SHOCK(صدمة)

OBJECTIVES

At the end of this session, each student should be able to:Define shock. Identify general signs and symptoms of

shock. Identify types of shock. Identify care management for shock.

DEFINITION OF SHOCK

Shock is a state of inadequate delivery of blood (perfusion) to the cells.

Shock requires IMMEDIATE (فوري) medical treatment. If not properly managed, the tissue damage

becomes irreversible, and finally leads to multi-organ failure.

باألنسجة، دائم ضرر سيحصل الصدمة، معالجة يتم لم حال في. العمل عن أعضاء عدة في فشل يتبعه وقد

The body cells most sensitive to lack of oxygen are in the heart, brain, and lungs.القلب، خاليا هي األكسجين بنقص تأثرا الجسم خاليا أكثر

. والرئتين الدماغ،

SHOCK’S GENERAL SIGNS AND SYMPTOMSللصدمة عامة وأعراض عالمات

Lusterless لمعان بدون

وبريق

وقاتم باهت جلداللون

TYPES OF SHOCKالصدمة أنواع

Hemorrhagic Shock ) نزفية ) النزيف بسبب صدمة Also called: Hypovolemic Shock حجم نقص صدمة

الدم

Non-Hemorrhagic Shock1. Cardiogenic Shock المنشأ قلبية صدمة2. Septic Shock ) تسممية ) إنتانية صدمة3. Neurogenic Shock ( بالجهاز المنشأ عصبية صدمة

العصبي(4. Anaphylactic Shock تحسسية Vasogenic/ صدمة

Shock وعائية صدمة5. Psychogenic Shock المنشأ نفسية صدمة6. Metabolic Shock أيضية صدمة

HEMORRHAGIC (HYPOVOLEMIC) SHOCK) نزفية ) النزيف بسبب صدمة) الدم ) حجم نقص صدمة

A sudden decrease in the volume of blood.

Most common cause is hemorrhage (نزيف) due to: (1) stab wounds طعنات عن ناتجة ,جروح(2) gunshot wounds طلقات عن ناتجة جروح and ,األسلحة(3) motor vehicle accidents السير . حوادث

Other causes for hypovolemic shock are: (1) dehydration الجفاف(caused by: excessive vomiting التقيؤand diarrheaإسهال ), and(2) burnsحروق .

Without sufficient blood or fluid replacement, hemorrhagic/hypovolemic shock may lead to:(1) irreversible cerebral and renal damage

( دائم وكلوي دماغي ,(ضرر(2) cardiac arrest ( القلب عضلة في and ,(توقف(3) death (الوفاة).

NON-HEMORRHAGIC SHOCKSنزيف عن الناتجة غير الصدمات

1. Cardiogenic Shock المنشأ قلبية صدمة2. Neurogenic Shock ( بالجهاز المنشأ عصبية صدمة

العصبي(3. Anaphylactic Shock تحسسية صدمة

Also called: Vasogenic Shock وعائية صدمة4. Septic Shock ) تسممية ) إنتانية صدمة5. Psychogenic Shock المنشأ نفسية صدمة6. Metabolic Shock أيضية صدمة

1. CARDIOGENIC SHOCKالمنشأ قلبية صدمة

It is a shock due to a decrease in the contraction ability of the heart muscle (myocardium)

على ) القلب عضالت قدرة في نقص عن ناتجة صدمة هي.(االنقباض

The most common cause is myocardial infarction

( موتها ) القلب عضلة with greater than 40 percent احتشاءmuscle necrosis ( تتعدى بنسبة خاليا مجموع% 40موت من

القلب ,(خاليا in which the heart fails to circulate blood

efficiently.

Reduction in cardiac output (( من الخارج الدم حجم نقصالقلب

results in: (1) decreased circulating blood supply, and (2) decreased oxygen delivery.

2. NEUROGENIC SHOCK) العصبي ) بالجهاز المنشأ عصبية صدمة

It is a shock that results due to the failure of nervous system to control the diameter of blood vessels leading to peripheral vasodilatation.

