Shock.pdf

EMERGENCY & DISASTER CARE SSN 288/NURS 254 PRESENTED BY ABENA KYEREW ABEBRESE  Objectives By the end of the lesson, students will be able to; Define shock Causes of shock Types of shock Management of shock AKA 2024 3 ...

EMERGENCY & DISASTER CARE SSN 288/NURS 254 PRESENTED BY ABENA KYEREW ABEBRESE  Objectives By the end of the lesson, students will be able to; Define shock Causes of shock Types of shock Management of shock AKA 2024 3  Shock Shock is the clinical manifestation of failure of cellular function due to inadequate tissue perfusion leading to hypoxia and altered cellular metabolism. If the total blood volume is reduced, or the heart fails to pump effectively, the effective circulating blood volume will reduced and tissue perfusion and oxygen delivery will become inadequate resulting into shock. AKA 2024 4  Cont’d For an average adult, oxygen delivery from arterial blood is 1000ml per minute and the body’s oxygen consumption is 3ml/kg/min (200 - 250ml). Oxygen delivery is normally five times the oxygen consumption i.e, (5:1). If the ratio falls to less than 2:1, tissue hypoxia would occur leading to shock. AKA 2024 5  Causes of shock The causes of shock are based on the type of shock. a. Basically, shock is caused by decrease in the amount of blood in circulation- through loss of blood exceeding 1.2 litres (acute hemorrhage) bleeding may be internal (e.g.) ruptured spleen, ruptured tubal pregnancy and external i.e. open wound, bleeding peptic ulcer, uterine bleeding either anti-partum or postpartum AKA 2024 6  Causes cont’d b. Shock can develop if the heart fails to pump blood through the circulatory system. This occurs when there is an obstruction to the flow of blood from the heart due to massive pulmonary embolism, myocardial infarction or sepsis. There is reduced cardiac output due to reduced effective circulation of blood AKA 2024 7  Causes cont’d c. peripheral vessel failure. If the blood vessels dilate as in severe infection or anaphylaxis (a severe reaction due to introduction of a foreign protein into the body), the vasodilatation of arteries and venules cause peripheral pooling of blood which reduce the effective circulating of blood leading to reduced tissue perfusion, hypoxia, cell damage and inflammation. AKA 2024 8  Causes cont’d An average person of 75- 80 / kg has about 4-5 L of blood. About 25% (1000ml) of blood must normally be lost before shock can occur. d. In primary shock, a decline/drop in Bp and appearance of symptoms of shock are seen immediately after injury due to emotional stimulus or pains and the patient recovers quickly in recumbent position. AKA 2024 9  Causes cont’d e. In secondary/delay/deferred shock, it occurs some time after the injury and is associated with heat stroke, crushing injuries, heart attack, poisoning, burns and other life threatening conditions. It is characterized by weakness, restlessness, low temperature & Bp, cold sweat, reduced urine output etc AKA 2024 10  Signs and symptoms of shock Initially the pulse is slow less than 60 but gradually it becomes rapid and feeble because of the adrenal and sympathetic stimulation. The skin is pale and blue or blue ash in color especially the lips and the finger nails. Sweating, cold and clammy skin because of poor perfusion and superficial vasoconstriction by sympathetic response. AKA 2024 11  s/s cont’d There is weakness and dizziness. There may be nausea and vomiting Thirst if the casualty is conscious There may be rapid and shallow breathing because the carbon dioxide level stimulates the respiration center He yawns and gasps for air (air hunger). The casualty becomes restless, anxious and aggressive because of poor perfusion to the brain. AKA 2024 12  s/s cont’d The pulse becomes very weak and thready and even imperceptible when blood supply to the brain is interrupted. The casualty may fall into unconsciousness and finally the heart will stop. Blood pressure is lower than normal because of reduced cardiac output and peripheral resistance. Decrease urine output or none because of poor glomerular filtration due to sympathetic vasoconstriction of renal vessels AKA 2024 13  Aims of management 1. To recognize the shock 2. To treat any obvious causes of shock. 3. To improve the blood supply to vital organs: heart, brain, lungs. 4. To arrange urgent removal of casualty to the hospital. AKA 2024 14 AKA 2024 15  First aid management of shock 1. Treat any possible cause of the shock e.g. bleeding or serious burns. 2. Rest and silence: lay the casualty down flat on a blanket. 3. Reassure constantly 4. Raise and support the legs to improve circulation to vital organs. 5. Loosen tight clothing to reduce constriction around the neck, chest, waist even socks. AKA 2024 16  Management cont’d 6. Take care of suspected fractures. 7. Keep casualty warm by covering him/her but care must be taken not to overheat the casualty. Place the casualty on blanket or rug 8. Check and record vital signs; Temperature, pulse and level of response. Be prepared to resuscitate if necessary. Take note of the rate and depth of the respiration. AKA 2024 17  Management cont’d 9. If the casualty is unconscious, do not force any drink. 10. If the casualty complains of thirst, moisten the lips with little water. 11. Pain should be relieved by either supporting an injured limb or putting the casualty in the most comfortable position AKA 2024 18 AKA 2024 19  TYPES OF SHOCK A. Syncope (fainting): It is a brief loss of consciousness caused by reduction of blood supply to the brain. Causes It may be due to reaction to pain. Exhaustion. Hunger Emotional stress AKA 2024 20  Syncope cont’d Long periods of standing in warm environments. This inactivity causes a pull of blood to the lower extremities thus depriving the amount of blood supply to the brain. Recovery is usually rapid and complete. AKA 2024 21  Management of syncope 1. Lay the casualty down 2. Raise and support the legs 3. Ensure fresh air by fanning 4. Reassure the casualty as he/she recovers. 5. Assist him/her to sit down gradually. 6. Look for and treat any injury. 