Chapter 11

Ready for Review
 Perfusion is the circulation of blood within an organ or tissue in adequate amounts to
meet the cells’ current needs for oxygen, nutrients, and waste removal. Perfusion
requires an intact cardiovascular system and a functioning respiratory system.
 Blood is the vehicle for carrying oxygen and nutrients through the vessels to the
capillary beds to tissue cells, where these supplies are exchanged for waste products.
 Blood flow through the capillary beds is regulated by the capillary sphincters that are
under the control of the autonomic nervous system. Regulation of blood flow occurs
by vessel constriction or dilation, along with sphincter constriction or dilation.
 The systolic pressure is the peak arterial pressure, or pressure generated every time
the heart contracts; the diastolic pressure is the pressure maintained within the arteries
while the heart rests between heartbeats.
 Perfusion depends on cardiac output, systemic vascular resistance (SVR), and
transport of oxygen. Cardiac output (CO) is the volume of blood that the heart can
pump per minute. Systemic vascular resistance is the resistance to blood flow within
all of the blood vessels except the pulmonary vessels.
 Most types of shock (hypoperfusion) are caused by dysfunction in one or more parts
of the perfusion triangle:
The pump (the heart)
The pipes, or container (blood vessels)
The content, or volume (blood)
 Shock (hypoperfusion) is the collapse and failure of the cardiovascular system, when
blood circulation slows and eventually stops.
 The body has neural and hormonal mechanisms for regulating blood pressure.
Maintenance of blood pressure is important to maintaining homeostasis. If perfusion
decreases, baroreceptors sense the decreased flow and activate the vasomotor center,
which oversees changes in the diameter of blood vessels, to begin constriction of the
vessels and increase blood pressure. Chemoreceptors are stimulated by decreases in
PaO2 and increases in PaCO2 and are important in regulating respiration.
 Failure of compensatory mechanisms to preserve perfusion leads to decreases in
preload and cardiac output. Myocardial blood supply and oxygenation decrease,
reducing myocardial perfusion. As cardiac output further decreases, coronary artery
perfusion also decreases, leading to myocardial ischemia.
 Multiple-organ dysfunction syndrome (MODS) is a progressive condition in which
several organs fail. This occurs when injury or infection triggers a massive systemic
immune, inflammatory, and coagulation response.
 The various types of shock are cardiogenic, obstructive, septic, neurogenic,
anaphylactic, psychogenic, and hypovolemic.
 Signs of compensated shock include anxiety or agitation; tachycardia; pale, cool,
moist skin; increased respiratory rate; nausea and vomiting; and increased thirst. If
there is any question on your part, treat for shock. It is never wrong to treat for shock.
 Signs of decompensated shock include labored or irregular respirations, ashen gray or
cyanotic skin color, weak or absent distal pulses, dilated pupils, and profound
 Irreversible shock is the terminal stage. Even aggressive treatment at this stage does
not usually result in recovery.
Remember, by the time a drop in blood pressure is detected, shock is usually in an
advanced stage.
Anticipate shock in patients who may have the following conditions:
Severe infection
Significant blunt force trauma or penetrating trauma
Massive external bleeding or index of suspicion for major internal
Spinal injury
Chest or abdominal injury
Major heart attack
Treating a pediatric or geriatric patient in shock is no different than treating any other
shock patient.
Treat all patients suspected to be in shock from any cause as follows and in this order:
Open and maintain the airway. If cardiac arrest is suspected, focus on
high-quality chest compressions prior to airway and breathing.
Provide high-flow oxygen and, as needed, provide bag-mask assisted
Control all obvious external bleeding.
Place the patient in the shock position or, if on a backboard or
stretcher, elevate the end of the board.
Maintain normal body temperature with blankets.
Provide prompt transport to the appropriate hospital.
Gain IV access.
Starting an IV and administering fluids is part of treating a patient who is in shock.
Administer IV volume expanders (warmed if possible) to replace blood loss. Isotonic
crystalloids, such as normal saline or lactated Ringer’s, should be used (synthetic
solutions may also be used). Call early for paramedic intervention to administer
vasopressors if needed.