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Prehospital Emergency Care, Ninth EditionJoseph J. Mistovich • Keith J. Karren
Objectives
1. Define key terms introduced in this chapter.2. Explain the pathophysiology of shock (hypoperfusion),
including the consequences of cellular hypoxia anddeath (slide 16).
3. Describe the physiology of maintaining adequateperfusion (slide 17).
4. Describe how inadequate vascular volume, inadequateheart function, and decreased peripheral vascularresistance can lead to shock (slide 18-22).
5. Give examples of conditions that can lead to (slides 18-22, 25-47):a. Loss of vascular volumeb. Inadequate heart functionc. Decreased peripheral vascular resistance
Objectives
6. Explain the mechanisms and pathophysiology of eachof the following categories and types of shock (slides23-50):a. Hypovolemic (hemorrhagic and nonhemorrhagic)b. Distributive (anaphylactic, septic, neurogenic)c. Cardiogenicd. Obstructivee. Metabolic or respiratory
7. Explain how compensatory mechanisms to shock aremaintained through (slides 53-56):a. Direct nerve stimulationb. Release of hormones
8. Explain the body’s compensatory responses tohypoperfusion and how they manifest in the early signsand symptoms of shock (slides 51-56).
Objectives
9. Differentiate between early (compensatory) and late(decompensatory/irreversible) signs of shock (slide 58).
10. Describe the progression of shock through thecompensatory, decompensatory (progressive), andirreversible stages (slide 58).
11. Explain how to identify the patient who is in a shockstate and demonstrate the assessment of patients toidentify shock (slides 59-64).
12. Explain the influence of age on the assessment andmanagement of patients with shock (slides 65-66).
13. Discuss the goals of prehospital management ofpatients with shock (slides 67-69).
Objectives
14. Describe the pathophysiology of cardiac arrest (slides70-73).
15. Differentiate between the electrical, circulatory, andmetabolic phases of cardiac arrest (slide 73).
16. Identify situations in which resuscitative attemptsshould be withheld (slides 76-77).
17. Explain each of the links in the Chain of Survival ofcardiac arrest (slides 78-79).
18. Explain the importance of early defibrillation in cardiacarrest (slides 80-81).
19. Explain the rationale for the “push hard and push fast”approach to cardiopulmonary resuscitation (CPR)(slides 82-83).
Objectives
20. Describe the features, functions, advantages,disadvantages, use, and precautions in the use ofautomated external defibrillators (AEDs) (slides 84-87).
21. Compare and contrast ventricular fibrillation, ventriculartachycardia, asystole, and pulseless electrical activity(slides 88-92).
22. Given a series of cardiac arrest scenarios involvinginfants, children, and adults, demonstrate appropriateassessment and resuscitative techniques, including theintegrated use of AEDs (automated andsemiautomated), ventilation, and CPR, and explain thepurpose and procedure for reassessment of thecardiac arrest patient (slides 94-101).
Objectives
23. Demonstrate assessment and management of a postcardiac-arrest patient with return of spontaneouscirculation (slides 98-101).
24. Given a cardiac arrest scenario, make decisionsregarding obtaining advanced cardiac life support(ACLS) (slide 105).
25. Describe the safety precautions to be taken to protectyourself, other EMS providers, the patient, andbystanders in resuscitation situations (slides 93, 107-108).
Objectives
26. Explain the importance of AED maintenance, EMTtraining and skills maintenance, and medical directionin the Chain of Survival of cardiac arrest (slides 109-115).
27. Discuss special considerations in the use of an AED inpatients with cardiac pacemakers and automaticimplanted cardioverter-defibrillators (slides 118-121).
28. List the advantages and disadvantages of automatedchest compression devices, impedance thresholddevices, and other circulation-enhancing devices(slides 122-129).
Multimedia Directory
Slide 22 Etiology of Shock AnimationSlide 50 Types of Shock AnimationSlide 69 Bleeding Control/Shock Management Video
Topics
ShockResuscitation in Cardiac ArrestAutomated External Defibrillation and CardiopulmonaryResuscitationRecognizing and Treating Cardiac ArrestSpecial Considerations for the AED
CASE STUDYCASE STUDY
Dispatch
Respond to 46 Hillman Street. You have a 26-year-old male patient who has been stabbed in
the leg and is bleeding profusely. Lawenforcement is en route.
EMS Unit 102
Time out 2102
• A police officer leads you into the basement• Patient is supine on the floor with a large pool of
blood around his right thigh• Patient is not alert, does not respond to voice,
and appears extremely pale
Upon Arrival
How would you proceed with theassessment of this patient?
Back to Topics
Shock
Inadequate tissueperfusion
Back to Objectives
Review of Respiratory Pathophysiology
Back to Objectives
Etiologies of Shock
Back to Objectives
Inadequate Volume
Fig. 15-01
Don’t have artyet - WDS
Fig. 15-02
Inadequate Pump Function
Don’t have artyet - WDS
Fig. 15-03
Inadequate VesselTone
Don’t have artyet - WDS
Etiology of Shock
Return to Directory
Click here to view an animation on the etiology of shock
Categories of Shock
Back to Objectives
Fig. 15-04
Don’t have artyet - WDS
Categories of Shock
Hypovolemic Shock
Back to Objectives
Fig. 15-05
Don’t have artyet - WDS
Categories of Shock
Distributive Shock
Fig. 15-06
Don’t have artyet - WDS
Categories of Shock
Cardiogenic Shock
Fig. 15-07
Don’t have artyet - WDS
Categories of Shock
Obstructive Shock
Fig. 15-08
Don’t have artyet - WDS
Categories of Shock
Metabolic orRespiratory Shock
Inability of thebody to use,
transport, and/oroffload oxygen
Specific Types of Shock
Specific Types of Shock
HemorrhagicHypovolemic Shock
Fig. 15-05a only(trim outnonhemorrhagichypovolemicshock)Don’t have art
• Heart rate• Pulse character• Respiratory rate and
tidal volume
Age Considerations inShock
Back to Objectives
Childrencompensate well
and then suddenlydecompensate.
Medications andadvanced age
decreasecompensation
ability.
General Goals ofPrehospital Management of
Shock
Back to Objectives
• Secure and maintain an airway• Assure adequate ventilation• Provide high-flow, high-concentration oxygen• Avoid hyperventilation• Stop any external bleeding• Splint fractures to reduce bleeding• Leave impaled objects in place• Keep the patient warm• Apply PASG if indicated and local protocol
allows• Provide rapid transport and perform other
interventions en route• Consider an ALS intercept
Bleeding Control/Shock Management
Return to Directory
Click here to view a video on the topic of bleeding control and shockmanagement.
Resuscitation inCardiac Arrest
Back to Topics
Sudden Death:the patient dieswithin one hourof the onset of
symptoms
Cardiac Arrest:cardiac output is
completelyineffective and nopulse can be felt
Resuscitation:bringing the
patient back froma potential or
apparent death
Back to Objectives
Pathophysiology ofCardiac Arrest
Electrical PhaseLess than four minutes following arrest, the cardiac
muscle uses its sugar/oxygen stores.
Circulatory PhaseFrom four to ten minutes following arrest, the cardiac
muscle switches to anaerobic metabolism.
Metabolic PhaseGreater than ten minutes following arrest, cardiac cells
swell, rupture, and die.Back to Objectives
Terms Related toResuscitation
SurvivalA patient who survives tobe discharged from the