7. Check and record pulse and respiration. 8. Transport the casualty to the hospital before he/she starts to faint again AKA 2024 22  Type of shock B. Anaphylactic shock- This is an allergic/hypersensitivity reaction occurring within seconds caused by the introduction of foreign protein or drugs into the body which causes certain chemical substances (prostaglandins, histamine, bradykinin from the mast cell out of the antigen - antibody reaction) to be released causing generalized vasodilatation of peripheral vessels, increased capillary permeability and constriction of air passages AKA 2024 23  Anaphylactic cont’d A typical case is the second injection of a patient with a serum he/she is allergic to. In the first injection, the patient produces antibodies. Subsequent injections produce antigens. The patient’s body therefore regards the subsequent serum as a foreign body or antigen and begins to fight it causing the reaction i.e. procaine penicillin. AKA 2024 24  Anaphylactic cont’d Anaphylactic shock is a life threatening condition that collapses patients and may even cause death. Other causes may be – Insect sting – Ingestion of some types of foods. – Blood transfusion and some radio-opaque substances. – Foreign protein can be from snake bite, scorpion, dog and spider bite AKA 2024 25  S /s of anaphylactic shock 1.There will be a fall in blood pressure. (Severe hypotension) 2. Anxiety 3. Widespread red spotted skin eruption (urticarial rashes) 4. There may be swelling of the face and neck and there may be puffiness around the eyes. 5. There is rapid pulse and faint 6. Impaired breathing e.g. chocking sensation, wheezing and cough AKA 2024 26  First aid management – The casualty with anaphylactic shock urgently needs oxygen and a life saving injection of adrenaline (at the hospital) – Assist the casualty to breath until professional help arrives. – Reassure casualty Prevention: a patient with a known history of allergy should be given A.T.S. sensitivity test before animal serum is given. AKA 2024 27  Type of shock C. Oligaemic /Hypovolaemic- This occurs when there is tissue damage leading to severe loss of blood or fluid from circulation. It is common in the following circumstances. Fracture Hemorrhage (hemorrhagic shock) Burns and scalds After surgical operation Severe vomiting and diarrhea AKA 2024 28  Hypovolaemic cont’d The main factor in Hypovolaemic shock is the reduction of fluid or circulating blood leading to hypoperfusion of cell, hypoxia and cellular dysfunction also cellular damage /death. First aid treatment is as in first aid management of shock. AKA 2024 29  Type of shock D. Neurogenic / psychical shock- It may occur when no injury had taken place but an emotional upset has occurred. This form of shock is due to vasodilatation of arterial and venules of muscles following sudden and unpleasant event such as: 1. Pain 2. Fear 3. High emotional state due to bad news 4. Excessive joy. AKA 2024 30  Type of shock Causes 5. Excessive anger or grief 6. Being involved in an accident although not physically wounded. AKA 2024 31  Signs /symptoms 1. Patient feels hot 2. Sweat profusely 3. Patient becomes pale 4. Blood pressure is low 5. The pulse is slow 6. May lose consciousness AKA 2024 32  First aid management 1. Lay the patient down flat with the head lowered 2. Reassure casualty 3. Ensure casualty’s airway is clear and casualty is breathing 4. Call for help 5. Transport casualty to hospital AKA 2024 33  Type of shock E. Septic/Infective Bacteraemia/Toximic Shock This is due to massive infections due to bacteria toxins from burns, septicaemia or infection anywhere in the body. It is a complex process involving both depression of the heart muscles and loss of fluid from circulation into the body tissue. AKA 2024 34  s/s Low Bp Fever Cyanosis Tachycardia Pale and cold arm and legs/ hypothermia Chills Difficulty breathing Decreased urine output Mental confusion & disorientation AKA 2024 35  Type of shock F. Cardiogenic shock. The important causes are cardiac tamponade, myocardial infarction, cardiac contusion, pneumothorax and pulmonary embolism. Signs and Symptoms There is venous congestion Facial cyanosis Distended neck veins Severe hypotension Weak pulse Cold clammy skin Dyspnoea AKA 2024 36  First Aid Treatment 1. Position casualty - Keep the patient lying in the recumbent position with head lowered 2. Prone the patient with the head turned to one side to aid blood flow to the brain. 3. If unconscious, lay him on the side with head low and tilted to one side. 4. Loose tight clothing. 5. Reassure casualty 6. Keep casualty warm 7. Call for help 8. Send casualty to the hospital AKA 2024 37  Cont’d NB-Elevation shouldn’t be done if there is head injury, the patient should be placed semi-recumbent, supported with three pillows if casualty complains of pain. If there is vomiting or difficulty in breathing, loosen tight clothing around the chest, neck and waist. AKA 2024 38  Cont’d Provision of warmth: Steps must be taken to reestablish the normal temperature but do not over heat or make patient to sweat as this will result in additional loss of fluid in the body. Blankets should be placed under and around him. AKA 2024 39  Cont’d No patient should be allowed to lie on the floor/ground for a long time because exposure is an important factor in the establishment of shock. Patients must have quick and stable relief from pain by action and not drugs. Do not give fluid if unconscious or partially conscious when patient faces any surgery/when there is penetrating abdominal wall/anorexia. AKA 2024 40  Signs of recovery from shock 1. Pulse becomes slower and stronger. 2. The blood pressure increases. 3. The skin feels warmer and regains its color. 4. The respiration is slower and deeper. 5. Patient vomits or has a tendency to vomit. 6. Adequate urine output is observed AKA 2024 41  Signs of recovery from shock NOTE In preventing shock the most important things to remember are: Rest Relief of pain Warmth Fluid AKA 2024 42  THANK YOU QUESTIONS? CONTRIBUTIONS?? AKA 2024 43