National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Shock

Chapter 10

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Anatomy and Physiology

Heart◦ Four chambers

Blood vessels◦ Arteries – away from the

heart◦ Veins – toward the heart

Blood

How the Heart Pumps Blood

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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What is Shock?

Failure of the circulatory system to maintain adequate blood flow to tissues

Leads to inadequate tissue perfusion in which cells do not receive sufficient O2 & nutrients

continued

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Stages of Shock

Compensated shock Decompensated shock Irreversible shock

Important terms:◦ Tachypnea & tachycardia

continued

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Types of Shock

Hypovolemic◦Results from a critical decrease in

circulating blood volume Caused by a loss of circulating blood

or internal body water

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Types of Shock

continued

Cardiogenic◦Heart cannot adequately pump blood

The defect occurs within the heart itself

Examples?

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Types of Shock

Distributive◦ Blood vessels lose their ability to

constrict appropriately 3 subtypes: septic, anaphylactic,

neurogenic

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Types of Shock Septic

◦Caused by an infection known as sepsis Anaphylactic

◦ Severe allergic reaction Neurogenic

◦Caused by disruptions of the CNS

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Types of Shock

Obstructive shock◦ Tension pneumothorax◦ Pericardial tamponade◦ Pulmonary embolism

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Factors Affecting Shock

Age Concurrent illness or injury Pre-existing medical condition Mind-altering substances or

medications Prescription or over-the-counter

(OTC) medications

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Patient Assessment

MOI◦ Scene size up◦Clues; suggestion possible shock

Classic signs◦ Tachycardia◦Hypotension◦ Tachypnea◦ Pale, cool, diaphoretic skin◦ Altered mental status

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Patient Management

High flow oxygen Return to homeostasis Place in shock position Transport in head down position

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River,

NJ

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Skill 10-1

Shock Management

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (a) Assess scene safety and initiate Standard Precautions. Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (b) Perform a primary assessment. Assess ABCDs and correct any problems found. Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (c) Call for help and arrange for transport that includes ALS. Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (d) Monitor the airway and administer high-flow oxygen. Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (e) To prevent heat loss, keep the patient warm and dry. Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (f) Place the patient with the head lower than the feet while maintaining spinal integrity. Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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OEC Skill 10-1 Shock Management (g) Provide for rapid transport. Copyright Selko

National Ski Patrol, Outdoor Emergency Care, 5th©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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continued

Early recognition!!

Early recognition of the potential for shock is essential in reducing the number of deaths from this condition.