INADEQUATE TISSUE PERFUSION
INSUFFICIENT BLOOD CIRCULATION TO THE VITAL TISSUES
IT ALSO CAUSES INADEQUATE REMOVAL OF WASTE PRODUCTS FROM THE CELLS
SHOCK IF NOT TREATED RESULTS IN DEATH
ELEMENTS IN THE DEVELOPMENT OF SHOCK
1. FLUID - BLOOD
2. CONTAINER - BLOOD VESSELS
3. PUMP - HEART
1. THE FLUID MAY BE LOST - INSUFFICIENT BLOOD
2. THE CONTAINER GETS BIGGER - VESSELS DILATE
3. THE PUMP BREAKS DOWN - HEART PROBLEMS
HYPOVOLEMIC - low volume. Cause - loss of body fluids
Excessive blood or plasma loss = HEMORRHAGIC SHOCK.
External or internal injuries, blunt abdominal trauma, crushing injuries, and burns
Dehydration, due to diarrhea, vomiting, diaphoresis can lead to this.
Problem? ________________
METABOLIC - severe disturbances of body fluid and chemical balance ( acid-base and salt balance) from diarrhea, vomiting, or polyuria (diabetes).
Some gland problems (adrenal,thyroid, or pituitary) can lead to this.
Problem ?________________
SEPTIC - severe infection throughout body releases toxins (poisons) into blood stream, cause vessels to dilate and leak. Seen in some nursing home calls.
Problem - very serious because pt is sick with infection
____________________
NEUROGENIC - failure of the nervous system to control the size of blood vessels. Spinal injury often cause. which creates other problems like inability to control temperature anymore. CNS damage can do it. Muscles in vessels no longer get stimulus to constrict and dilate out.
Problem ? _________________
PSYCHOGENIC - Fainting. Often in a hot, stuffy crowded room, or standing a long time in the heat. Nervous system reaction to fear, good or bad news, sight of blood, etc. Sudden release of hormones that causes dilation of vessels, and blood flow to brain is temporarily interrupted. Usually self correcting. Major concern - fall.
Problem ?_____________________
CARDIOGENIC - heart's failure to circulate the blood.
Problem ? ____________________
RESPIRATORY - Inadequate breathing to get in enough O2 and get CO2 out.
Problem ? ____________________
COMPENSATING MECHANISMS
Body has some built in automatic treatment for keeping the perfusion at an acceptable level thruout the body. As pt goes deeper into shock, body compensates by shunting if it can - taking blood that normally runs to extremities and shunting it to the important organs of the heart, brain, lungs, and kidneys.
Early Stages of Compensation
1. Restlessness or combativeness. Pt feels something is wrong. May look afraid.
2. Pulse rate increases. Body trying to adjust to less fluid, bigger container, or weaker pump. Speeds up more if they sit up.
3. Respiratory rate increases. Body senses tissue is not getting rid of enough waste or not getting enough O2.
Loss of Compensation
4. Capillary refill time increases and skin changes occur. Skin turns pale, cool and clammy, diaphoretic and cyanotic. Body beginning to redirect blood away from the extremities to the important organs.
5. Thirst, weakness, and nausea may be noticed. Remember - give nothing to the pt to drink.
6. Weak, rapid pulse and shallow & rapid breathing indicates body is losing the battle to compensate.
7. Changes in the LoC occur when brain doesn't get enough O2. If not arrested, it will go from confused, to disoriented, to sleepy, to unconscious
8. Drop in blood pressure - A late sign of shock. Indicates that body has lost its fight to compensate. Unless pt receives immediate effective care he will decline rapidly.
THE BEST CARE FOR SHOCK IS TO PREVENT SHOCK
ANAPHYLACTIC - Severe allergic reaction to a substance.
1. Injection - Drugs like penicillin, tetanus antitoxin, ...caine etc.
2. Ingestion - eating of certain foods - shellfish, oral penicillin, eggs
3. Sting - honey bee, wasp, etc common.
4. Inhalation - breathing in dusts, pollens etc
5. Absorbed chemicals through the skin produce this reaction
Vessels dilate rapidly, tissues that line the resp system swell and obstruct the airway. Wheezing & dyspnea develop. Fluid pours out of the tissue in reaction to the substance. The bronchi constrict & that shuts down air passages. Difficulty of getting air out as well as in.
(Always ask if pt is allergic to anything.)
Immed subQ, IM injection of .5-1mg 1/1000 Epi
Problem with EMT giving drugs. "Assist the Pt"
Prompt transport - life threatening situation. - with respiratory support
& ventilatory support enroute