a critical condition that results in the inadequate perfusion of cells, tissue, and organs.
shock
the ability or tendency to maintain internal stability in an organism to compensate for environmental changes.
homeostasis
inadequate amounts of oxygen and glucose delivered to cells
hypoperfusion
an acute type of pericardial effusion in which fluid, pus, blood, clots, or gas accumulates in the pericardium (the sac in which the heart is enclosed), resulting in slow or rapid compression of the heart.
pericardial tamponade
shock that is caused by a low volume of blood or fluid
hypovolemic
an escape of blood from a ruptured blood vessel, especially when profuse.
hemorrhage
forms of hypovolemia that are associated with fluid loss from burns and dehydration
nonhemorrhage
the state or quality of a material or membrane that causes it to allow liquids or gases to pass through it
permeability
shock state caused by a reduction in systemic and peripheral vascular resisance
distributive shock
shock caused by ineffective pump function of the heart
cardiogenic shock
shock that results from a condition that obstructs forward blood flow
obstructive shock
sudden blockage in a lung artery, also called: Blood clots in the lung
pulmonary embolism
type of shock described as a dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, off-load at the cell, or be used effectively by the cell for metabolism
metabolic shock or respiratory shock
shock that results from the loss of whole blood from the intravascular space
hemorrhagic hypovolemic shock
shock caused by loss of fluid from the intravascular space; however, red blood cells and hemoglobin remain within the vessels.
nonhemorrhagic hypovolemic shock
medication of choice in the anaphylactic shock patient. __________ contains alpha properties that cause systemic vasoconstriction
epinephrine
emergency care for anaphylactic shock
airway management, ventilation, and oxygenation - epinephrine
emergency care for hemorrhagic hypovolemic shock
stopping the bleeding is the first step in management of this patient. often requires administration of whole blood or blood components to replace intravascular blood volume that was lost
emergency care for nonhemorrhagic hypovolemic shock
administration of intravenous fluids - ALS
emergency care for burn shock
establish and maintain adequate airway, ventilation, and oxygenation. also, prevent further contamination of the burn injury.
type of distributive shock. it results from an infection that releases bacteria or toxins in the blood, causing the vessels throughout the body to dilate and become permeable
septic shock
emergency care for septic shock
manage the airway, ventilation, and oxygenation. benefit from intravenous fluids and medication to constrict the vessels - ALS
type of distributive shock - spinal cord injury.
neurogenic shock
emergency care for neurogenic shock
spinal immobilization and management of the airway, ventilation, and oxygenation. patient may benefit from intravenous fluids to fill the vascular space and medications to constrict the vessels. - ALS
emergency care for cardiogenic shock
manage the airway, ventilation, and oxygenation. patient may benefit from intervention and medications administered by ALS
the effects of the sympathetic stimulation, which occur immediately, are:
increase in heart rate
increase in force of ventricular contraction (stroke volume)
vasoconstriction
stimulation of the release of epinephrine and norepinephrine from the adrenal gland
stimulatory effect of alpha1
contraction of the muscles controlling the iris
contraction of vascular smooth muscle causing vasoconstriction
stimulation of sweat glands
stimulatory effect of beta1
increased heart rate
increased speed of impulse through conduction system
increased force of contraction
stimulatory effect of beta2
bronchial smooth muscle dilation
skeletal muscle contractility
sign or symptom of alpha1 stimulation
dilated pupils
pale cool skin, narrow pulse pressure
localized sweating, clammy skin
sign or symptom of beta1 stimulation
tachycardia
pounding heart
sign or symptom of beta 2 stimulation
decreased airway
tremors
In this stage of shock the body is compensating for blood loss. The signs and symptoms are limited and the human system functions normally.
compensated shock
epinephrine effect on body:
increased heart rate increased contractility vasoconstriction sweat gland stimulation decreased insulin secretion conversion of non-carbohydrates into sugar iris muscle constriction
epinephrine release sign or symptom:
tachycardia pounding heart pale cool skin clammy skin increased blood glucose level pupillary dilation
norepinephrine effect on body:
vasoconstriction
sweat gland stimulation
norepinephrine release sign or symptom:
pale cool skin
clammy skin
antidiuretic hormone (vasopressin) effect on body:
increased sodium reabsorption in the kidneys
vasoconstriction
antidiuretic hormone (vasopressin) release sign or symptom:
decreased urine
increased blood pressure
angiotensin II effect on the body:
vasoconstriction
increased heart rate
sodium reabsorbtion in the kidney
angiotensin II release sign or symptom:
pale cool skin
tachycardia
decreased urine output
aldosteronen effect on the body:
sodium reabsorbtion in the kidney
aldosteronen release sign or symptom:
decreased urine output
glucagon effect on the body:
conversion of stored glucose in liver to blood glucose
conversion of noncarbohydrates into sugar
increased heart rate and contractility
glucagon release sign or symptom:
increased BGL
tachycardia
advanced stage of shock in which the body’s compensatory mechanisms are no longer able to maintain a blood pressure and perfusion of the vital organs.
decompensated shock
a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism (to keep tissue alive).
ischemic
I’ski:mic
occurs when blood flow to your heart is reduced, preventing it from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart’s arteries (coronary arteries).
