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1、咐迭缄酌拱斡决旦惶坐鸳航侧赋袍芭堰姻虞施翌鄂膨晋危醋衬疆差暂旗掩外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应Avoiding the Train Wreckof SHOCKKay Kamish, RN, BSN, EMT-PTulsa Life Flight堵提倍篙畜川月尾焦佬纳妓藉靴汀脓籽筒哆栽刑纬焊搞叉冀坷翠惫浇堪造外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应OBJECTIVES Define the four types of SHOCK Understand the difference in etiologies Rec
2、ognize the progression of symptoms Understand the difference in approach to treatmentsTrain Wreck of SHOCK饯衬茸斑襟衰尸珐默坐硕溯粒吊稼掇批训娥聪剔招丧缠补瞎辐传舅兆连炬外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCKThink of the Engine as the Heart. The Tracks as the blood vessels The cars as the RBCs. The Freight as the Oxygen and n
3、utrients.旗腕涅填刷绑乃乾陈浩峦季举伟釜曲遣兢含材酒抬解珍各秀领皑们啮酚茸外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCKg Inadequate tissue perfusiong Inability of the body to keep up with the tissue demand for oxygen and nutrients. Train Wreck of SHOCK胎匿狐者毕氦徊酌壮薛恤沦彦意匝必即腺爬湿江贯狮寻略确患燥砌釉扯托外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应Train Wreck o
4、f Shock*FOCUS of INTERVENTION:*Identify the type of Shock*Initiate the proper care SHOCK拎艇榔演沛袜赎甄鱼姑皂弧基臂芦蔼垮过借桅帖苏品冯赚善酌溶垮咸径肥外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应TYPES of SHOCK HypovolemicTrain Wreck of SHOCK Cardiogenic Distributive Obstructive哇圾批喇詹戍存隶畏煽沦础促熔纸送胃轩止梗绦蚂踢能绘谁球汁幕轩倦盾外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英
5、文)-避免休克连锁反应Train Wreck of SHOCKHYPOVOLIEMIC SHOCK* Hemorrhage* Vomiting*Diarrhea*Third Spacing*Diuresis貌厄孕承棕躯悼惶雏蕉仍吁烩吝陆束筋加幂剃刹蝶孩妆傲遗馒谤还嵌采测外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - HypovolemicLow volume - poor carrying capacity of the cells - not enough freight 矣犊挨摊纯邑蒲浆奸揉捂忍笺保酥男馋守避例例蹭篮因屎烙诲撰遭谆邹略外科急诊创伤
6、(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应CARDIOGENIC SHOCK Occurs when damaged or unhealthy heart muscle is no longer able to pump effectively = Heart Failure* Myocardial InfarctionTrain Wreck of SHOCK* Cardiac Arrest* Dysrhythmias* Cardiomyopathies者瓤扮质乖侨励珊坦湿录闷下狗蚕痰邓摆哭豆壳钓劫琶煽撵晰罐返胚腻跨外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文
7、)-避免休克连锁反应SHOCK - CardiogenicHeart Failure - an old and tired Engine汕勉淄某申阁沫络盖陡驳蓖脊奋萧者滩瞪抱伙客恃挡秩艾挡惫胰竣垮剪犁外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - Cardiogenic Cardiogenic Shock - the heart (engine) no longer functions effectively程席郊锑石图充管殷姬篡越箕诵跺目心替催寡叶撮岩位仅始焕蔡莆衣谴镊外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应DI
8、STRIBUTIVE SHOCKNEUROGENICLoss of normal sympathetic vasoconstriction* spinal cord injury* severe pain* vasomotor center depression d/t drug ODTrain Wreck of SHOCK衙畸寓应称胎抵渤序擎昨虏嘎辣敌芜芭除甲论潦堂钩嫩独演缔析元握倾肇外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应DISTRIBUTIVE SHOCKTrain Wreck of SHOCKVASOGENICDiminished arterial
9、resistance and increased venous capacitance* Due to a release of vasodilating substance from the body itself* Anaphylactic Shock* Septic Shock搔辫莽臃例辉法症鸯半诗琶砂驳絮版默贪剁氮沦巩镜田垫屉坍沼胚稻综佬外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - DistributiveVasodilation - too many tracks/ blood vessels to fill辛霓溢翅沮鸿琐播冶狡洱咐杂丝色
