Transcript Shock - Ronna

Chapter 3






Define shock
Recognize the shock state
Determine the cause
Apply treatment principles
Recognize the importance of early
hemorrhage identification and control
Manage patient’s response






What is shock?
Is the patient in shock?
What is the cause of the shock state?
What can I do about it?
What is the patient’s response?
What are the pitfalls?

Generalized state of hypoperfusion
◦
◦
◦
◦
◦
Inadequate substrate delivery
Catecholamines and other responses
Anaerobic metabolism
Cellular dysfunction
Cell death






Tachycardia
Alteration in LOC, anxiety
Tachypnea, shallow respirations
Cold, diaphoretic skin
Lowered urinary output
Hypotension
Hemorrhagic
Blood loss
vs
Non-hemorrhagic
Tension pneumothorax
Cardiac tamponade
Cardiogenic
Neurogenic
Septic


Physical examination
Diagnostic adjuncts to primary survey
◦ Chest X-ray
◦ CT/FAST/DPL
◦ AP X-ray pelvis



Direct pressure, splint fractures, reduce pelvic
volume
Restore volume: IV access, warmed fluids
Prevent hypothermia

Indentify improved organ function
◦
◦
◦
◦
◦
CNS: improved level of consciousness
Renal: improved urinary output
Skin: warm, capillary refill
Respirations: improved rate and depth
Vital signs: return to normal

Rapid responder
◦ A rapid infusion of crystalloid will fill vascular space
and result in a temporary improvement in vital
signs

Transient responder
◦ Increasing the amount of crystalloid in larger
deficits will decrease hematocrit

Nonresponder
◦ In large losses, crystalloid infusion will have
minimal or no effect
I
II
III
IV
Blood Loss
(%)
(mL)
< 15%
< 750
HR
< 100
> 100
> 120
> 140
BP
Normal
Normal
i
ii
RR
14-20
20-30
30-40
> 35
UOP (mL/hr)
> 30
20-30
5-15
Negligible
MS
Slightly
Anxious
Mildly
Anxious
Anxiety &
Confusion
Confusion &
Lethargy
15-30
30-40
750-1500 1500-2000
> 40
> 2000








Equating BP with cardiac output
Hemoglobin, hematocrit levels
Age extremes
Hypothermia
Athletes
Pregnancy
Medications
Pacemaker






What is shock?
Is the patient in shock?
What is the cause of the shock state?
What can I do about it?
What is the patient’s response?
What are the pitfalls?