug OD,Train Wreck of SHOCK,DISTRIBUTIVE SHOCK,Train Wreck of SHOCK,VASO
6、GENIC,Diminished arterial resistance and increased venous capacitance,* Due to a release of vasodilating substance from the body itself,* Anaphylactic Shock,* Septic Shock,SHOCK - Distributive,Vasodilation - too many tracks/ blood vessels to fill,OBSTRUCTIVE SHOCK,Train Wreck of SHOCK,* Arterial Ste
7、nosis,* Pulmonary Embolism,* Pulmonary Hypertension,* Cardiac Tamponade,* Tension Pneumothorax,Train Wreck of SHOCK,Review: Four Types of SHOCK,HYPOVOLEMIC,Volume Loss,CARDIOGENIC,Heart Failure,DISTRIBUTIVE,Vasodilation,OBSTRUCTIVE,SHOCK,You have the engine (the heart) but no cars (volume) and too m
8、any tracks to fill up (excess venous capacitance).,Train Wreck of Shock,STAGES 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 possible
9、,STAGES of SHOCK,Train Wreck of Shock,Early Stage,Pathophysiology, Decrease in MAP, Results in reduced or unevenmicrocirculatory blood flowand decreased O2 deliveryto cells,Clinical Signs, Usually there arefew at this point,STAGES of SHOCK,Train Wreck of Shock,Early Stage,Pathophysiology,Compensator
10、y mechanisms can restore MAP to reasonable levels.,Clinical Signs,Therefore: There are few clinical signs,AND: No disruption of vital organ function,STAGES of SHOCK,Train Wreck of Shock,* Important Point *, VITAL ORGAN FUNCTION Now drops 10 -15 mmHg,*Compensatory Mechanisms are put in motion, Heart
11、rate increases, Respirations increase,STAGES of SHOCK - Compensatory,Train Wreck of Shock,Cardiac Output,CO,=,Heart rate,X,Stroke volume,Normal CO = 4 to 6 Liters/ minute,Normal SV = 60 to 100 cc,Normal HR = 60 to 100 bpm,STAGES of SHOCK - Compensatory,Train Wreck of Shock,Cardiac Output Increases,W
12、HY ?,To perfuse Vital Organs : heart, lungs, brain, kidneys,STAGES of SHOCK - Compensatory,Train Wreck of Shock,Pathophysiology, Renal & Chemical Compensation, Renal vasoconstriction,decreased perfusion,stimulates release of:,* ADH,* Aldosterone,* Catecholamines,Clinical Signs, Decreased urinary out
13、put, Skin cool, clammy, mottled, Pupils dilated, Decreased bowel sounds, Hyperglycemia,WHY?,STAGES of SHOCK - Compensatory,Train Wreck of Shock,Hyperglycemia,* Liver is breaking down glycogento increase the availability of glucosefor more energy,* Therefore: if you do a finger stick, yourDextrostix may be elevated,
