L3 - Clinical Shock Component 5 (September 2020) PDF

Clinical Shock Component 5  Clinical Shock – Component 5 Objective Explain the types, causes, stages and the management of shock © Department of Clinical Education & Standards 2  Clinical Shock – Component 5 Types of Shock Hypovol...

Clinical Shock Component 5  Clinical Shock – Component 5 Objective Explain the types, causes, stages and the management of shock © Department of Clinical Education & Standards 2  Clinical Shock – Component 5 Types of Shock Hypovolaemic Distributive Cardiogenic Obstructive Dissociative © Department of Clinical Education & Standards 3  Clinical Shock – Component 5 Hypovolaemic Shock Acute loss of circulating blood volume Can be caused by: Severe haemorrhage (internal/external) where whole blood volume is lost Extensive Burns – Serum is lost Severe Diarrhoea +/- Vomiting – Water & electrolytes are lost © Department of Clinical Education & Standards 4  Clinical Shock – Component 5 Distributive shock Caused by widespread dilation of the peripheral vascular system Creates the effect of a larger container for the same blood volume In cases of sepsis/anaphylaxis this creates “leaky” blood vessels allowing fluid to move into the interstitial space © Department of Clinical Education & Standards 5  Clinical Shock – Component 5 Distributive shock Common causes of distributive shock Anaphylaxis Sepsis Nervous system related, such as spinal cord injury © Department of Clinical Education & Standards 6  Clinical Shock – Component 5 Cardiogenic shock Causes by the heart being unable to circulate sufficient blood to meet the body's metabolic needs Most common following a myocardial infarction Acute heart failure Arrhythmia © Department of Clinical Education & Standards 7  Clinical Shock – Component 5 Obstructive shock Uncommon cause of shock caused by an obstruction in the flow to/from the heart. Often caused by Tension Pneumothorax Cardiac tamponade Pulmonary embolism © Department of Clinical Education & Standards 8  Clinical Shock – Component 5 Dissociative shock Caused by the oxygen carrying capacity of the blood being affected by inadequate number of red blood cells available to carry sufficient oxygen. Or when competing molecules take up space on red blood cells © Department of Clinical Education & Standards 9  Clinical Shock – Component 5 Dissociative shock Causes: Anaemia Carbon monoxide poisoning © Department of Clinical Education & Standards 10  Clinical Shock – Component 5 Signs & Symptoms of Shock Tachycardia (Increased Pulse Rate) Tachypnoea (Increased Respiratory Rate) or Depth Abnormal Behaviour (agitation or confusion) Feeling dizzy/faint Pale , cold extremities, delayed capillary refill Sweating, dilated pupils, thirst Stage 4 – Near fatal – Reduced LOC, Bradycardia © Department of Clinical Education & Standards 11  Clinical Shock – Component 5 Signs & Symptoms of Shock Certain patient groups may not have abnormal vital signs until significant (1,000ml-1,500ml) has been lost Young athletic/healthy people Pregnant patients Patients on Beta Blocker medication © Department of Clinical Education & Standards 12  Clinical Shock – Component 5 Management of shock R A B C D E Assess for Time Critical Administer high % oxygen If conscious, position patient flat with head and shoulders slightly raised Consider raising lower limbs If unconscious, in stable side position Treat other injuries and bleeding © Department of Clinical Education & Standards 13  Clinical Shock – Component 5 Management of shock Do not overheat or allow to become cold Avoid rough handling, be gentle Constant reassurance Constant observations (pulse, level of consciousness, respiration) Give nil by mouth – ?need for anaesthetic Time Critical transfer to appropriate facility Consider paramedic / medical help © Department of Clinical Education & Standards 14 Clinical Shock – Component 5 © Department of Clinical Education & Standards 15