Escolar Documentos
Profissional Documentos
Cultura Documentos
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
3
SHOCK
SHOCK SYNDROMES IN
THE TRAUMA PATIENT
Low volume shock
Hemorrhagic (loss of blood)
Burn (loss of plasma)
Mechanical shock
Cardiac tamponade (obstructive)
Tension pneumothorax (obstructive)
Myocardial contusion (pump failure)
4
SHOCK
SHOCK
Altered LOC
Hypotension
Decreased
peripheral pulses
Decreased
urinary output
Finally cardiac
arrest
6
SHOCK
CAPILLARY REFILL
TEST
Positive if >2 seconds
Not a useful indicator of early
shock in adults
Always delayed if patient is cold
SHOCK
HEMORRHAGIC
SHOCK
Loss of blood
volume
Early shock is
evident with 1520% blood loss
Late shock
develops with
30-40% blood
loss
8
SHOCK
BASIC MANAGEMENT
HEMORRHAGIC SHOCK
Control the bleeding
100% oxygen
Load & Go
Fluid replacement when
indicated
9
SHOCK
SPECIFIC TREATMENT
VARIES WITH SITUATION
External hemorrhage that can be
controlled
External hemorrhage that cannot
be controlled
Internal hemorrhage
10
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
11
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
SHOCK
MANAGEMENT
INTERNAL HEMORRHAGE
Supine position
100% oxygen
Load & Go
IV access en route
Give fluid to maintain a systolic BP of
90-100
SHOCK
MANAGEMENT OF
MECHANICAL SHOCK
Tension
pneumothorax
Cardiac
tamponade
Myocardial
contusion with
shock
14
SHOCK
SHOCK
15
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
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
18
SHOCK
QUESTIONS?
19
SHOCK