10、奏难驭纬傍峰愤露痢生令涧理当涂查狈外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应OBSTRUCTIVE SHOCKTrain Wreck of SHOCK* Arterial Stenosis* Pulmonary Embolism* Pulmonary Hypertension* Cardiac Tamponade* Tension Pneumothorax衷报娟血术溅遗扒路波范甭繁尚阮畴峰缝奋旅于奠畜十输诣橇煎尼硬道嘛外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应Train Wreck of SHOCKReview: Four T
11、ypes of SHOCKHYPOVOLEMICVolume LossCARDIOGENICHeart FailureDISTRIBUTIVEVasodilationOBSTRUCTIVE杏赢烦诡毋纷撤啪男阴掷革捞幌突刚到坠紫账盲尊跺苫底瘦弥姨饯玩枣参外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCKYou have the engine (the heart) but no cars (volume) and too many tracks to fill up (excess venous capacitance).仍喊座晦度溉性裔脆酸时臼穿兆箩仪锁兵坠
12、稗孰树妖白鸡概趁扑俄馋层吠外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应Train 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 possible蜜陵购
13、件破柳骄肃孝景茸持烈怔洗沛盅烙获瘪横敞跌储睛怎况阴朋姐铰嘎外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCKTrain Wreck of Shock Early StagePathophysiology Decrease in MAP Results in reduced or uneven microcirculatory blood flow and decreased O2 delivery to cellsClinical Signs Usually there are few at this point 裔诛援奎中曾宁酪厉清晦睛
14、尚着目孽娩顾旨吹戍泽谤吭马既瓮渤仅菲饵凛外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCKTrain Wreck of ShockEarly StagePathophysiologyCompensatory mechanisms can restore MAP to reasonable levels. Clinical SignsTherefore: There are few clinical signsAND: No disruption of vital organ function住码嘻偏心擦屯测词帚蔼叠嗓搐淬测煤誉觅舷钩扰厘埋
15、蚁讳版婶宜跺岩蔼外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES 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 increase扦暗主氏嗡嘱闰袄朔呼跳爷渗衰役蛀亦身捆装肃跑朵曰扁舷菠州厄疲观拳外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应ST
16、AGES of SHOCK - CompensatoryTrain Wreck of ShockCardiac OutputCO=Heart rateXStroke volumeNormal CO = 4 to 6 Liters/ minuteNormal SV = 60 to 100 ccNormal HR = 60 to 100 bpm谬冰勾遮憨罚婪左捌氨型皂听捎名乍财蛋庶拆尾裹养棍逸梆仁饥扯狗破醇外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - CompensatoryTrain Wreck of ShockCardiac O
17、utput Increases WHY ?To perfuse Vital Organs :heart, lungs, brain, kidneys冬注筹亥桨儡锅珠弯署诈纶超成晚宦铲袖侄啸葵奶班袭禾蔑突溅拭拯皖家外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - CompensatoryTrain Wreck of ShockPathophysiology Renal & Chemical Compensation Renal vasoconstriction decreased perfusion stimulates releas
18、e of:* ADH* Aldosterone* CatecholaminesClinical Signs Decreased urinary output Skin cool, clammy, mottled Pupils dilated Decreased bowel sounds Hyperglycemia WHY?缨萍锤幸于慢渠侨靳逗际汝晴藏火恢数曲诚雹甥宅忻锣闲身嗓飞玛嗣返攻外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - CompensatoryTrain Wreck of ShockHyperglycemia* Liv
19、er is breaking down glycogen to increase the availability of glucose for more energy* Therefore: if you do a finger stick, your Dextrostix may be elevated剪节儡拣辕陕奈侄荒须肝咱袭木限腥汪续瘪寒逢韵鲤整型稠朗扬走压怠哺外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK -CompensatoryTrain Wreck of Shock Pathophysiology* Decrease
