Shock

1. Shock Jennifer L. Doherty, MS, LAT, ATC Management of Medical Emergencies

2. Overview • Shock occurs when a diminished amount of blood is available to the circulatory system • The vascular system fails to hold the fluid portion of the blood • Vasodilation of the blood vessels occurs and disrupts the osmotic fluid balance in the body

3. Overview • Plasma cells leave the blood and enter the interstitial spaces • The formed elements remain in the blood • Blood viscosity increases • The rate of blood flow decreases • Insufficient amounts of O2 are being transported in the blood

4. Predisposing Factors • Extreme fatigue • Extreme exposure to heat or cold • Extreme dehydration • Illness • Severe injury

5. Signs and Symptoms • Low Blood Pressure • Systolic BP is usually below 90 mmHg • Pulse is rapid and weak • Respiration is rapid and shallow • Skin is pale, cool, and clammy • Drowsiness

6. Types of Shock Hypovolemic Shock • Results from trauma in which there is blood loss • Decreased blood volume causes a decrease in blood pressure • Insufficient amounts of O2 is being transported to body tissues and organs

7. Types of Shock Respiratory Shock • Results when the lungs are unable to supply enough O2 the circulating blood • Trauma that may produce respiratory shock include: • Pneumothorax • Injury to the respiratory control center

8. Types of Shock Neurogenic Shock • Results due to the overall dilation of the blood vessels within the cardiovascular system • Decreased blood pressure • Insufficient amounts of O2 is being transported to body tissues and organs

9. Types of Shock Psychogenic Shock • Commonly known as “fainting” (syncope) • Results due to a temporary dilation of the blood vessels in the body causing a decrease in the blood flow to the brain

10. Types of Shock Cardiogenic Shock • Results due to the inability of the heart to pump enough blood to the body • Decreased cardiac output • Decreased blood pressure • Insufficient amounts of O2 is being transported to body tissues and organs

11. Types of Shock Septic Shock • Results due to a severe infection • Usually a bacterial infection • Toxins released by the bacteria cause dilation of the blood vessels within the cardiovascular system • Decreased blood pressure • Insufficient amounts of O2 is being transported to body tissues and organs

12. Types of Shock Anaphylactic Shock • Results due to a severe allergic reaction • Allergic reaction may be caused by: • Foods • Insect bites • Drugs • Inhaling dusts, pollens, etc…

13. Types of Shock Metabolic Shock • Results due to a severe illness that goes untreated • For example, untreated diabetes • Results due to an extreme loss of bodily fluid • For example, excessive urination, diarrhea, or vomiting

14. Psychological Impact • Shock can be compounded, or produced by the psychological reaction to an injury or a situation • Fear is the common • Provide reassurance and comfort

15. Immediate Management

16. Immediate Management • Maintain normal body temperature • In most cases, elevate the feet and legs above the level of the heart • Exceptions include: • Neck injury – immobilize in the position found • Head injury – elevate the head and shoulders • Leg fracture – splint and elevate

17. Secondary Management

18. Vital Signs Pulse Respiration Blood pressure Temperature Skin color Pupils Level of consciousness Movement Abnormal nerve response Secondary Management

19. A direct extension of the functioning of the heart Normal pulse rate for adults 60 – 80 bpm Normal pulse rate in children 80 – 100 bpm Pulse

20. Rapid and weak Shock Bleeding Diabetic coma Heat exhaustion Rapid and strong Heatstroke Severe fright Slow and strong Skull fracture Stroke No pulse Cardiac arrest Death Abnormal Pulse

21. Respiration • Normal respiration rate for adults • ~ 12 breaths per minute • Normal respiration rate for children • ~ 20 breaths per minute • Rapid and shallow respiration is indicative of shock

22. Blood Pressure • Normal systolic blood pressure in adults • Males: 115 – 120 mm Hg • Females: 105 – 110 mm Hg • Normal diastolic blood pressure in adults • Males: 75 – 80 mm Hg • Females: 65 – 70 mm Hg

23. Blood Pressure • High Blood Pressure • Systolic BP > 140 mm Hg • Diastolic BP > 90 mm Hg • Low Blood Pressure • Systolic BP < 100 mm Hg • Diastolic BP < 60 mm Hg

24. Temperature • Normal body temperature • ~ 98.6°F (~ 37°C) • Core temperature is most accurately measured at the tympanic membrane of the ear • Changes in body temperature are reflected in the skin

25. Skin: Temperature • Cool, clammy skin • Shock • Trauma • Heat exhaustion • Cool, dry skin • Overexposure to cold • Hot, dry skin • Disease • Infection • Overexposure to environmental heat

26. Three skin colors are commonly identified in medical emergencies: Red White Blue Red skin color Heatstroke High blood pressure Elevated body temperature Skin: Color

27. White skin color Shock Insufficient circulation Fright Hemorrhage Heat exhaustion Insulin shock Blue skin color Airway obstruction Respiratory insufficiency Skin: Color

28. Pupils • Pupils are extremely sensitive to changes in the nervous system • If one or both pupils are dilated… • Shock • Head injury • Heatstroke • Hemorrhage • CNS stimulant drug • One constricted pupil… • CNS depressant drug

29. Pupils • If one or both pupils fail to respond to light… • Brain injury • Alcohol • Drug poisoning • Pupil response to light is more critical than the evaluation of pupil size

30. Level of Consciousness • In normal conditions, the athlete is… • Alert • Aware of the surrounding environment • Responds quickly to vocal stimulation • Abnormal levels of consciousness may result due to… • Shock • Head injury • Heatstroke

31. Summary • May not be able to determine the type of shock • Immediate management of shock is universal • Provide reassurance and comfort • Maintain normal body temperature • In most cases, elevate the feet and legs above the level of the heart