EMS SERVICES (SHOCK, TISSUE
INJURIES, AND SEIZURES)
SHOCK
Inadequate perfusion(blood flow) leading to inadequate oxygen delivery to tissues
PHYSIOLOGY
Cell is the basic unit of life
Cells get energy needed to stay alive by reacting oxygen with fuel (usually glucose)
No oxygen, no energy
No energy, no life
PERFUSION FAILURE
Pump Failure (heart)
Pipe Failure (vessels)
Loss of Volume (blood)
PHASES OF SHOCK
Compensated Shock
Decompensated Shock
Irreversible Shock
COMPENSATED SHOCK
Body still compensates for blood loss
Pulse rate increases
Pulse strength decreases
Pale, diaphoretic skin
Anxiety, restlessness, combativeness
Thirst, weakness, eventual air hunger
DECOMPENSATED
Body compensatory mechanisms fail
Unpalpable pulse
Precipitous drop in blood pressure
Patient becomes unconscious
Respirations slow or cease
IRREVERSIBLE
Lack of circulation causes:Cellular death
Tissue dysfunctionOrgan dysfunction
Patient death
SHOCK ETIOLOGY
Psychogenic
Hypovolemic
Distributive
Obstructive
Cardiogenic
Respiratory
Neurogenic
PSYCHOGENIC SHOCK
Simple fainting (syncope)
Caused by stress, fright, pain
Heart rate slows, vessels dilate
Brain becomes hypo-perfused
Loss of consciousness occurs
Patient usually recovers by self
HYPOVOLEMIC SHOCK
Loss of volume
Causes:Blood loss from traumaPlasma loss from burns
Fluid/electrolyte loss from vomiting, diarrhea, sweating, increased urine output, increase
respiratory loss“Third space” fluid shifts
HYPOVOLEMIC S/S
Anxiety, restlessness, irritability
Rapid, weak pulse
Change in mental status
Signs of inadequate perfusion (diaphoresis, cyanosis, pale/clammy skin)
Increased respiratory rate
ANAPHYLACTIC SHOCK
Results from severe allergic reactions
Body responds to allergen by releasing histamine
Histamine release causes vessels to dilates and become “leaky
S/S
Sudden onsetMild itching, rash, uticaria, hives
Burning sensation (skin)Hypotension
Generalized edemaAngiodema, airway compromise
Respiratory distressComa, rapid death
May have anxiety and restlessness
TREATMENT
ABC’s
Apply O2, assist ventilations as needed
Keep patient in position of comfort
Control bleeding, stabilize fractures
Prevent loss of body heat
Assist with medications
Nothing by mouth
Calm and reassure
TREATMENT
Elevate lower extremities 8 to 12 inches in hypovolemic shock
Do NOT elevate the lower extremities in cardiogenic shock
BLEEDING CONTROL AND TISSUE INJURY DIRECT PRESSURE over injury
Elevate: Raise the extr4emity above the level of the heart
Apply direct pressure at major artery
Closed soft tissue injury- body is struck by a blunt object but does not break the skin.
A SEIZURE IS….
A sudden, brief disruption of the normal functioning of neurons in the brain
SEIZURE CAN APPEAR AS…
A sudden cry and fall, followed byConvulsive movements of all limbsShallow/interrupted breathing - cyanosisLoss of bowel/bladder controlSlow return to consciousness, post-seizure confusion and/or fatigue
This is a generalized tonic-clonic or “grand mal” seizure.
OR MAY APPEAR AS…
Blank staring, chewing, other repetitive purposeless movements
Wandering, confusion, incoherent speech
Crying, screaming, running, flailing
A sudden loss of muscle tone and fall
Picking at clothes, disrobing
This is one type of partial seizure known as a complex partial seizure.
CAUSES
High fever, especially in infantsDrug use, alcohol withdrawalNear-drowning or lack of oxygen from another causeMetabolic disturbancesHead traumaBrain tumor, infection, strokeComplication of diabetes or pregnancy
A COMMON CAUSE OF SEIZURES IS EPILEPSY Epilepsy (also known as a ‘seizure disorder’) is a chronic neurological disorder characterized by recurring seizures that are not otherwise provoked by an acute injury or health emergency.
Epilepsy is not contagious, it is not a mental illness or a cognitive disability. The
neurological dysfunction seen in epilepsy can begin at birth, childhood, adolescence, or even in
adulthood.
Other neurological conditions
Genetic factors
StrokeBrain tumorBrain infectionPast head injuryMetabolic problems
In a generalized seizure the electrical
disruption involves the entire brain.
TONIC-CLONIC SEIZURE -“GRAND MAL”
Loss of consciousness, fall and stiffening of limbs, followed by rhythmic shaking.Breathing may stop temporarily - skin, nails, lips may turn blue Loss of bladder/bowel control may occurGenerally lasts 1 to 3 minutesFollowed by confusion, sleepiness
In a partial seizure
the electrical disruption involves a limited area of the brain.
SIMPLE/PARTIAL SEIZURE
Seizure activity in the brain causing:
Rhythmic movements - isolated twitching of arms, face, legs
Sensory symptoms -tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions
Psychic symptoms - déjà vu, hallucinations, feelings of fear or anxiety
Usually last less than one minute May precede a generalized seizure
COMPLEX PARTIAL SEIZURE
Characterized by altered awareness Confusion, inability to respond Automatic, purposeless behaviors such as picking at clothes, chewing or mumbling.
Emotional outbursts May be confused with:
Drunkenness or drug use Willful belligerence, aggressiveness
EMS TREATMENT
Assure scene safety
If trauma is not suspected, place patient in recovery position
Protect head/limbs from injury
Follow A B C protocol:
Maintain airway – suction PRN
Administer O2
Monitor cardio-respiratory status
Patients may experience a Postictal phase- time when patient begins to recover and maybe confused, sleepy, and have difficulty thinking. -