05 Shock Evaluation

8/19/2019 05 Shock Evaluation

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SHOCK EVALUATIONSHOCK EVALUATION

AND MANAGEMENTAND MANAGEMENT

SHOCK EVALUATIONSHOCK EVALUATION

AND MANAGEMENTAND MANAGEMENT


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OVERVIEWOVERVIEWOVERVIEWOVERVIEW

• Pathophysiology of sho!Pathophysiology of sho!

• R"#i"$ of sho! sy%&'o("sR"#i"$ of sho! sy%&'o("s

• Ass"ss("%t a%& (a%ag"("%tAss"ss("%t a%& (a%ag"("%t

• C)''"%t i%&iatio%s fo' th"C)''"%t i%&iatio%s fo' th"a%tisho! ga'("%ta%tisho! ga'("%t


3/19

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SHOCKSHOCKSHOCKSHOCK

• A stat" of $i&"sp'"a& i%a&"*)at" tiss)"A stat" of $i&"sp'"a& i%a&"*)at" tiss)"p"'f)sio%p"'f)sio%

• Lo$ +P &o"s %ot "*)al sho!Lo$ +P &o"s %ot "*)al sho!

• A&"*)at" tiss)" p"'f)sio% '"*)i'"s,A&"*)at" tiss)" p"'f)sio% '"*)i'"s,

– Intact vascular system

– Adequate air exchange

– Functioning pump (heart) – Adequate volume o !lood and plasma


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SHOCK S-NDROMES INSHOCK S-NDROMES INTHE TRAUMA PATIENTTHE TRAUMA PATIENT

SHOCK S-NDROMES INSHOCK S-NDROMES INTHE TRAUMA PATIENTTHE TRAUMA PATIENT

• Lo$ #ol)(" sho!Lo$ #ol)(" sho!

– #emorrhagic (loss o !lood)

– $urn (loss o plasma)

• High spa" sho!High spa" sho! – %eurogenic shoc& (relative hypovolemia)

• M"ha%ial sho!M"ha%ial sho!

– 'ardiac tamponade (o!structive)

– ension pneumothorax (o!structive) – yocardial contusion (pump ailure)


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SIGNS . S-MPTOMS O/SIGNS . S-MPTOMS O/HEMORRHAGIC SHOCKHEMORRHAGIC SHOCKSIGNS . S-MPTOMS O/SIGNS . S-MPTOMS O/HEMORRHAGIC SHOCKHEMORRHAGIC SHOCK

• W"a!%"ssW"a!%"ss

• Thi'stThi'st

• Pallo' Pallo'

• Tahya'&iaTahya'&ia

•Diapho'"sisDiapho'"sis

'ourtesy o $onnie eneely+ ,-%-


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SIGNS . S-MPTOMS O/SIGNS . S-MPTOMS O/HEMORRHAGIC SHOCKHEMORRHAGIC SHOCKSIGNS . S-MPTOMS O/SIGNS . S-MPTOMS O/HEMORRHAGIC SHOCKHEMORRHAGIC SHOCK

• Alt"'"& LOCAlt"'"& LOC

• Hypot"%sio%Hypot"%sio%

• D"'"as"&D"'"as"&p"'iph"'al p)ls"sp"'iph"'al p)ls"s

• D"'"as"&D"'"as"&)'i%a'y o)tp)t)'i%a'y o)tp)t

• /i%ally a'&ia/i%ally a'&iaa''"sta''"st'ourtesy o $onnie eneely+ ,-%-


7/19

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CAPILLAR- RE/ILLCAPILLAR- RE/ILL

TESTTEST

CAPILLAR- RE/ILLCAPILLAR- RE/ILL

TESTTEST• Positi#" if 01 s"o%&sPositi#" if 01 s"o%&s

• Not a )s"f)l i%&iato' of "a'lyNot a )s"f)l i%&iato' of "a'ly

sho! i% a&)ltssho! i% a&)lts – Al0ays delayed i patient is cold

• May 2" h"lpf)l i% s(all hil&'"%May 2" h"lpf)l i% s(all hil&'"%

• Is %"gati#" i% %")'og"%i sho!Is %"gati#" i% %")'og"%i sho! – atient cannot vasoconstrict


