Shock

Definition

A serious condition that occurs when the cardio-vascular system is unable to supply enough blood flow to the body, causing inadequate tissue perfusion.

Major classes of shock include:

Shock is a life-threatening condition that requires immediate medical treatment. Some degree of shock can accompany any medical emergency. Shock can get worse very rapidly.

Recognition

Depending on the specific cause and type of shock, symptoms may include:

Cardiogenic Shock

This occurs when heart muscle damaged, most commonly by a severe myocardial infarction, is not able to pump enough blood to meet the needs of the body. Other causes which can compromise cardiac output are:

Hypovolemic shock

A form of shock. A condition where the heart is unable to supply enough blood to the body because of blood loss, or inadequate blood volume. Clinical symptoms may not present until 10-20% of total whole-blood volume is lost.

Causes and Risks:

Loss of approximately one-fifth or more of the normal blood volume produces hypovolemic shock. The loss can be from any cause, including external bleeding, internal bleeding, or diminished blood volume resulting from excessive loss of other body fluids (such as can occur with diarrhoea, vomiting and burns).

Prevention:

Preventing shock is easier than trying to treat it once it happens. Prompt treatment of the underlying cause will reduce the risk of developing severe shock.

Stages of Hypovolemic Shock

Stage 1

Stage 2

Stage 3

Stage 4

The 4 areas that life threatening haemorrhage can occur
  1. Chest - Myocardium, great vessels, lung lacerations
  2. Abdomen - Intra-abdominal injuries
  3. Pelvis/Thighs - Pelvic and Femur fractures
  4. Entire body - Look over entire body for external haemorrhage
Management

GO DR SHAVPU ACBC 

Treat other injuries, Arrest any major external haemorrhage,  Keep patient warm, Raise legs to aid venous return, Continually monitor patient vital signs, Reassurance, Keep nil by mouth, patient position - lying flat or in recovery position, High concentration of O A paramedic will gain venous entry with a cannula and commence a fluid challenge as part of his/her management of shock

Secondary Survey

ASHICE (Consider)

Transport to Hospital - Continually monitor patient vital signs.

Professional Handover

 

Anaphylactic Shock

Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic reaction that can involve various areas of the body. Symptoms occur within minutes to two hours after contact with the allergy-causing substance, but in rare instances may occur up to four hours later. Minute amounts of allergens may cause a mild to life-threatening reaction.

Common causes of anaphylaxis include:
Signs and Symptoms

Anaphylaxis

The symptoms are related to the action of immunoglobulin E (IgE) which acts to release histamine and other mediator substances from mast cells. Histamine induces, beside other effects, vasodilation and bronchospasm (constriction of the airways).

Management

GO DR SHAVPU ACBC 

Patient position - lying flat with legs raised if comfortable, Consider use of salbutamol for any wheezing, High concentration of O2 Adrenaline 1:1000, Get paramedic backup running, Be prepared to carry out BLS

Secondary Survey

ASHICE (Consider)

Transport to Hospital 

Professional Handover

Neurogenic Shock

A sudden disruption of signals that maintain autonomic nervous system control over vasoconstriction leading to hypotension, occurs after an acute spinal cord injury that blocks sympathetic activity. Neurogenic shock should be suspected if there is a cervical or high thoracic injury with no signs of fluid loss where the following signs and symptoms are exhibited.

Signs and symptoms:

More information
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Blood Loss in Trauma Patients

  • Pelvis 3000mls
  • Femur 1000mls
  • Tibia 650mls
  • Abdominal 2000mls
  • Thoracic 2000mls

Stroke Volume

  • (SV) The amount of blood ejected with each beat.

Cardiac Output

  • (CO) The volume of blood leaving the heart each minute

Heart Rate

  • (HR) The number of beats per minute of the heart

Cardiac Output

  • By definition, the value of the cardiac output (CO) is equal to the stroke volume (SV) multiplied by the heart rate (HR). eg. 70ml x 70 BPM = 4.9 Ltrs. This equates to nearly all the blood volume of an adult in a 60 second period.