  Common causes are:

(1) nerve paralysis (spinal cord or brain injuries), (2) severe blows شديدة ,to the abdomen ضربات(3) hot bath or hot vapor bath, (4) certain drugs, and (5) hypoglycemia causing vasomotor center depression ( باألوعية الخاص الحركي المركز عمل .(تردي

3. ANAPHYLACTIC/VASOGENIC SHOCK

وعائية / صدمة تحسسية صدمة It is a shock that results from an extreme and

generalized allergic antigen-antibody reaction( مستضد ضد that may bring on vascular (تفاعلcollapse due to dilatation ( عمل انهيار إلى يؤدي

التوسع نتيجة .(األوعيةThe allergic antigen-antibody reaction causes

widespread histamine release, which results in

(1) swelling of the lips and tongue, (2) bronchioles constriction ( هوائية قصيبات (تضيق (causing wheezingصفير , stridor), (3) decreased cardiac output and hypoxia أكسجين نقص , بالخاليا(4) flushing, and (5) pruritus (حكة).

Common causes are: 1. exposure to sensitive drugs or other

substances (serum, vaccines enzymes, hormones, penicillin and other antibiotics, local anesthestetics, salicylates),

2. exposure to diagnostic chemicals (radiographic contrast dye),

3. sensitivity to certain food (legumes, nuts, berries, seafood, eggs), and

4. exposure to insect venom سم (honeybees, mosquitoes, certain spiders).

4. SEPTIC OR TOXIC SHOCK) تسممية ) إنتانية صدمة

It is a condition that shows vascular dilatation due to a major infection.

The biochemical mediators (such as cytokines) cause a damage to the blood vessels walls, which lose their ability to constrict.

Diseases and conditions that predispose a patient to septic shock include: 1. liver disease, and 2. immune suppression (AIDS, drug therapy

for cancer).

5. PSYCHOGENIC SHOCKالمنشأ نفسية صدمة

It is a shock that results from a sudden dilation of the blood vessels takes place in response to an emotional or traumatic situation causing the patient to faint ( يصاب.(باإلغماء

  Stimulation of the vagus nerve ( الحائر (العصب

causes the heart to slow down (bradycardia). When the bradycardia is severe enough,

insufficient blood flow to the brain results and the patient loses consciousness (faints).

Several conditions may cause psychogenic shock including: 1. severely scared situations مخيفة مواقف

مفزع , بشكل2. severe exhaustion ( شديد and ,(إعياء3. hearing bad news (e.g.: death of

someone, failure in an exam).

6. METABOLIC SHOCKأيضية صدمة

This shock occurs due to a change in the blood chemistry.

The change in the chemistry might be due to: 1. salt and acid-base imbalance, 2. failure of the: adrenaline ( – للغدة هرمون األدرينالين هرمون ,(الكظرية

thyroid glands ( درقية ,(غدد pituitary glands ( نخامية and ,(غدد

3. diabetes mellitus ( السكري .(داء

MANAGEMENT OF SHOCK

Check Responsiveness.

Activate the EMS immediately.

Check the person's circulation, airway, and breathing.

If necessary, begin cardiopulmonary resuscitation (CPR) to prevent irreversible organ damage and death.

Place the victim in a comfortable position. If the victim DOES NOT have an injury to

the head, neck, or spine فقري :عمود elevate the victim legs 30 cm

(Trendelenburg’s position), with the head turned to one side.

Careful 1 Do NOT reposition the victim if there

is a possibility of spinal or neck injuries.

Careful 2 In Cardiogenic Shock: Place the victim

flat. BUT لكن

If cardiogenic shock victim complains of difficulty breathing, place the victim in semi-Fowler’s position

ضع تنفس، ضيق من القلبية الصدمة مصاب من اشتكى إذاالمصاب

. جلوس شبه بوضعية

Give appropriate first aid for any wounds, injuries, or illnesses.

Keep the victim warm (but not hot). Prevent hypothermia. Minimize effect of shock.

Loosen tight clothing.

Provide oxygen therapy, if available.

TREATMENT HINTS

Fluid therapy and drug therapy should be provided as soon as possible by trained health professionals.

Careful 3In Anaphylactic/Vasogenic Shock: More attention should be paid to:

Securing the airway. Assessing for dyspnea ( تنفس ,(ضيق

respiratory difficulty, cyanosis, wheezing ( التنفس خالل can be) (الصفيرlife-threatening).

Observing for vertigo (دوار), decreased blood pressure, and increased pulse.

Terminating the exposure to causative agent.

Careful 4In Anaphylactic/Vasogenic Shock: First-line therapies, during acute stage include:

(1) epinephrine, (2) IV fluids, and (3) oxygen.

Second-line therapies, after acute stage include: (1) antihistamines, and (2) corticosteroids.