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HEMORRHAGICHEMORRHAGIC

SHOCKSHOCK

HEMORRHAGICHEMORRHAGIC

SHOCKSHOCK• Loss of 2loo&Loss of 2loo&

#ol)("#ol)("

– arly shoc& isevident 0ith 1*4256 !lood loss

– 7ate shoc&develops 0ith

354"56 !loodloss


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+ASIC MANAGEMENT+ASIC MANAGEMENTHEMORRHAGIC SHOCKHEMORRHAGIC SHOCK+ASIC MANAGEMENT+ASIC MANAGEMENT

HEMORRHAGIC SHOCKHEMORRHAGIC SHOCK

• Co%t'ol th" 2l""&i%gCo%t'ol th" 2l""&i%g

• 3445 o6yg"%3445 o6yg"%• Loa& . GoLoa& . Go

• /l)i& '"pla"("%t $h"%/l)i& '"pla"("%t $h"%

i%&iat"&i%&iat"&


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SPECI/IC TREATMENTSPECI/IC TREATMENTVARIES WITH SITUATIONVARIES WITH SITUATIONSPECI/IC TREATMENTSPECI/IC TREATMENT

VARIES WITH SITUATIONVARIES WITH SITUATION

• E6t"'%al h"(o''hag" thatE6t"'%al h"(o''hag" that a%a% 2"2"o%t'oll"&o%t'oll"&

• E6t"'%al h"(o''hag" thatE6t"'%al h"(o''hag" that a%%ota%%ot 2" o%t'oll"&2" o%t'oll"&

• I%t"'%al h"(o''hag"I%t"'%al h"(o''hag"


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MANAGEMENT O/ SERIOUSMANAGEMENT O/ SERIOUSHEMORRHAGE THAT CAN +EHEMORRHAGE THAT CAN +E

CONTROLLEDCONTROLLED

MANAGEMENT O/ SERIOUSMANAGEMENT O/ SERIOUSHEMORRHAGE THAT CAN +EHEMORRHAGE THAT CAN +E

CONTROLLEDCONTROLLED• S)pi%" positio%S)pi%" positio%

• 3445 o6yg"%3445 o6yg"%

• Loa& . GoLoa& . Go

• May )s" PASG i%itiallyMay )s" PASG i%itially

• IV a"ss "% 'o)t"IV a"ss "% 'o)t"

– 25cc9&g !olus

– ,eassess+ repeat luid !olus as necessary

• Mo%ito' los"lyMo%ito' los"ly


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MANAGEMENT O/ SERIOUSMANAGEMENT O/ SERIOUSHEMORRHAGE THAT CANNOTHEMORRHAGE THAT CANNOT

+E CONTROLLED+E CONTROLLED

MANAGEMENT O/ SERIOUSMANAGEMENT O/ SERIOUSHEMORRHAGE THAT CANNOTHEMORRHAGE THAT CANNOT

+E CONTROLLED+E CONTROLLED• S)pi%" positio%S)pi%" positio%

• 3445 o6yg"%3445 o6yg"%

• Loa& . GoLoa& . Go

• IV a"ss "% 'o)t"IV a"ss "% 'o)t" – :ive luid to maintain a systolic $ o 854155

• Us" to)'%i*)"ts if %""ssa'yUs" to)'%i*)"ts if %""ssa'y

• PASG o%t'ai%&iat"&PASG o%t'ai%&iat"&

• Notify M"&ial Di'"tio%Notify M"&ial Di'"tio%


13/19

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MANAGEMENTMANAGEMENTINTERNAL HEMORRHAGEINTERNAL HEMORRHAGE

MANAGEMENTMANAGEMENTINTERNAL HEMORRHAGEINTERNAL HEMORRHAGE

• S)pi%" positio%S)pi%" positio%

• 3445 o6yg"%3445 o6yg"%

• Loa& . GoLoa& . Go• IV a"ss "% 'o)t"IV a"ss "% 'o)t"

