Lecture Notes on Shock Management

Introduction

• Presenter: John from Florida
• Chapter: 13
• Topic: Shock
• Focus Areas: Pathophysiology, management of shock, respiratory failure or arrest, cardiac arrest, and post-resuscitation management.

Pathophysiology of Shock

• Definition: Inadequate cellular perfusion leading to cellular death or injury.
• Homeostasis: Body’s attempts to maintain through various mechanisms.
• Diffusion: Passive process of oxygen and carbon dioxide exchange across alveoli.
• Impairment: In shock, CO2 transport is impeded, leading to cardiovascular collapse.
• Early Recognition: Key to saving lives; requires rapid intervention.

The Perfusion Triangle

• Components: Heart (pump), blood vessels (pipes), blood (fluid).
• Issues in any component: Leads to shock.

Blood Pressure

• Systolic & Diastolic: Measures of arterial pressure.
• Pulse Pressure: Difference between systolic and diastolic pressures.
• Capillary Sphincters: Regulate blood flow based on cellular needs.

Types of Shock

1. Cardiogenic Shock

• Causes: Heart attack, trauma, obstructive causes.
  • Symptoms: Back up of blood into pulmonary vessels leading to pulmonary edema.

2. Obstructive Shock

• Causes: Tension pneumothorax, cardiac tamponade, pulmonary embolism.
  • Effects: Pressure on the heart preventing proper filling.

3. Distributive Shock

• Causes: Septic shock, neurogenic shock, anaphylactic shock.
  • Symptoms: Widespread dilation, vessel wall damage, blood pooling.

4. Hypovolemic Shock

• Causes: Blood loss, severe dehydration, burns.
  • Considerations: Often trauma-related; requires rapid intervention.

Stages of Shock

• Compensated Shock: Body still compensating; early stage.
• Decompensated Shock: Late stage; marked by falling blood pressure.
• Recognition: Critical to distinguish and address early signs.

Signs and Symptoms

• Compensated Shock: Agitation, anxiety, restlessness, pale/cool/clammy skin.
• Decompensated Shock: Declining mental status, labored breathing, cyanotic skin.

Special Considerations

• Infants and Children: Compensate until they suddenly decompensate.
• Older Adults: Medication can mask signs of shock; baseline vitals important.

Management and Treatment

• Immediate Actions: Recognition and rapid treatment, oxygen administration.
• Patient Assessment: Early intervention before blood pressure measurement.
• Transport Decision: Choosing appropriate facility crucial.

Treatment Strategies

• Oxygen and Warmth: Universal initial treatment across shock types.
• ALS Involvement: Consider for advanced interventions if available.

Specific Treatments

• Cardiogenic Shock: Avoid nitroglycerin if hypotensive.
• Obstructive Shock: Address through surgical intervention or ALS support.
• Septic Shock: Hospital sepsis protocols.
• Anaphylactic Shock: Epinephrine administration.

Conclusion

• Key Takeaway: Early recognition and treatment are critical to effective shock management.
• Collaboration: Working with ALS can enhance patient care.
• Patient Monitoring: Continuous reassessment and documentation vital for patient safety and effective treatment.