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ACS

Shock
Focused Discussion

ACS

Objectives

Define Shock.
Recognize the shock state.
Determine the cause.
Apply treatment principles.
Apply principles of fluid management.
Monitor patients response.
Employ options for vascular access.
Recognize complications of vascular access.

ACS

Key Questions

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?

ACS

Key Questions

Is the patient in shock?

What is shock?

ACS

What is shock?

Inadequate organ perfusion

Inadequate substrate delivery
Anaerobic metabolism
Celular dysfunction
Cell death

ACS

ACS

Key Questions

Is the patient in shock?

What is shock?
How do you recognize it?

ACS

How do you recognize it?

Scene information/mechanism of injury

Physical examination
Inadequate
Tachycardia
perfusion
Alteration in LOC, anxiety
Cold, diaphoretic skin
Urinary output
Organ
Hypotension
dysfunction
Tachypnea, shallow repirations
(AMPLE History Sec.Survey)

Recognition of Shock State

ACS

1. Tachycardia
2. Vasoconstriction
2. Cardiac output
Narrow pulse pressure
3. Map
3. Blood Flow
Caution : Compensatory mechanisms

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ACS

Class I Hemorrhage
750 mL BVL (<15%)

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Class II Hemorrhage
750 1500 mL BVL (15-30%)

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Class III Hemorrhage

1500 2000 mL BVL (30-40%)

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Class IV Hemorrhage
2000 mL BVL (>40%)

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ACS

Key Quetions

Is the patient in shock?

What is shock?
How do you recognize it?
What preparations are necessary?

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ACS

Preparations?

Trauma team activation?

Summon the trauma personel
Organize the equipment
Standard precautions
Warm room and fluids

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ACS

Key Questions

Is the patient in shock?

What is the cause of the shock state?

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ACS

What is the cause?

Hemorrhagic

Blood loos

vs

Nonhemorrhagic

Spinal cord
Lung
Heart
Brain
Septic

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ACS

Key Questions

Is the Patient in shock?

What is the cause of the shock state?
How do you locate the bleeding?

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ACS

How to locate the bleeding?

Physical examination
Diagnostic adjuncts to primary survey
Chest x-ray
DPL / Ultrasound
AP pelvis x-ray

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ACS

Key Questions

Is the patient in shock?

What is the cause of the shok state?
What can I do about it?

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ACS

What can I do about it?

Stop the bleeding!

Restore volume!

Direct pressure
Operation
Reduce pelvic volume
Splint fractures
Vascular access
Warmed fluids

Prevent hypothermia!

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ACS

Key Questions

Is the patient in shock?

What is the cause of the shock state?
What can I do about it?
How do I evaluate the response to
treatment?

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ACS

Response evaluation?
Identify Improved Organ Perfusion

CNS: Improved LOC

Renal: Urinary output

Skin: Warm, capillary refill

Repirations: Improved rate and depth

Vital signs: Return to normal

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ACS

Key Questions

Is the patient in shock?

What is the cause of the shock state?
What can I do about it?
What is the patients response?

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ACS

What is the patients response?

Rapid Responder
Transient Responder
Nonresponder

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ACS

Key Questions

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?

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ACS

What are the pitfalls?

BP = Cardiac output
Age extremes
Hypothermia
Athletes
Pregnancy
Medications
Pacemaker

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Questions

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ACS

Summary

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?