| There are specific types of shock in medicine in many cases Shock, is the failure of the cardiovascular system to provide sufficient blood circulation to all parts of the body. It can occur rapidly, Placing your patient in critical condition in a moments notice. The Types of Shock: Hemorrhagic Shock: Is caused by blood loss or lose of plasma as seen in burns and crushing injuries. Also known as hypovolemic shock. Cardiogenic Shock: Is created by the heart failing to pump blood adequately to all parts of the body. Neurogenic Shock: Is created by the failure of the nervous system to control the diameter of the blood vessels as seen with your spinal cords injuries. Once the blood vessels are dilated, there is not enough blood in circulation to fill this new volume, causing inadequate circulation of the blood. Anaphylactic Shock: This is a Life-threating reaction of the body to an allergen, something to which the patient is extremely allergic too. Psychogentic Shock: also known as fainting. This is not to be confused with Neurogenic shock. Psychogentic Shock is often brought about by fear, bad news, the sight of blood, or minor injury. This is a nervous system reaction where there is a sudden dilation of the blood vessels where the blood flow to the brain is momentarily interrupted, causing your patient to faint. This is a temporary condition and is considered a self-correcting form of shock. Metabolic Shock: is associated with diarrhea, vomiting, and polyuria (excessive urination). Such conditions cause loss of body fluids and changes in body chemistry, including salt balance and acid-base balance. This can be a form of hypovolemic shock as fluids are lost from the bloodstream. Signs and Symptoms of Shock: Weakness Nausea Thirst Dizziness Coolness A feeling of impending doom. Your patient may show fear and restlessness and should be documented with your other findings in your assessment. Other signs that are associated with your observations can include Involving the entire body Restlessness Profuse external bleeding Vomiting Shaking and trembling (rare) Note: The state of awareness when making your assessment of your patient. Your patient may become unresponsive, faint, or lose consciousness suddenly. Pulse-rapid and weak Breathing-shallow and rapid Blood pressure-marked drop to 90/60 and below Skin- pale, moist, and cool. Often profuse sweating and a clammy feel to the touch. Eyes-lackluster, dilated pupils Eyelids-pale inner surfaces Face-pale, often with cyanosis at the lips and ear lobes most species. Preventing and Treating Shock in your Patient's: -Administer O2 -Maintain an open airway. Stay alert for Vomiting. Control Bleeding -Use direct pressure, pressure points, splints, a blood pressure cuff, or tourniquet if require. -The loss of blood to your patient is life threatening. -Apply MAST garment if needed. MAST (Military Aniti-Shock Trousers). -A tourniquet should be applied only as a last resort. -Splint fractures. Position your patient. Elevate legs to 12-18 inches. If you suspect any kind of cervical, spinal injures, head injuries or abdominal injuries. Do not tilt the patients entire body into a head down position.To do so will press the abdominal organs against the diaphragm. Always stay alert for vomiting. -Reassure your patient. Keeping them still, movement aggravates shock. -Prevent loss of body heat. -Keep NPO. (nothing by mouth) -Assess vital signs q 5 min and document. -Start IV fluids must have a CMO order before starting an IV. Military Anti-Shock Trousers: MAST Anti-shock garments or trousers are pneumatic counter-pressure devices. This means that air is used to create a pressure against something. In this case, the pressure is applied against the flow of blood. Anti-shock garments are referred to as Military Anti-shock Trousers or MAST. The anti-shock garment is used primarily for the patient who has developed or is certain to develop sever hypovolemic shock. The anit-shock garment is designed to correct or counteract certain internal bleeding conditions and hypovolemia. It does this by developing an encircling pressure up to 120 mmHg around both lower extremities, pelvis, and abdomen. This pressure will: -Slows or stops venous and arterial bleeding in the areas of the body enclosed by the pressurized garment. -Forces available blood from the lower body to the heart, brain, and other vital upper organs -Prevents the return and pooling of the available circulating blood to the lower extremities. Other Advantages are: -Serves as an air splint for fracture lower extremities. -Stabilizes a patient so effectively and quickly that other persons with more critical injuries can be treated first. Patient monitoring is still required. -When a patient is effectively stabilized with an anit-shock garment, diagnosis and preparation for surgery may be delayed for an hour or even longer, while an unstable patient often must be diagnosed and prepared for surgery in minutes. -EKG's and X-rays can be taken, and a foley catheter can be inserted while a patient is in an inflated garment. Indications for use: -Systolic blood pressure less than 80 mmHg. -Systolic blood pressure less than 100 mmHg. and exhibiting the classic signs of shock. -Profuse bleeding from injuries to the lower extremities. Note: In the past, MAST garments were recommended for patients who developed cardiac arrest. This is a controversial procedure and is currently under study. Contraindications: Pulmonary edema is the only absolute contraindication for the application of MAST. The CMO may choose not to order MAST on the following conditional contraindications: -CHF Congestive heart failure -Heart Attack -Cerebrovascular Accident (stroke) -Pregnancy, unless the abdominal compartment can be left uninflated. Other Conditional Contraindications are: Massive bleeding into the thoracic cavity. -Abdominal injury with evisceration. -Abdominal penetration where the object is still in the abdomen. -Injury above the level of the garment that has external bleeding that cannot be controlled with a simple pressure dressing. Note: The application of MAST for patients with hypovolemia, secondary to hypothermia, may cause Ventricular fibrillation. Make certain that your CMO is given a full patient assessment before he orders you to apply MAST. Removing MAST: -CMO must be present. -IV therapy has begun. -VS are stable -OR ready 1. Slowly deflate the abdominal compartment. 2. Wait 20 minutes, then slowly deflate one leg compartment. 3. Wait another 20 minutes, then slowly deflate the other leg compartment. Note: DC deflation if systolic blood pressure drops more than 10 mmHg from the previous level or if the systolic blood pressure is 110 mmHg or less. Additional IV infusion is needed before deflation can continue. The time for deflation should not be less than 20 minutes. VS q 10 min. Warning: There is no indication for the pre-hospital removal of MAST. Ref: Emergency Care. Grant, Murray, and Bergeron Anne E. Erickson, MD. Commander SFEF Stardate: 55299.76 04/19/02 |
| Shock Treatment & Medical Management |
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