SHOCK EVALUATION SHOCK

AND MANAGEMENT

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 OVERVIEW SHOCK

• Pathophysiology of shock
• Review of shock syndromes
• Assessment and management
• Current indications for the
antishock garment

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 SHOCK SHOCK

• A state of widespread inadequate

tissue perfusion
• Low BP does not equal shock
• Adequate tissue perfusion requires:
– Intact vascular system
– Adequate air exchange
– Functioning pump (heart)
– Adequate volume of blood and plasma
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 SHOCK SYNDROMES IN SHOCK
THE TRAUMA PATIENT
• Low volume shock
– Hemorrhagic (loss of blood)
– Burn (loss of plasma)
• High space shock
– Neurogenic shock (relative hypovolemia)
• Mechanical shock
– Cardiac tamponade (obstructive)
– Tension pneumothorax (obstructive)
– Myocardial contusion (pump failure)
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 SIGNS & SYMPTOMS OF SHOCK
HEMORRHAGIC SHOCK

• Weakness
• Thirst
• Pallor
• Tachycardia
• Diaphoresis Courtesy of Bonnie Meneely, R.N.

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 SIGNS & SYMPTOMS OF SHOCK
HEMORRHAGIC SHOCK

• Altered LOC
• Hypotension
• Decreased
peripheral pulses
• Decreased
urinary output
• Finally cardiac
arrest Courtesy of Bonnie Meneely, R.N.

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 CAPILLARY REFILL SHOCK

TEST
• Positive if >2 seconds
• Not a useful indicator of early
shock in adults
– Always delayed if patient is cold
• May be helpful in small children
• Is negative in neurogenic shock
– Patient cannot vasoconstrict
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 HEMORRHAGIC SHOCK

SHOCK
• Loss of blood
volume
– Early shock is
evident with 15-
20% blood loss
– Late shock
develops with
30-40% blood
loss
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 BASIC MANAGEMENT SHOCK
HEMORRHAGIC SHOCK

• Control the bleeding

• 100% oxygen
• Load & Go
• Fluid replacement when
indicated

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 SPECIFIC TREATMENT SHOCK
VARIES WITH SITUATION

• External hemorrhage that can be

controlled
• External hemorrhage that cannot
be controlled
• Internal hemorrhage

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 MANAGEMENT OF SERIOUS
HEMORRHAGE THAT CAN BE SHOCK

CONTROLLED
• Supine position
• 100% oxygen
• Load & Go
• May use PASG initially
• IV access en route
– 20cc/kg bolus
– Reassess, repeat fluid bolus as necessary
• Monitor closely
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 MANAGEMENT OF SERIOUS
HEMORRHAGE THAT CANNOT SHOCK

BE CONTROLLED
• Supine position
• 100% oxygen
• Load & Go
• IV access en route
– Give fluid to maintain a systolic BP of 90-100
• Use tourniquets if necessary
• PASG contraindicated
• Notify Medical Direction
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 MANAGEMENT SHOCK
INTERNAL HEMORRHAGE

• Supine position
• 100% oxygen
• Load & Go
• IV access en route
– Give fluid to maintain a systolic BP of
90-100
• Notify Medical Direction
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 MANAGEMENT OF SHOCK
MECHANICAL SHOCK

• Tension
pneumothorax
• Cardiac
tamponade
• Myocardial
contusion with
shock

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 SHOCK

HIGH SPACE SHOCK

NEUROGENIC SHOCK
(commonly called spinal shock)

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 MANAGEMENT SHOCK
NEUROGENIC SHOCK
• Supine position
• 100% oxygen
– Assist ventilation as needed
• Load & Go
• IV access en route
– Give fluid to maintain systolic BP of 90-100
• PASG can be used if there is no
evidence of internal injuries
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• Monitor closely
 INDICATIONS FOR USE OF
THE PNEUMATIC SHOCK

ANTISHOCK GARMENT
• Shock secondary to hemorrhage that
can be controlled
• Neurogenic shock without evidence of
other internal injuries
• Isolated fractures of the legs without
other internal injuries (blow up to air-
splint pressure only)
• Shock with no palpable pulse
(controversial)
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 SUMMARY SHOCK

• Shock is a critical condition that

leads to death
• Diagnosis and management must
be accomplished quickly
• Knowledge of shock syndromes
and their management is essential

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 QUESTIONS? SHOCK

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