Objectives

Define shock
Recognize the shock state
Determine the cause
Apply treatment principles
Recognize the importance of early
hemorrhage identification and control
Manage patients response
 Key Questions

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

Generalized state of hypoperfusion

Inadequate substrate delivery

Catecholamines and other responses
Anaerobic metabolism
Cellular dysfunction
Cell death
 Alteration in
LOC, anxiety Tachypnea,
shallow
Hypotension respiration
Tachycardia
Cold,
diaphoretic Urinary
skin output
 How do I recognize it?

Scene information / mechanism of injury

AMPLE history

Inadequate Organ
perfusion dysfunction
 What preparations are needed?

Trauma team activation?

Organize the equipment
Standard precautions
Warm room and fluids
 What are the causes?

Hemorrhagic VS Nonhemorrhagic
Blood loss Tension pneumothorax
Cardiac tamponade
Cardiogenic
Neurogenic
Septic
 How do I Locate the bleeding?

Physical examination
Diagnostic adjuncts to primary survey
Chest x-ray
FAST / DPL
AP x-ray of pelvis
 What can I do about it?

Restore Volume!
Vascular access (catheter, sites)
Warmed fluid (type)
Monitor response
Prevent hypothermia!
 How do I evaluate the response?

Identify Improved Organ Function

CNS: Improved level of consciousness
Renal: urinary output
Skin: Warm, capillary refill
Respiration: Improved rate and depth
Vital signs: Return to normal
 What is the patients response?

Related to Volume or persistence of

hemorrhage
Rapid responder
Transient responder
Nonresponder
Slightly Respirations
anxious 14-20/min

Urine
Heart rate
30 mL/hr <100/min BP

crystalloid
Mildly Respirations
anxious 20 30/min
Heart rate
Urine
>100/min BP
20-30 mL/hr
Pulse
Crystalloid, pressure
? blood
Confused,
anxious Respirations
30-40/min
Urine
Heart rate
5-15 ml/hr
> 120/min BP
Crystalloid,
Pulse
blood, operation
pressure
Confused,
Respirations
lethargic
>35/min
Urine Heart rate
negligible >140/min
BP
Rapid fluids,
Pulse
blood, operation
pressure
 What are the pitfalls?

Equating BP Hypothermia
with cardiac Athletes
output Pregnancy
Hemoglobin, Medications
hematocrit levels
Pacemaker
Age extremes
Is the patient in shock?
What is the cause of the shock state?
What can I do about it?
What is the patients response?
What are the pitfalls?