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Chapter 32
Shock
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Objectives
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Perfusion
• Circulation of blood through an organ or a
part of the body
• Shock
– Inadequate circulation of blood through an
organ or a part of the body = inadequate
perfusion
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Cardiogenic Shock (Pump Failure)
• Possible causes:
– Heart attack
– Too fast or too slow
heart rhythm
– Injury to the heart
– Other conditions that
affect the heart’s ability
to pump
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Hemorrhagic Shock (Volume Problem)
• Caused by severe bleeding
• Bleeding may be internal, external, or both
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Hypovolemic Shock (Volume Problem)
• Shock caused by:
– Loss of blood (trauma)
– Loss of plasma (burns)
– Other body fluid
• Vomiting
• Diarrhea
• Excessive sweating
• Excessive urination
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Obstructive Shock
• Blood flow is slowed or stopped by a
mechanical or physical obstruction
– Cardiac tamponade
– Tension pneumothorax
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Distributive Shock (Pipe Problem)
• Blood vessels lose ability to adjust flow of
blood
– Blood vessels remain enlarged
– Amount of fluid in the body remains
constant
– Blood pools in outer areas of the body
– Not enough blood to fill enlarged vessels
– Vital organs are not perfused
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Distributive Shock (Pipe Problem)
• Four major causes of this type of shock are:
– Injury to the spinal cord
• Neurogenic shock
– Severe infection
• Septic shock
– Severe allergic reaction
• Anaphylactic shock
– Psychological causes
• Psychogenic shock
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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
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Stages of Shock
• Early (compensated)
• Late (decompensated)
• Irreversible (terminal)
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Stages of Shock
Early Shock
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Stages of Shock
Late Shock
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Irreversible Shock
•
•
•
•
•
Body’s defense mechanisms have failed
Irregular pulse
Heart can no longer effectively pump blood
Permanent damage occurs to vital organs
Eventually:
– Heart stops
– Breathing stops
– Death results
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Common Causes of Shock in Children
• Trauma
• Fluid loss
• Infection
• Anaphylaxis
• Congenital heart disease
• Chest wall injury
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Indicators of Shock
• Altered mental status
• Tachycardia
• Weak distal pulses
• Delayed capillary refill time
• Cool, mottled extremities
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Infants and Children
•
Can maintain normal blood pressure until
more than half their blood volume is gone
•
By the time their blood pressure drops, they
are close to death
•
Tend to compensate longer but get worse
faster when compensatory mechanisms fail
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Capillary Refill
• Assess capillary refill
in children younger
than 6 years of age
• Delayed capillary
refill in an infant
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Mottled Skin in a Child
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Older Adults
• Suspect septic shock if tachycardic and
hypotensive if other causes of shock are not
obvious.
• Difficulty tolerating hypotension caused by
hemorrhage
• Beta-blockers, calcium channel blockers
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Older Adults
• Airway
– Arthritis of cervical vertebrae
– Dentures
– Coughing often ineffective
• Breathing
– Higher resting respiratory rate
– Lower tidal volume
– Less elasticity/compliance of the chest
wall
• Circulation
– Higher resting heart rate
– Irregular pulse
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Emergency Care of Shock
•
Scene size-up
– Evaluate mechanism of injury or nature
of the illness
– Put on appropriate PPE
•
Perform a primary survey
– Stabilize cervical spine if needed
– Manage airway and breathing
– Control all obvious external bleeding
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Emergency Care for Shock
• Place patient supine
– Raise feet 6 to 12 in if no trauma present
• Give oxygen
• Prevent heat loss
• Perform physical examination
• Take vital signs, gather medical history
• Rapid transport
• Splint any bone or joint injuries en route
• Comfort, calm, and reassure patient
• Reassess at least every 5 minutes
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Questions?
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