Shock
Remember Perfusion ….
Shock is inadequate perfusion
(aka Hypoperfusion)
The organs and tissues of the
body do not get enough oxygen
and nutrients.
Shock
It can occur
with either
traumatic injuries
or serious medical
conditions
What causes Shock?
Shock is the result of a malfunction of
at least 1 of 3 systems
• Pump (Heart)
• Tubing (Blood Vessels)
• Fluid (Blood)
(colors have significance)
What are the types of shock?
Remember MASHNCPR
Metabolic
Excessive loss of fluid &
electrolytes with nonhemorrhagic cause
1. GI: vomiting/diarrhea/ urination,
2. burns
3. drugs
4. hyperglycemia
5. heat stroke
Anaphylactic
Systemic allergic reaction
causing widespread
vasodilation and generalized
edema ; has an upper
respiratory component
1. insect sting or bite
2. ingestion (eg legumes),
3. Rx (eg penicillin PCN)
4. inhalants (pollen, dust)
Septic
Systemic infection, usually
bacterial, damages vessel
walls resulting in leakage and
vasodilation;
1. untreated wound,
2. surgery,
3. trauma (peritonitis);
4. disease (pericarditis), or
5. contagion (meningitis,
pneumonia)
Bleeding due to
1. Blunt trauma to solid abdominal
organ,
2. great vessel tear,
3. major bleed from laceration or fx
Hypovolemic
Loss of fluid volume (blood)
with hemorrhagic cause (eg
trauma); could be external or
internal
Neurogenic
Sudden loss of the control by 1. brain => Increased Intercranial
pressure due to trauma, tumor, bleeding
CNS of nerves & muscles,
causing vasodilation &
2. spinal cord => due to fx, vertebral
muscle paralysis
bleeding, or tumor
Cardiogenic
Heart muscle can no longer
generate enough pressure to
circulate blood to all organs;
leads to pulmonary edema
1. Myocardial Infarction
2. Disease (CHF, pericarditis),
3. Electrical,
4. Trauma (Pericardial tamponade)
5. Valve dysfunction,
Psychogenic
fainting resulting from
temporary vascular dilation
(loss of blood pressure) and
lack of blood to brain
Shock to senses, strong emotional
response, or psychotic crisis
Respiratory
Insufficiency
Inability to oxygenate the
blood at level required
1. Disease (Asthma, COPD)
2. Trauma (pneumothorax, flail
chest)
3. obstruction
Progression of Shock:
Compensated Shock
When the body’s systems work to
maintain perfusion by going into
“overdrive”
Progression of Shock:
What do you see
Compensated Shock –
Brain =
anxiety, restlessness, ALOC
Heart =
weak rapid pulse, OK to  BP
Respiration = rapid, shallow TV, noise
Skin Sx = pale, cool, clammy
Cap Refill = > 2 secs
Other: nausea or vomiting; decrease in body
temp
Progression of Shock:
Decompensated Shock
Body’s efforts to maintain
perfusion fail.
Children can compensate longer
than adults, but crash quickly
Falling BP is the
key sign.
Progression of Shock:
What do you see
Decompensated Shock
Brain =
ALOC -> unconsciousness
Heart =
thready or irr or absent, BP
Respiration = labored
Skin Sx =
ashen, cyanotic, diaphoretic
Cap Refill = > 2 secs
Other: nausea or vomiting; decrease in body
temp; dull eyes; dilated pupils
What can you do? --• BSI, ABCs
-
Open airway, Control Bleeding
-
Provide high flow O2; assist respirations
• Place patient supine with legs elevated 6”
to 12” above heart; If spinal injury elevate
backboard
• May use other position of comfort for heart
patient, breathing distress, etc
• Keep patient warm (easy hypothermia)
What can you do? --• Record vitals every 5 minutes
• Splint bone or joint injuries
• Give nothing by mouth; have
suction ready
• Emergency evacuation
Anticipate Shock!!
Plan Ahead
 Always anticipate shock when
a suitable mechanism of injury
or illness exists
 Early anticipation and care can
prevent or delay decompensated
shock
Transport
Head up or down?
• Normally, for shock, head down
(want feet elevated)
• BUT, what if head injury and
signs of shock? Judgment call –
head (brain swelling) would be
priority
Anaphylactic Shock –
What can you do? -- The only truly effective treatment
is EPINEPHRINE (opens airway)
followed by ANTIHISTAMINE
(reduces bronchial swelling)
 Many people with known
serious allergic reactions
carry epipens