Myocardial ischemia
microemboli
small clots
fibrinolysis
substances that attempt to break up blood clots
signs of poor perfusion:
altered metal status pale, cool, clammy, skin delayed capillary refill decreased urine output weak or absent peripheral pulses
physical assessment indicators of hypovolemic shock - vital signs:
decreasing blood pressure narrowing pulse pressure tachycardia tachypnea pale, cool, clammy skin unobtainable or poor SpO2 reading
physical assessment indicators of hypovolemic shock - signs of poor perfusion:
anxiety/decreased metal status pale, cool clammy skin delayed capillary refill weak or absent peripheral pulses decreased urine output
physical assessment indicators of cardiogenic shock - vital signs:
decreasing blood pressure
narrowing pulse pressure
tachycardia or bradycardia; may be irregular
tachypnea
pale, cool clammy skin; cyanotic or mottled skin
decreased Sp02 reading
physical assessment indicators of cardiogenic shock - signs of poor perfusion:
anxiety/decreased mental status
pale, cool clammy skin; cyanotic or mottled skin
jugular venous distention and peripheral edema (right-sided heart failure)
weak or absent peripheral pulses
decreased urine output
other sign: crackles or rales upon auscultation (left-sided heart failure)
physical assessment indicators of distributive shock - vital signs:
decreasing blood pressure
tachycardia (anaphylactic and septic shock)
relative braycardia or normal heart rate (neurogenic shock associated with a spinal cord injury)
tachypnea with respiratory distress and wheezing (anaphylactic shock)
normal respiratory rate (neurogenic)
warm, flushed skin (neurogenic)
warm, flushed skin with hives, possible cyanosis (anaphylactic)
mottled, cyanosos (late-sepsis, anyphylactic and neurogenic)
severely decreased Sp02 reading (anaphylactic)
physical assessment indicators of distributive shock - signs of poor perfusion:
anxiety/decreased mental status mottled, cyanosis weak or absent peripheral pulses decreased urine output other signs: fever loss of motor/sensory function edema
occurs when the ventricles of the heart, for any of a variety of reasons, are not contracting or when the cardiac output is completely ineffective and no pulses can be felt
cardiac arrest
uncoordinated twitching in the heart
ventricular fibrillation
three phases a patient goes through following cardiac arrest that lead to biological death:
electrical phase
circulatory phase
metabolic phase
during this early and initial phase, the heart still has a good supply of oxygen and glucose; therefore, aerobic metabolism is maintained with continued energy production for cell function and prevention of mass production of acid.
electrical phase
during this phase, the oxygen stores have been exhausted and the myocardial cells shift from aerobic to anaerobic metabolism. this results in very little energy production for cell function, in addition to the production of acid.
circulatory phase
at this point the heart is starved of oxygen and glucose and has a large amount of acid buildup. the tissues are very ischemic and may begin to die. the chances of survival drop dramatically during this phase.
metabolic phase
______is from the time the patient goes into cardiac arrest until CPR is effectively being performed.
downtime
_______is the total time from when the patient went into cardiac arrest until you delivered the patient to the emergency department.
total downtime
________is when the patient regains a spontaneous pulse during the resuscitation effort. the patient may not yet have begun to breathe on his own; however, if the pulse returns spontaneously it is considered a ROSC.
return of spontaneous circulation
______ is when the EMT witnessed the patient become unresponsive, apneic, and pulseless. it does not refer to a layperson watching the patient collapse
witnessed cardiac arrest
______is when the emt arrives on the scene and the patient is already unresponsive, apneic, and pulseless.
unwitnessed cardiac arrest
adult chain of survival:
immediate recognition and activation early CPR rapid defibrillation effective advanced life support integrated post-cardiac-arrest care
pediatric chain of survival:
prevention of arrest
early high-quality CPR performed by bystanders
rapid activation of EMS or other emergency medical responders
effective advanced life support and rapid transport to an appropriate medical facility
integrated post-cardiac-arrest care
the procedure of sending an electrical current through the chest, is necessary to convert an abnormal and lethal rhythm with no pulse to an organized rhythm capable of producing a pulse.
defibrillation
VF SCA
ventricular-fibrillation-induced sudden cardiac arrest
disorganized cardiac rhythm that produces no pulse or cardiac output.
ventricular fibrillation (VF or V-Fib)
very fast heart rhythm that is generated in the ventricle of the sinoatrial node in the atrium. because the pumping is so rapid, the heart does not refill properly and cardiac output is sharply reduced.
ventricular tachycardia (VT or V-Tach)
_____is the absence of electrical reactivity and pumping action in the heart.
asystole “flatline”
heart has an organized rhythm, but either the heart muscle is so weakened that it fails to pump, or the heart muscle does not respond to the electrical activity, or the circulatory system has lost so much blood that there is nothing to pump
pulseless electrical activity
These devices, powered by long-life batteries, are placed under the skin and have tiny electrodes connecting to the heart. Whenever the patient’s heart rate moves outside a certain range, the device takes over the task of setting the hearts pace.
Cardiac pacemakers
These devices are surgically implanted and used in cases of ventricular heart rhythm disturbances that cannot be controlled by medication.
Automatic implantable cardioverter defibrillators