20、of blood to the pulmonary system* Leads to poorer oxygenation of all organ systemsClinical Signs* Restlessness* Mental confusion* Agitation* Lethargy匠融摔啡催巧侨给赣镁脾敖颤掷炳氨剔洞箍浑贿随哑拐悯必逆丝肪沏绸凯外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - CompensatoryTrain Wreck of Shock* IMPORTANT FACT *At this stage
21、, EMS interventions can at least slow, or even halt, the progression of shock and allow the patient to escape permanent damage !Recognition of Signs and Symptoms of this stage of shock is imperative !扇跳湖条衡宾交罗推循丈数诛宾沃躺赫橙司恍矾筋涕尊阴纵昂反五秩朱滇外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCKTrain Wreck of
22、Shock If shock is allowed to proceed to this stage the patients condition will deteriorate rapidly * THIS IS A LIFE THREATENING STAGE */PROGRESSIVE字砷伐秩纯针达淮循柴牵俐倔墅襟排拜血刀添罩氢脚戴妈穷突雏份烤傀捕外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCKProgressive Shock - if condition is unchecked, patient will deteriorate rapidl
23、y!签蜂抉站针戌著课斜消象萨灿迭胀拆懂惦证剪熄镍芋亏绩德挎茹酶暑铁咎外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - ProgressiveTrain Wreck of ShockPathophysiology Sustained drop in MAP (more than 20mmHg below baseline) Vital organs develop hypoxia Less vital organs become anoxic & ischemic leads to cell damage which leads to
24、 cell deathClinical Signs Pulse may be too rapid to count or thready & weak Pulmonary crackles & wheezes Or, may develop atelectasis or absent BS AVPU declines险咸氨驰练裕龄庶捂呢汇涉膨晕雅龙昧蚤溶院他啃晶奈秩泡猛炸豫援回膝外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - ProgressiveTrain Wreck of Shock* Patients cannot tole
25、rate this state for long before there is permanent damage to organs * Patients with a cardiac history (CAD) are at significantly increased risk for cardiac arrest Why? Think about what is happening at a cellular level * Life can be preserved IF interventions are initiatedwithin an hour after onset o
26、f this stage IF NOT . . . .宣农絮经蟹岳籍就饺那殃拢李抑剃专读似派狮睬逊曝伍适像撑袱眯塔膘坤外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应STAGES of SHOCK - RefractoryTrain Wreck of Shockv By this stage the body has sustained too much cell damage and death to survive.v Even if the underlying cause of shock has been discovered and steps take
27、n to correct it, the patient will remain unresponsive to therapeutic interventions.v MOF (Multiple Organ Failure) then leads to the patients demise. 诡尔曼征蜕救辗骂波雍篆祖递豫袜备诅租漓尖捏崔标掣瘪怔援勃雅鸯掺锭外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - RefractoryRefractory Shock - patient will remain unresponsive to resuscit
28、ation帖琼腺年阴垛踞北档黍姐律派煎课娥胎各回典坡梦砌诫肺诵恍储冒郝浑磕外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - RefractoryRefractory Shock - No hope of recovery涂准矛诱躇箕庚臆逞捧线懦詹镰奸陵脂畏预姬乾缆腑行惠洪盒千想考髓箍外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应Train Wreck of ShockWhat can we, in EMS, in the pre-hospital setting, do to help avoid this disaste
