ObjectivesObjectives

Define shock Define shock Recognize the shock stateRecognize the shock stateDetermine the causeDetermine the causeApply treatment principlesApply treatment principlesRecognize the importance of early Recognize the importance of early

hemorrhage identification and controlhemorrhage identification and controlManage patientManage patient’s response’s response

Key QuestionsKey Questions

What is shock?What is shock?Is the patient in shock?Is the patient in shock?What is the cause of the shock state?What is the cause of the shock state?What can I do about it?What can I do about it?What is the patientWhat is the patient’s response?’s response?What are the pitfalls?What are the pitfalls?

What is shock?What is shock?

→ → Inadequate substrate deliveryInadequate substrate delivery

→→ Catecholamines and other responsesCatecholamines and other responses

→→ Anaerobic metabolismAnaerobic metabolism

→→ Cellular dysfunction Cellular dysfunction

→→ Cell deathCell death

Generalized state of hypoperfusionGeneralized state of hypoperfusion

TachycardiaTachycardia

Alteration in LOC, anxiety Tachypnea, Tachypnea,

shallow shallow respirationrespiration

Cold, Cold, diaphoretic diaphoretic

skinskin ↓↓Urinary Urinary outputoutput

HypotensionHypotension

How do I recognize it?How do I recognize it?

Scene information / mechanism of injuryScene information / mechanism of injuryAMPLE historyAMPLE history

Inadequate Inadequate perfusionperfusion

Organ Organ dysfunctiondysfunction

What preparations are needed?What preparations are needed?

Trauma team activation?Trauma team activation?Organize the equipmentOrganize the equipmentStandard precautionsStandard precautionsWarm room and fluidsWarm room and fluids

What are the causes?What are the causes?

Blood lossBlood loss Tension pneumothoraxTension pneumothoraxCardiac tamponadeCardiac tamponadeCardiogenicCardiogenicNeurogenicNeurogenicSepticSeptic

Hemorrhagic VS NonhemorrhagicHemorrhagic VS Nonhemorrhagic

How do I Locate the bleeding?How do I Locate the bleeding?

Physical examinationPhysical examinationDiagnostic adjuncts to primary surveyDiagnostic adjuncts to primary survey

• Chest x-ray Chest x-ray

• FAST / DPL FAST / DPL

• AP x-ray of pelvisAP x-ray of pelvis

What can I do about it?What can I do about it?

Restore Volume!Restore Volume!

••Vascular access (catheter, sites)Vascular access (catheter, sites)

••Warmed fluid (type)Warmed fluid (type)Monitor responseMonitor responsePrevent hypothermia!Prevent hypothermia!

How do I evaluate the response?How do I evaluate the response?

Identify Improved Organ FunctionIdentify Improved Organ FunctionCNS: Improved level of consciousnessCNS: Improved level of consciousnessRenal: Renal: ↑ urinary output ↑ urinary outputSkin: Warm, capillary refillSkin: Warm, capillary refillRespiration: Improved rate and depthRespiration: Improved rate and depthVital signs: Return to normalVital signs: Return to normal

What is the patientWhat is the patient’s response?’s response?

Related to Volume or persistence of Related to Volume or persistence of hemorrhagehemorrhageRapid responderRapid responderTransient responderTransient responderNonresponderNonresponder

Slightly Slightly anxiousanxious

Respirations Respirations 14-20/min14-20/min

Heart rate Heart rate <100/min<100/min

Urine Urine

30 mL/hr 30 mL/hr ↔ ↔ BPBP

crystalloidcrystalloid

Mildly Mildly anxiousanxious

Respirations Respirations 20 –30/min20 –30/min

UrineUrine

20-30 mL/hr20-30 mL/hr

Heart rate Heart rate >100/min>100/min ↔↔ BPBP

↓↓Pulse Pulse pressurepressureCrystalloid,Crystalloid,

? blood? blood

Confused, Confused, anxiousanxious Respirations Respirations

30-40/min30-40/min

Urine Urine 5-15 ml/hr5-15 ml/hr

Heart rate Heart rate > 120/min> 120/min BPBP

Pulse Pulse pressurepressure

Crystalloid, Crystalloid, blood, operationblood, operation

Confused, Confused, lethargiclethargic

Respirations Respirations >35/min>35/min

Heart rate Heart rate >140/min>140/min

Urine Urine negligiblenegligible

BPBP

Pulse Pulse pressurepressure

Rapid fluids, Rapid fluids, blood, operationblood, operation

What are the pitfalls?What are the pitfalls?

Equating BP Equating BP with cardiac with cardiac outputoutput

Hemoglobin, Hemoglobin, hematocrit levelshematocrit levels

Age extremesAge extremes

HypothermiaHypothermiaAthletes Athletes PregnancyPregnancyMedicationsMedicationsPacemakerPacemaker

Is the patient in shock?Is the patient in shock?What is the cause of the shock state?What is the cause of the shock state?What can I do about it?What can I do about it?What is the patientWhat is the patient’s response?’s response?What are the pitfalls?What are the pitfalls?