Transcript Shock - Silver Cross Emergency Medical Services System

January 2013
Silver Cross EMS
EMD CE
The Problem
 Damage to internal soft tissues and organs can cause
life-threatening problems.
 Internal bleeding results in shock.
 Shock is a state of collapse of the cardio-vascular
system that results in inadequate delivery of blood and
oxygen to the organs. Poor tissue perfusion and
oxygen/carbon dioxide exchange.
 More trauma patients die from shock than from any
other condition.
The Components
 The Heart (pump)
 The Blood (fluid)
 The Vessels (pipes)
 Problems with any one of these can cause shock
Parts and Function of the
Circulatory System
 The pump
 The heart functions as the body’s pump.
 The heart consists of four separate chambers.


The two upper chambers on the top of the heart are
the atrias.
The two lower chambers on the bottom of the heart
are the ventricles.
Parts and Function of the
Circulatory System
Blood Flow Through the Heart
Memory Aid Abbreviation
V
RA
RV
PA
PV
LA
LV
A
 Veins carry blood to the
Vena Cava, then goes
through the Rt. Atrium.
The Rt. Ventricle carries
the blood to the lungs
through the Pulmonary
Artery. The Pulmonary
Vein carries blood to the
Lt. Atrium. The Lt.
Ventricle pumps the
blood to the body via the
Aorta.
Parts and Function of the
Circulatory System
 The pipes
 The arteries carry blood
away from the heart after
it’s been oxygenated in the
lungs.
 The capillaries form a
network that distributes
blood to all parts of the
body and exchanges the
oxygen and carbon dioxide.
 The veins return the blood
from the capillaries to the
heart to be re-oxygenated.
Parts and Function of the
Circulatory System
 The fluid
 The liquid part of the
blood is plasma.
 Red blood cells carry
oxygen and CO2.
 White blood cells
consume bacteria and
viruses to combat
infections in the body.
 Platelets form clots that
help stop bleeding.
Pump Failure
 Cardiogenic shock occurs if the heart cannot pump
enough blood to supply the needs of the body.
 Pump failure can result from a heart attack.
 Inadequate pumping of the heart can cause blood to
back up in the vessels of the lungs, resulting in
congestive heart failure (CHF).
Pipe Failure
 Pipe failure is caused by the expansion of the
capillaries to as much as three or four times their
normal size.
 Blood pools in the capillaries.
 The rest of the body is deprived of blood.
 Blood pressure falls and shock results.
 Shock induced by fainting (psychogenic shock)
 Fainting is a short-term condition that corrects itself
once the patient is placed in a horizontal position.
Pipe Failure
 Anaphylactic shock
 Caused by an extreme allergic reaction to a foreign
substance
 The patient appears flushed, breathing may become
difficult, and blood pressure drops rapidly.
 Death will result if prompt action is not taken.
Pipe Failure
 Spinal shock
 May occur in patients who have sustained a spinal cord
injury
 The injury allows the capillaries to expand, and blood
pools below the level of the injury.
 The brain, heart, lungs, and other vital organs are
deprived of blood, resulting in shock.
Fluid Loss
 Fluid loss caused by excessive bleeding (hemorrhage)
is the most common cause of shock.
 Blood escapes from a wound and the system’s total
fluid level drops.
 The heart begins to pump faster to maintain pressure in
the pipes.
 The pump eventually stops pumping, resulting in
cardiac arrest.
Fluid Loss
 External bleeding is easy to detect.
 With internal bleeding, the bleeding cannot be seen,
but you may see these signs:
 Bruising
 Swelling
 Rigidity in the affected area
 Severe pain in the immediate area
Fluid Loss
 Whether the bleeding is external or internal, if it
remains unchecked, the result will be shock, pump
failure, and death.
 Fluid loss could be from illness also.
 An average adult has about 12 pints (6 L) of blood
circulating in the system.
 The loss of 2 or more pints can lead to shock.
Signs and Symptoms
of Shock
 Shock deprives the body of sufficient blood to
function normally.
 As shock progresses, the body alters its functions in an
attempt to maintain sufficient blood supply.
 Signs and symptoms of shock
 Confusion, restlessness, or anxiety
 Cold, clammy, sweaty, pale skin
Signs and Symptoms
of Shock
 Signs and symptoms of shock (cont’d)
 Rapid breathing
 Rapid, weak pulse
 Increased capillary refill time
 Nausea and vomiting
 Weakness or fainting
 Thirst
General Treatment
for Shock
 Maintain the patient’s ABCs.
 Treat the cause of shock, if possible.
 Maintain the patient’s body temperature.
 Keep the patient calm.
 Do not allow the patient to eat or drink.
 Eating or drinking may cause vomiting.
 Patients in shock may need surgery and should not
have anything in their stomachs.
General Treatment
for Shock
 Position the patient correctly.
 If the patient has no head injury, extreme
discomfort, or difficulty breathing, lay the
patient flat on his or her back on a horizontal
surface.
 Elevate the legs 6" to 12" off the floor.
Treatment for Anaphylactic Shock
 Transport as soon as possible.
 Some patients may carry an epinephrine auto-injector.

The patient should follow their doctor’s instructions
for administration of any medications.

Place patient in a position of comfort and monitor
ABC’s.
Treatment for Shock Caused by
Fluid Loss
 Shock caused by internal blood loss
 Bleeding from stomach ulcers, ruptured blood vessels,
or tumors can cause internal bleeding and shock.
 Patients with internal bleeding may exhibit:




Coughing or vomiting of blood
Abdominal tenderness, rigidity, bruising, distention
Rectal bleeding
Vaginal bleeding in women
Controlling External Blood Loss
 Capillary bleeding
 Most common type of external blood loss
 The blood oozes out.
 Apply direct pressure to the site.
 Venous bleeding
 Second most common type
 This bleeding has a steady flow.
 Apply direct pressure for at least 5 minutes.
Controlling External Blood Loss
 Arterial bleeding
 Most serious type of bleeding
 Arterial blood spurts or surges with each heartbeat.
 Exert direct pressure and maintain pressure until EMS
arrives.
Controlling External Blood Loss
 Direct pressure
 Place a dry, sterile dressing directly on the wound and press with
a gloved hand.
 Do not remove a dressing after you apply it.
 Elevation
 If direct pressure does not stop external bleeding from
an extremity, elevate the injured arm or leg as you
maintain direct pressure. Do not do this is there’s a
suspected fracture.
Controlling External Blood Loss
 Tourniquets
 Indicated only in situations where life threatening
extremity bleeding cannot be controlled by direct
pressure or elevation.
 If the caller has already applied a tourniquet do not
have it removed but never advise the caller to apply
one.
SUMMARY
 If shock is not treated, the patient will
quickly deteriorate and die.
 Whatever the cause of shock, the general
treatments are the same.
 Maintain the patient’s ABC’s to keep them
from declining until they can get more
advanced care.
Sources
 AAOS Emergency Medical Responder, 5th Edition
 Will County 9-1-1 EMDPRS, 2012 Edition