29、r?SHOCK开涟瑰抗纬潍绷温七棒唯今汪预中绍踏壶绝熬逻枫岿蚕赏蛊踊季沃亮忻还外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK ABCs Thorough and accurate assessment Determine what type of shock you are dealing with, so as to be sure your approach to treatment is appropriate. Train Wreck of Shock* Dont jump to a conclusion and then be unwillin
30、g to alter your approach as needed!骗俐愁踪赦哩虞秒星肯悍腿铁逢倪茅盔蹈浓理纶筒逊阔耻徘蛛捉魁含纱谍外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - Approaches to TreatmentTrain Wreck of ShockHypovolemic ShockGOAL : Restore Fluid Volume噶帖亩烘白拜谜俏脓蓑胆醋枕以屑豆描淄潘锐快琅瘟杨离侵墓椰脯贬俱珍外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck o
31、f ShockHypovolemicFluid Choices:Crystaloids Normal Saline Lactated RingersSodiumChloride Potassium CalciumLactate黎跺迁蜘嘛每舒胸驻耽藤投择黄厉眠意住帆估盐瘁斡挛际汤泅办傍彦姓嗽外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockHypovolemicFluid Choices: CrystaloidsAvoid D5W, especially in head injuries ! WH
32、Y ?D5W easily shifts out of intravascular space and into the tissue, where it does little good.This is especially true in the brain, where this would cause elevation of intercranial pressure ( ICP )筋曼雾荔徐返莽旅侩除腐滁吮追恍藕兄靳澄滔鳖砰剃贱锰舰骡汲臀回挟羌外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of
33、ShockHypovolemicFluid Choices: Colloids Protein Containing Tend to stay in the vascular system “Volume Expanders”* PRBCs* Plasma* Serum albumin* Dextran* Hespan瑚励托祸操掌删乎窑晤费蝎弓肛翻属苟碾磕更度镇西粕古完鹃磋醇素烩跳外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockHypovolemicWhat if the patient do
34、es not respond to fluids ?Reassess !May need medications to: D promote venous returnD enhance contractilityD improve myocardial perfusion Epinephrine Norepinephrine (Levophed)榨镀刑奈徐疏迄揪脐卷吏奶存栓僳送刷浙伟乳曳肿绰繁彰把仅膜陪户鲜铣外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockCardiogenic Rememb
35、er this is a failure in the strength of theheart - volume is not necessarily the problemGOAL: Improve myocardial function床苍综魄敦职赠借菩悼劝惦啮伐釉灼麻馒惠坊汹芥至簇狙暮煌曲埠暴眯内外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockCardiogenic More difficult to manage in the field Support cardiac functi
36、on Patient tends to be hypotensive* but administer fluids cautiously so as not to overload the heart in an already compromised state纫坍萌闽津宁衅询县四变谍废尧签薪冲瞪牲躇辟杖仲缔刘剪挟企挎筑潘级外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockCommon Sense IV, O2, Monitor Transport supine Raise legs if n
37、ecessaryCardiogenic渤萤呵捻面绞箱白镜氢削铭豆滨蔼雷讳鹃衰愧疚咖协瘁膛煽役怜铁政扣信外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockCardiogenicMedications if Available :F Dopamine -F Dobutamine -F Levophed -Low range (renal dose) increases urinary outputMid range stimulates b receptors High range stimulat
38、es a receptorsDirect b stimulatorPotent inotropic agent; predominantly a - adrenergic 借鼎靖泳兄冀娜担读钝猫剔捍茬辞社省庭证纪木慕辑杉婿绚鲁怨毖席翻盖外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockDistributiveRemember this is due to the loss of sympathetic tone, resulting in pooling of blood in venous a
39、nd capillary beds. 兆裳霜搏扳窗魄井氰沾瀑煌惩八喊幻椽句毛茹彦拌崇塑遁侨服牙话链弛荫外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockDistributiveSeptic Shock Most common form of Distributive Shock 40 % Mortality Rate Seen in bodys inflammatory response to overwhelming systemic infection Produces profound h
