Understanding Shock in Medical Emergencies

Overview

• Shock occurs when the circulatory system doesn't have enough blood.
• The vascular system is unable to retain blood fluid.
• Vasodilation disrupts the osmotic fluid balance in the body.
• Blood viscosity increases, slowing blood flow.
• Insufficient oxygen is transported throughout the blood.

Predisposing Factors

• Extreme fatigue
• Extreme exposure to heat or cold.
• Extreme dehydration
• Illness
• Severe injury

Signs and Symptoms

• Low blood pressure, typically below 90 mmHg systolic.
• Rapid and weak pulse.
• Rapid and shallow respiration.
• Pale, cool, and clammy skin.
• Drowsiness.

Types of Shock

• Hypovolemic Shock:
  • Occurs due to blood loss from trauma.
  • Decreased blood volume leads to decreased blood pressure.
  • Insufficient oxygen delivery to tissues and organs.
• Respiratory Shock:
  • The lungs fail to adequately oxygenate circulating blood.
  • Causes:
    • Pneumothorax.
    • Injury to the respiratory control center.
• Neurogenic Shock:
  • Widespread dilation of blood vessels in the cardiovascular system.
  • Decreased blood pressure.
  • Insufficient oxygen delivery to tissues and organs.
• Psychogenic Shock:
  • Also known as fainting (syncope).
  • Temporary blood vessel dilation, reducing blood flow to the brain.
• Cardiogenic Shock:
  • The heart is unable to pump enough blood to the body.
  • Reduced cardiac output.
  • Decreased blood pressure.
  • Insufficient oxygen delivery to tissues and organs.
• Septic Shock:
  • Severe infection, often bacterial.
  • Bacterial toxins cause blood vessel dilation in the cardiovascular system.
  • Decreased blood pressure.
  • Insufficient oxygen delivery to tissues and organs.
• Anaphylactic Shock:
  • Severe allergic reaction.
  • Triggers may include:
    • Foods.
    • Insect bites.
    • Drugs.
    • Inhaling dusts, pollens, etc…
• Metabolic Shock:
  • Severe, untreated illness, such as diabetes.
  • Extreme loss of bodily fluids, like excessive urination, diarrhea, or vomiting.

Psychological Impact

• Shock can be worsened or caused by the psychological response to an injury or situation.
• Fear is a common factor.
• Providing reassurance and comfort is crucial.

Immediate Management

• Maintain normal body temperature.
• In most cases, elevate the feet and legs above heart level.
• Exceptions:
  • Neck injury - immobilize in the position found.
  • Head injury - elevate the head and shoulders.
  • Leg fracture - splint and elevate.

Secondary Management

• Monitor vital signs:
  • Pulse.
  • Respiration.
  • Blood pressure.
  • Temperature.
  • Skin color.
• Assess:
  • Pupils.
  • Level of consciousness.
  • Movement.
  • Abnormal nerve response.

Pulse

• Direct measure of heart function.
• Normal pulse rates:
  • Adults: 60-80 bpm.
  • Children: 80-100 bpm.

Abnormal Pulse

• Rapid and weak:
  • Shock.
  • Bleeding.
  • Diabetic coma.
  • Heat exhaustion.
• Slow and strong:
  • Skull fracture.
  • Stroke.
  • No pulse:
    • Cardiac arrest.
    • Death.
• Rapid and strong:
  • Heatstroke.
  • Severe fright.

Respiration

• Assess for normal or abnormal breathing.
• Rapid and shallow respiration indicates shock.

Blood Pressure

• Normal systolic blood pressure:
  • Males: 115-120 mmHg.
  • Females: 105-110 mmHg.
• Normal diastolic blood pressure:
  • Males: 75-80 mmHg.
  • Females: 65-70 mmHg.

Blood Pressure

• High blood pressure:
  • Systolic above 140 mmHg.
  • Diastolic above 90 mmHg.
• Low blood pressure:
  • Systolic below 100 mmHg.
  • Diastolic below 60 mmHg.

Temperature

• Normal body temperature.
• Core temperature is most accurately measured at the tympanic membrane of the ear.
• Skin reflects changes in body temperature.

Skin: Temperature

• Cool, clammy skin:
  • Shock.
  • Trauma.
  • Heat exhaustion.
• Cool, dry skin:
  • Overexposure to cold.
• Hot, dry skin:
  • Disease.
  • Infection.
  • Overexposure to environmental heat.

Skin: Color

• Three primary skin colors:
  • Pale.
  • Blue (cyanotic).
  • Red.
• Red skin color:
  • Heatstroke.