ObjectivesObjectives
Define shock Define shock Recognize the shock stateRecognize the shock stateDetermine the causeDetermine the causeApply treatment principlesApply treatment principlesRecognize the importance of early Recognize the importance of early
hemorrhage identification and controlhemorrhage identification and controlManage patientManage patient’s response’s response
Key QuestionsKey Questions
What is shock?What is shock?Is the patient in shock?Is the patient in shock?What is the cause of the shock state?What is the cause of the shock state?What can I do about it?What can I do about it?What is the patientWhat is the patient’s response?’s response?What are the pitfalls?What are the pitfalls?
What is shock?What is shock?
→ → Inadequate substrate deliveryInadequate substrate delivery
→→ Catecholamines and other responsesCatecholamines and other responses
→→ Anaerobic metabolismAnaerobic metabolism
→→ Cellular dysfunction Cellular dysfunction
→→ Cell deathCell death
Generalized state of hypoperfusionGeneralized state of hypoperfusion
TachycardiaTachycardia
Alteration in LOC, anxiety Tachypnea, Tachypnea,
shallow shallow respirationrespiration
Cold, Cold, diaphoretic diaphoretic
skinskin ↓↓Urinary Urinary outputoutput
HypotensionHypotension
How do I recognize it?How do I recognize it?
Scene information / mechanism of injuryScene information / mechanism of injuryAMPLE historyAMPLE history
Inadequate Inadequate perfusionperfusion
Organ Organ dysfunctiondysfunction
What preparations are needed?What preparations are needed?
Trauma team activation?Trauma team activation?Organize the equipmentOrganize the equipmentStandard precautionsStandard precautionsWarm room and fluidsWarm room and fluids
What are the causes?What are the causes?
Blood lossBlood loss Tension pneumothoraxTension pneumothoraxCardiac tamponadeCardiac tamponadeCardiogenicCardiogenicNeurogenicNeurogenicSepticSeptic
Hemorrhagic VS NonhemorrhagicHemorrhagic VS Nonhemorrhagic
How do I Locate the bleeding?How do I Locate the bleeding?
Physical examinationPhysical examinationDiagnostic adjuncts to primary surveyDiagnostic adjuncts to primary survey
• Chest x-ray Chest x-ray
• FAST / DPL FAST / DPL
• AP x-ray of pelvisAP x-ray of pelvis
What can I do about it?What can I do about it?
Restore Volume!Restore Volume!
••Vascular access (catheter, sites)Vascular access (catheter, sites)
••Warmed fluid (type)Warmed fluid (type)Monitor responseMonitor responsePrevent hypothermia!Prevent hypothermia!
How do I evaluate the response?How do I evaluate the response?
Identify Improved Organ FunctionIdentify Improved Organ FunctionCNS: Improved level of consciousnessCNS: Improved level of consciousnessRenal: Renal: ↑ urinary output ↑ urinary outputSkin: Warm, capillary refillSkin: Warm, capillary refillRespiration: Improved rate and depthRespiration: Improved rate and depthVital signs: Return to normalVital signs: Return to normal
What is the patientWhat is the patient’s response?’s response?
Related to Volume or persistence of Related to Volume or persistence of hemorrhagehemorrhageRapid responderRapid responderTransient responderTransient responderNonresponderNonresponder
Slightly Slightly anxiousanxious
Respirations Respirations 14-20/min14-20/min
Heart rate Heart rate <100/min<100/min
Urine Urine
30 mL/hr 30 mL/hr ↔ ↔ BPBP
crystalloidcrystalloid
Mildly Mildly anxiousanxious
Respirations Respirations 20 –30/min20 –30/min
UrineUrine
20-30 mL/hr20-30 mL/hr
Heart rate Heart rate >100/min>100/min ↔↔ BPBP
↓↓Pulse Pulse pressurepressureCrystalloid,Crystalloid,
? blood? blood
Confused, Confused, anxiousanxious Respirations Respirations
30-40/min30-40/min
Urine Urine 5-15 ml/hr5-15 ml/hr
Heart rate Heart rate > 120/min> 120/min BPBP
Pulse Pulse pressurepressure
Crystalloid, Crystalloid, blood, operationblood, operation
Confused, Confused, lethargiclethargic
Respirations Respirations >35/min>35/min
Heart rate Heart rate >140/min>140/min
Urine Urine negligiblenegligible
BPBP
Pulse Pulse pressurepressure
Rapid fluids, Rapid fluids, blood, operationblood, operation
What are the pitfalls?What are the pitfalls?
Equating BP Equating BP with cardiac with cardiac outputoutput
Hemoglobin, Hemoglobin, hematocrit levelshematocrit levels
Age extremesAge extremes
HypothermiaHypothermiaAthletes Athletes PregnancyPregnancyMedicationsMedicationsPacemakerPacemaker