1 / 36

Chapter 9

Chapter 9. Shock: A State of Hypoperfusion. Overview. Hypoperfusion Causes of Hypoperfusion Physiologic Response to Shock Assessment Management of Hypoperfusion. Hypoperfusion. Hypoperfusion means inadequate perfusion

truong
Download Presentation

Chapter 9

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 9 Shock: A State of Hypoperfusion

  2. Overview • Hypoperfusion • Causes of Hypoperfusion • Physiologic Response to Shock • Assessment • Management of Hypoperfusion

  3. Hypoperfusion • Hypoperfusion means inadequate perfusion • Hypoperfused tissue is no longer being given enough oxygen and will stop working optimally

  4. Hypoperfusion • The brain is the most sensitive organ in the body to decreases in blood and oxygen supply

  5. Causes of Hypoperfusion • Three basic components of the circulatory system can affect perfusion: • Fluid • Container • Pump

  6. Causes of Hypoperfusion • The fluid • Hypoperfusion will occur if • There is not enough blood in the system • The blood in the system is not carrying enough oxygen

  7. Causes of Hypoperfusion • Hypovolemic shock • When body fluids are lost and not adequately replenished, the total body fluid volume is low • When shock results from an actual loss of blood, it can be specifically called hemorrhagic shock • Other means of fluid loss are excessive vomiting, diarrhea, sweating, or urinating

  8. Causes of Hypoperfusion • The container • Blood vessels have the ability to significantly alter their diameter by contraction or relaxation of the smooth muscles in their walls • This can be harmful in some circumstances, such as anaphylactic, septic, or neurogenic shock

  9. Causes of Hypoperfusion • Anaphylactic shock • The result of a severe allergic reaction • Causes vasodilation and subsequent hypotension • Patient will have urticaria (hives), airway swelling, and hypotension

  10. Causes of Hypoperfusion • Septic shock • Severe infection may lead to generalized blood vessel dilation, with a drop in blood pressure and diminished perfusion • Certain types of bacteria can produce toxins that prevent the vessels from constricting appropriately, causing them to leak

  11. Causes of Hypoperfusion • Neurogenic shock • Is caused by a loss of control of the smooth muscles in the vessel walls • May occur as a result of spinal cord injury where the vessels no longer have the ability to constrict when appropriate • Also termed spinal shock

  12. Causes of Hypoperfusion • The pump • Inadequate pumping action of the heart can result in hypoperfusion • If the pump does not have enough power to generate adequate forward flow, the amount of blood pumped will be smaller • The smaller volume will result in a lower cardiac output

  13. Causes of Hypoperfusion • Cardiogenic shock • If the heart muscle is damaged, as during a heart attack, it does not pump to full capacity • Shock that results from inadequate cardiac pumping is called cardiogenic shock

  14. Physiologic Response to Shock • Compensated shock • The body attempts to compensate for hypoperfusion by: • Increasing the volume of blood pumped with each stroke or the heart rate • Increasing respiratory rate • Adjusting blood flow to only core areas (shunting)

  15. Physiologic Response to Shock • Compensated shock • Signs and symptoms • Pale • Cool • Clammy • Weakening peripheral pulses • Elevated heart rate • Elevated respiratory rate • Nausea • Altered mental status

  16. Physiologic Response to Shock • Decompensated shock • Systolic blood pressure drops to less than 90 mm Hg • The body is no longer able to compensate for an event • When hypotension is noted, the patient is considered to be in decompensated shock and must be aggressively managed for survival to be possible

  17. Physiologic Response to Shock • Irreversible shock • Prolonged periods of decompensated shock resulting in the failure of multiple organs • Patients with irreversible shock often do not survive

  18. Stop and Review • What is hypoperfusion? • What are the three main causes of hypoperfusion? • List the signs and symptoms associated with compensated shock. • What is the tell-tale sign of decompensated shock?

  19. Assessment • In assessing a patient, be careful to look for signs of compensated shock • If you don’t look for it, you won’t find it • It is necessary to begin to treat the patient in shock before she decompensates and becomes hypotensive

  20. Assessment • The look test • Ensure your own safety and adequate PPE • Form general impression

  21. Assessment • Mental status • Assess for AVPU • ABCs • Once ABCs have been assessed, look for signs of hypoperfusion

  22. Assessment • Vital signs • Obtain a complete set of vital signs • Orthostatic vital signs • Vital signs measured in two different positions • Positive tilt test

  23. Management of Hypoperfusion • The treatment of shock is geared toward restoring adequate oxygenation, ventilation, and circulation • The EMT must maximize perfusion while rapidly transporting the patient to a hospital, where definitive treatment will be available

  24. Management of Hypoperfusion • Oxygen • Apply high-flow 100% oxygen in any stage of shock • Control bleeding • Locate source of bleeding and control it in whatever way possible • Trendelenburg • Elevate the legs and utilize the force of gravity to increase the blood volume in the thorax and abdomen

  25. Management of Hypoperfusion • MAST/PASG • Military anti-shock trousers or a pneumatic anti-shock garment • A device that may support blood pressure in certain circumstances • MAST/PASG improves the blood supply to the upper body and vital organs

  26. Management of Hypoperfusion • MAST/PASG • Indications • Severe hypotension (systolic BP less than 50 mm Hg • Hypotension (systolic BP less than 90 mm Hg) because of severe pelvic injuries

  27. Management of Hypoperfusion • MAST/PASG • Contraindications (absolute) • Penetrating thoracic injury • Pulmonary edema

  28. Management of Hypoperfusion • MAST/PASG • Contraindications (relative) • Pregnancy • Penetrating object • Evisceration

  29. Management of Hypoperfusion • MAST/PASG • Application • Trouser method • Wrapper method

  30. MAST/PASG • Watch this video clip demonstrating the use of MAST/PASG

  31. Management of Hypoperfusion • MAST/PASG • Removal • Should never be deflated by the EMT • Physicians should be familiar with the procedure of slow deflation • Gradual process

  32. Management of Hypoperfusion • Reduce heat loss • Prevent excessive heat loss during the evaluation and treatment of the critically ill or injured patient • Cover the patient with blankets once the assessment has been completed

  33. Management of Hypoperfusion • Transport • Consider ground or air transport • Reassess patient frequently and monitor vital signs every five minutes • Consider ALS intercept • Consult local protocols

  34. Stop and Review • What can the EMT do to manage the patient presenting with shock? • What are the absolute contraindications for using PASG/MAST?

More Related