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SHOCK EVALUATION

AND MANAGEMENT

SHOCK

OVERVIEW

Pathophysiology of shock
Review of shock syndromes
Assessment and management
Current indications for the
antishock garment

SHOCK

SHOCK
A state of widespread inadequate tissue
perfusion
Low BP does not equal shock
Adequate tissue perfusion requires:
Intact vascular system
Adequate air exchange
Functioning pump (heart)
Adequate volume of blood and plasma
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SHOCK

SHOCK SYNDROMES IN
THE TRAUMA PATIENT
Low volume shock
Hemorrhagic (loss of blood)
Burn (loss of plasma)

High space shock


Neurogenic shock (relative hypovolemia)

Mechanical shock
Cardiac tamponade (obstructive)
Tension pneumothorax (obstructive)
Myocardial contusion (pump failure)
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SHOCK

SIGNS & SYMPTOMS OF


HEMORRHAGIC SHOCK
Weakness
Thirst
Pallor
Tachycardia
Diaphoresis
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Courtesy of Bonnie Meneely, R.N.

SHOCK

SIGNS & SYMPTOMS OF


HEMORRHAGIC SHOCK

Altered LOC
Hypotension
Decreased
peripheral pulses
Decreased
urinary output
Finally cardiac
arrest
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Courtesy of Bonnie Meneely, R.N.

SHOCK

CAPILLARY REFILL
TEST
Positive if >2 seconds
Not a useful indicator of early
shock in adults
Always delayed if patient is cold

May be helpful in small children


Is negative in neurogenic shock
Patient cannot vasoconstrict
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SHOCK

HEMORRHAGIC
SHOCK
Loss of blood
volume
Early shock is
evident with 1520% blood loss
Late shock
develops with
30-40% blood
loss
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SHOCK

BASIC MANAGEMENT
HEMORRHAGIC SHOCK
Control the bleeding
100% oxygen
Load & Go
Fluid replacement when
indicated
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SHOCK

SPECIFIC TREATMENT
VARIES WITH SITUATION
External hemorrhage that can be
controlled
External hemorrhage that cannot
be controlled
Internal hemorrhage

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SHOCK

MANAGEMENT OF SERIOUS
HEMORRHAGE THAT CAN BE
CONTROLLED

Supine position
100% oxygen
Load & Go
May use PASG initially
IV access en route
20cc/kg bolus
Reassess, repeat fluid bolus as necessary

Monitor closely
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SHOCK

MANAGEMENT OF SERIOUS
HEMORRHAGE THAT CANNOT
BE CONTROLLED

Supine position
100% oxygen
Load & Go
IV access en route
Give fluid to maintain a systolic BP of 90-100

Use tourniquets if necessary


PASG contraindicated
Notify Medical Direction
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SHOCK

MANAGEMENT
INTERNAL HEMORRHAGE

Supine position
100% oxygen
Load & Go
IV access en route
Give fluid to maintain a systolic BP of
90-100

Notify Medical Direction


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SHOCK

MANAGEMENT OF
MECHANICAL SHOCK
Tension
pneumothorax
Cardiac
tamponade
Myocardial
contusion with
shock
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SHOCK

SHOCK

HIGH SPACE SHOCK


NEUROGENIC SHOCK
(commonly called spinal shock)

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MANAGEMENT
NEUROGENIC SHOCK

SHOCK

Supine position
100% oxygen
Assist ventilation as needed

Load & Go
IV access en route
Give fluid to maintain systolic BP of 90-100

PASG can be used if there is no evidence of


internal injuries
Monitor closely
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INDICATIONS FOR USE OF


THE PNEUMATIC
ANTISHOCK GARMENT
Shock secondary to hemorrhage that
can be controlled
Neurogenic shock without evidence of
other internal injuries
Isolated fractures of the legs without
other internal injuries (blow up to airsplint pressure only)
Shock with no palpable pulse
(controversial)
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SHOCK

SUMMARY
Shock is a critical condition that
leads to death
Diagnosis and management must
be accomplished quickly
Knowledge of shock syndromes
and their management is essential

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SHOCK

QUESTIONS?

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SHOCK

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