Copyright 2002, Delmar, A division of Thomson Learning Chapter 21 Male Genitalia.
Chapter 9 Shock: A State of Hypoperfusion. © 2005 by Thomson Delmar Learning,a part of The Thomson...
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Transcript of Chapter 9 Shock: A State of Hypoperfusion. © 2005 by Thomson Delmar Learning,a part of The Thomson...
Chapter 9Shock: A State of Hypoperfusion
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Hypoperfusion Causes of Hypoperfusion Physiologic Response to Shock Assessment Management of Hypoperfusion
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Hypoperfusion
Hypoperfusion means inadequate perfusion Hypoperfused tissue is no longer being given
enough oxygen and will stop working optimally
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Hypoperfusion
The brain is the most sensitive organ in the body to decreases in blood and oxygen supply
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Causes of Hypoperfusion
Three basic components of the circulatory system can affect perfusion:– Fluid– Container– Pump
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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Compensated shock– Signs and symptoms
• Pale• Cool• Clammy• Weakening peripheral pulses• Elevated heart rate• Elevated respiratory rate• Nausea• Altered mental status
Physiologic Response to Shock
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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
Physiologic Response to Shock
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Irreversible shock– Prolonged periods of decompensated shock
resulting in the failure of multiple organs– Patients with irreversible shock often do
not survive
Physiologic Response to Shock
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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?
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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
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Assessment
The look test– Ensure your own safety and adequate PPE – Form general impression
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Assessment
Mental status– Assess for AVPU
ABCs– Once ABCs have been assessed,
look for signs of hypoperfusion
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Assessment
Vital signs– Obtain a complete set of vital signs
Orthostatic vital signs– Vital signs measured in two different positions– Positive tilt test
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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
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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
Management of Hypoperfusion
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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
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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
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Management of Hypoperfusion
MAST/PASG– Contraindications (absolute)
• Penetrating thoracic injury• Pulmonary edema
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Management of Hypoperfusion
MAST/PASG– Contraindications (relative)
• Pregnancy• Penetrating object• Evisceration
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Management of Hypoperfusion
MAST/PASG– Application
• Trouser method• Wrapper method
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MAST/PASG
Watch this video clip demonstrating the use of MAST/PASG
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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
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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
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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
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Stop and Review
What can the EMT do to manage the patient presenting with shock?
What are the absolute contraindications for using PASG/MAST?