Download Ch03_Shock modified

Committee on Trauma Presents
STOP
the
Bleeding!
Shock
ACS
Objectives

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
ACS
What is shock?
Generalized state of hypoperfusion

Inadequate substrate delivery

Catecholamines and other responses

Anaerobic metabolism

Cellular dysfunction

Cell death
ACS
How do I recognize it?
Alteration in
LOC, anxiety
Hypotension
Tachypnea,
shallow
respirations
Tachycardia
Cold,
diaphoretic
skin
 Urinary
output
ACS
What are the causes?
Hemorrhagic

Blood loss
vs Nonhemorrhagic

Tension pneumothorax

Cardiac tamponade

Cardiogenic

Neurogenic

Septic
ACS
What can I do about it?

Restore volume!

Vascular access (catheter, sites)

Warmed fluids (type)
Monitor response
 Prevent hypothermia!

ACS
How do I evaluate the response?
Identify Improved Organ Function

CNS: Improved level of consciousness

Renal:  urinary output

Skin: Warm, capillary refill

Respirations: Improved rate and depth

Vital signs: Return to normal
ACS
What is the patient’s response?
Related to volume or persistence of
hemorrhage

Rapid responder

Transient responder

Nonresponder
ACS
Class I Hemorrhage
750 mL BVL (15%)
Slightly
anxious
Urine
30 mL/hr
Responder
Respirations
14-20/min
Heart rate
<100/min
 BP
Crystalloid
ACS
Class II Hemorrhage
750-1500 mL BVL (15-30%)
Mildly
anxious
Urine
20-30 mL/hr
Crystalloid,
? blood
Responder
Respirations
20-30/min
Heart rate
100/min
 Pulse
pressure
 BP
ACS
Class III Hemorrhage
1500-2000 mL BVL (30-40%) Transient
or nonresponder
Confused,
anxious
Urine
5-15 mL/hr
Crystalloid,
blood, operation
Respirations
30-40/min
Heart rate
120/min
Pulse
pressure
 BP
ACS
Class IV Hemorrhage
2000 mL BVL (>40%)
Nonresponder
Confused,
lethargic
Urine
negligible
Rapid fluids,
blood, operation
Respirations
>35/min
Heart rate
140/min
 Pulse
pressure
 BP
ACS
What are the pitfalls?



Equating BP with
cardiac output
Hemoglobin,
hematocrit levels
Age extremes

Hypothermia

Athletes

Pregnancy

Medications

Pacemaker
ACS
©ACS
Summary

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?
©ACS