– :ive luid to maintain a systolic $ o854155

• Notify M"&ial Di'"tio%Notify M"&ial Di'"tio%


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MANAGEMENT O/MANAGEMENT O/MECHANICAL SHOCKMECHANICAL SHOCK

MANAGEMENT O/MANAGEMENT O/MECHANICAL SHOCKMECHANICAL SHOCK

• T"%sio%T"%sio%p%")(otho'a6p%")(otho'a6

• Ca'&iaCa'&iata(po%a&"ta(po%a&"

• Myoa'&ialMyoa'&ialo%t)sio% $itho%t)sio% $ith

sho!sho!


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HIGH SPACE SHOCKHIGH SPACE SHOCKHIGH SPACE SHOCKHIGH SPACE SHOCK

NEUROGENIC SHOCKNEUROGENIC SHOCK

7o((o%ly all"& spi%al sho!87o((o%ly all"& spi%al sho!8


16/19

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MANAGEMENTMANAGEMENTNEUROGENIC SHOCKNEUROGENIC SHOCK

MANAGEMENTMANAGEMENTNEUROGENIC SHOCKNEUROGENIC SHOCK

• S)pi%" positio%S)pi%" positio%

• 3445 o6yg"%3445 o6yg"%

– Assist ventilation as needed

• Loa& . GoLoa& . Go• IV a"ss "% 'o)t"IV a"ss "% 'o)t"

– :ive luid to maintain systolic $ o 854155

• PASG a% 2" )s"& if th"'" is %o "#i&"%" ofPASG a% 2" )s"& if th"'" is %o "#i&"%" of

i%t"'%al i%9)'i"si%t"'%al i%9)'i"s• Mo%ito' los"lyMo%ito' los"ly


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INDICATIONS /OR USE O/INDICATIONS /OR USE O/THE PNEUMATICTHE PNEUMATIC

ANTISHOCK GARMENTANTISHOCK GARMENT

INDICATIONS /OR USE O/INDICATIONS /OR USE O/THE PNEUMATICTHE PNEUMATIC

ANTISHOCK GARMENTANTISHOCK GARMENT• Sho! s"o%&a'y to h"(o''hag" thatSho! s"o%&a'y to h"(o''hag" that

a% 2" o%t'oll"&a% 2" o%t'oll"&

• N")'og"%i sho! $itho)t "#i&"%" ofN")'og"%i sho! $itho)t "#i&"%" of

oth"' i%t"'%al i%9)'i"soth"' i%t"'%al i%9)'i"s

• Isolat"& f'at)'"s of th" l"gs $itho)tIsolat"& f'at)'"s of th" l"gs $itho)toth"' i%t"'%al i%9)'i"s 72lo$ )p to ai':oth"' i%t"'%al i%9)'i"s 72lo$ )p to ai':spli%t p'"ss)'" o%ly8spli%t p'"ss)'" o%ly8

• Sho! $ith %o palpa2l" p)ls"Sho! $ith %o palpa2l" p)ls"7o%t'o#"'sial87o%t'o#"'sial8


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SUMMAR-SUMMAR-SUMMAR-SUMMAR-

• Sho! is a 'itial o%&itio% thatSho! is a 'itial o%&itio% thatl"a&s to &"athl"a&s to &"ath

•Diag%osis a%& (a%ag"("%t ()stDiag%osis a%& (a%ag"("%t ()st2" ao(plish"& *)i!ly2" ao(plish"& *)i!ly

• K%o$l"&g" of sho! sy%&'o("sK%o$l"&g" of sho! sy%&'o("sa%& th"i' (a%ag"("%t is "ss"%tiala%& th"i' (a%ag"("%t is "ss"%tial


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;UESTIONS

05 Shock Evaluation

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