Download Shock Resuscitation

Shock & Resuscitation
Shock
• Inadequate perfusion to cells, tissues, &
organs
• AKA hypoperfusion
• Includes oxygen & glucose
Review Pathophysiology
• Aerobic Metabolism
• Breaking glucose into energy
• Energy
• Needed for sodium/potassium pump
Oxygen Delivery
• Pt breathing adequately
• Alveoli diffusing properly
• Oxygen capable carrying cells
• Adequate volume of blood
• Oxygen must break bond from cell
Etiologies of Shock
• Inadequate Volume
• Inadequate Pump Function
• Inadequate Vessel Tone
Inadequate Volume
• Causes:
• Loss of whole blood
• Loss of plasma
• Pt Needs:
• Increase in blood volume
• Blood transfusion (blood loss)
• IV fluids (dehydration)
Inadequate Pump
• Causes:
• Injury to heart
• MI, CHF, Heart valve disease, arrhythmias
• Pt needs:
• Not fluid-may make things
worst
• Improve pump function
Inadequate Vessel Tone
• Causes:
• Relates to size of vessel
• Vasodilation,
• Not a fluid problem
• Pt needs:
• ALS support
• Improve pressure, perfusion, cellular
oxygenation & delivery of glucose
REMEMBER!!!!
• Does not matter what caused the shock,
pt needs rapid transport to nearest
facility
Categories of Shock
• Hypovolemic
• Distributive
• Cardiogenic
• Obstructive
• Metabolic/Respiratory
Hypovolemic
• Low blood volume
• Most common
• Hemorrhagic
• Blood loss
• Nonhemorrhagic
• Volume/dehydratio
n
Distributive
• Decrease in
intravascular volume
• Caused by
vasodilation/increase
capillary permeability
• Usually not fluid
problem
• Caused because vessel
large enough not
enough volume to fill
it
• Capillaries can also
become permeable &
leak fluid into
interstitial space
Cardiogenic
• ineffective pump function
• Has adequate volume & tone
• >40% loss of pump function
Obstructive
• Blocks blood flow
• Pump, vessel, &
volume adequate
• Pulmonary
Embolism
• Cardiac Tamponade
• Tension
Pnuemothorax
Metabolic/Respiratory
• Inability for O2 to diffuse into blood, be
carried by hemoglobin, leave the RBC,
or tissue unable to use O2
• Examples:
• Carbon monoxide poisoning
• Cyanide poisoning
Types of Shock
Remember RANCHPMS
•
•
•
•
•
•
•
•
Respiratory
Anaphylactic
Neurogenic
Cardiogenic
Hypovolemic
Psychogenic
Metabolic
Septic
• These each fall
under a category of
shock
• Some named as the
same as the category
• Most common types
of shock
Regardless of the type of shock:
Cells are starved for oxygen-rich
blood
Without adequate oxygen:
Cells begin to break down
Waste products build up
Death may follow unless
adequate perfusion is quickly
restored
• Fight or Flight
Body Response
• Sympathetic nervous
system
• Direct nerve stimulation
• Increase heart rate
• Increase force of contraction
• Vasoconstriction
• Release epinephrine &
norepinephrine
• Release of Hormones
• Stimulate Alpha & Beta
• Others released which
decrease urine output
Stages of Shock
• Compensatory
• Decompesatory
• Irreversible
Shock & Resusciation
Day 2
Review
• What is shock?
• What are the categories of shock?
• What are the different types of shock?
• What are the etiologies of shock?
• What are the types of shock and what is
happening with the body in each
phase?
Shock Assessment
• Identify quickly
• Obtain History
• Physical exam
• Signs & Symptoms
• Altered mental status
• Pale, cool, clammy skin
• Delayed capillary refill
• Decreased urine output
• Weak or absent peripheral pulses
Assessment Continued
• Vital Signs
• Blood pressure
• Heart rate
• Pulse character
• Respiratory rate and tidal volume
• Skin color, temperature, and condition
• Pulse oximetery reading
Age Consideration
• Normal systolic for a child less than 10
• Times age by 2 & add to 70
• Hypotension is a late finding in
children
• Geriatrics do not compensate well
• Medications may prevent some signs and
symptoms
Treatment
• Improve oxygenation
• Secure & maintain airway
• Ventilate-do not hyperventilate
• Stop bleeding
• Splint fractures
• Do not remove FB
• Keep in supine position
• Apply PASG if suspected pelvic fracture
• Maintain body temperature
•
Remove wet clothing
• Rapid transport
Cardiac Arrest
• Ventricles are not contracting
• Brain cells begin to die within 4-6
minutes without oxygen
Phases of Cardiac Arrest
ELECTRICAL PHASE
• Begins immediately
• Ends 4 minutes after the arrest has
started
• Heart still has good O2 & glucose
reserves
• Ultimate goal is get ventricles beating
Circulatory Phase
• Begins at 4 minutes & ends at 10
minutes
• Oxygen stores depleted
• If in this phase must do chest
compressions to help rebuild the
supplies to the tissues
Metabolic Phase
• Begins after 10 minutes
• Starved of oxygen & glucose
• Tissue ischemic
Vocabulary
• Downtime
• Total downtime
• Return of spontaneous circulation
(ROSC)
• Survival
• Witnessed cardiac arrest
• Unwitnessed cardiac arrest
Withholding Resuscitation
• DNR
• POLST
• MOLST
• Decapitation
• Rigor mortis
Chain of Survival
1. Early access
• Recognition of emergency
• Calling 9-1-1
22-38
Chain of Survival
2. Early CPR
22-39
Chain of Survival
3. Early defibrillation
22-40
Chain of Survival
4. Early advanced care
22-41
Chain of Survival
• Integrated
post-cardiac
arrest care
22-42
AED & CPR
• Early intervention
• Push hard & Push fast compressions
• Early defibrillation
Types of Defibrillators
• Manual
• semiautomated
• Automated
• Fully automated
• Advantages
Ventricular Fibrillation: Shockable!
Ventricular Tachycardia: Shockable!
Asystole: NOT Shockable!
Pulseless Electrical Activity: NOT Shockable!
Organized electrical
activity with no pulse
NEVER touch the
patient, AED, or cables
when the AED is
analyzing a rhythm.
Back to Objectives
To Be or Not to Be
• Do Not Use in children less than 1
• Children 1-8-adult pads can be used
• Use in non-traumatic patients
Assessment
• Scene size up and primary assessment
• Secondary assessment
• Emergency Medical Care
• Reassessment
Transport
• If the following occur:
• Gains a pulse
• Total of three shocks have been delivered
• AED has said no shock X2
• Local Protocol
Things to watch for
• Water
• Metal
• Transdermal patches
• Implanted device
• Hairy chest
• Energy Levels
• Pacemakers
• AICD