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. -