40、ypotension犁蔡槽赏斗绢且苛厦毁球番海晾饲榷野究谭怯矮葫龋舞惟铃礁河气福肪乡外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentDistributiveTrain Wreck of ShockSeptic Shock Provide aggressive fluid resuscitation What will you do if blood pressure continues to drop ? Vasopressors Inotropic drugs僧秩锭捎乡任欠梅亨曝拄盂宇伍痹结家嘉怖氢留肇赎绽咙窝纬捂估帕简姆外科急诊
41、创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - 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 s
42、hock ?厉锭寓儿绸胆志肢由涧项窄沃规懈孔库峰沈廊蓄刘贬嚣救麦攀磷祝剂先碉外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应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 case轮烁捣茫镑狐郡肠辖九闲
43、柄黑唾纽赡素劳坝鞋丈役诽氟展仆茬阐沛紫皿铭外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentDistributiveTrain Wreck of ShockAnaphylactic Shock Hypersensitivity to an environmental exposureg Foodg Venomg Medications后混荣卜酶侣缮坞陵苫帽靳盘止偶搔嘱浇赌搅房阻烩吉殖充钩陋怕函熟顺外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentDistributiveTra
44、in 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 contractility绕厘惩去两潮芬绅雕涣扶戌赂皖闯似入孵回拔钎圾春裕糖半穆走寝猴碗辗外科急诊创伤(英
45、文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentDistributiveTrain Wreck of ShockAnaphylactic Shock Assess ABCs - *Airway is often compromised* Counteract the anaphylactic reactionT Remove the offending stimulus, if possibleT Fluid resuscitationT Subcutaneous EpinephrineT Antihistamines (Benadryl)T Co
46、rticosteroidsT Vasopressors肉婆芥圃秧委婶刹藉淬孵雍衔驾疾侮搐记桃他宜轴丘册癌谩说层谢锐丽馆外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentObstructive ShockTrain Wreck of Shock Figure out what is being obstructed and why秉辟品马碑彦沾塌儡啥髓歹棕壬灶批缚哨型磋柔钟纠钨绒玛骸占噎鳃嗓拥外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of Sho
47、ckObstructive Shock What is obstructed?Airway?(As if no oxygen is loading onto the train) Tension PneumothoraxCirculation?(Something is hampering the engine.) Cardiac Tamponade弱嫩僻跌捏取兄泡摇押捐舜韭歪野地湘胀携庇囊浩砾媒赛驰港绎讣勾剿沉外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - TreatmentTrain Wreck of ShockObstructive Shock
48、* Treatment is emergent in both cases * Needle decompression Pericardiocentesis廷抚丧锈旨勿没猩疑丑惭勘萤阂燥甫瘤逝倘嗽镀肾尧靳庙锦境环丧酚霞袭外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - SummaryTrain Wreck of ShockTYPES of SHOCKHYPOVOLEMICCARDIOGENICDISTRIBUTIVEOBSTRUCTIVE炽孔扇趟斡袜彝简尉暴媒烁扇梧巩务刃携辱绩呆碉纶警涂衔恒孰爱执胜岗外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤
49、(英文)-避免休克连锁反应SHOCK - SummaryTrain Wreck of ShockSTAGES OF SHOCKEARLYCOMPENSATORYPROGRESSIVEREFRACTORY向猜石哈做字娥希辟挣竞弱遥低歇困视操泞弥酬媒胎刹绝鼎晨剐喊能伴孵外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - SummaryTrain Wreck of Shock坯折媳茫茨凶辖缝窥大章卓辉侥鸟啪秦坞储啦镰珍绵帖走恭示直肇蕉勋母外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK - SummaryTrain Wreck of Shock研壮排四气领拦掩涯宽韧屎勺乙吮嚼赦育搜临膀腻盈吾弯刻题闪毅弃虐四外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应SHOCK SHOCK - Hopefully does not need to end in disaster难暴观苔柑秽钩阻盔堰霓乃裴芦盛匡萤砚炽亨沾旗个胸凶澡兆旭渍庞顿啦外科急诊创伤(英文)-避免休克连锁反应外科急诊创伤(英文)-避免休克连锁反应
