Surgery - Shock PDF

Shock Dr.fawzi salih Ass.prof.of pediatric surgery Overview ▪ Shock occurs when a diminished amount of blood is available to the circulatory system ▪ The vascular system fails to hold the fluid portion of the blood ▪ Vasodilation of the blood vessels occurs and disrupts the osmotic fluid...

Shock Dr.fawzi salih Ass.prof.of pediatric surgery Overview ▪ Shock occurs when a diminished amount of blood is available to the circulatory system ▪ The vascular system fails to hold the fluid portion of the blood ▪ Vasodilation of the blood vessels occurs and disrupts the osmotic fluid balance in the body Overview ▪ Blood viscosity increases ▪ The rate of blood flow decreases ▪ Insufficient amounts of O2 are being transported in the blood Predisposing Factors ▪ Extreme fatigue ▪ Extreme exposure to heat or cold ▪ Extreme dehydration ▪ Illness ▪ Severe injury Signs and Symptoms ▪ Low Blood Pressure ▪ Systolic BP is usually below 90 mmHg ▪ Pulse is rapid and weak ▪ Respiration is rapid and shallow ▪ Skin is pale, cool, and clammy ▪ Drowsiness Types of Shock Hypovolemic Shock ▪ Results from trauma in which there is blood loss ▪ Decreased blood volume causes a decrease in blood pressure ▪ Insufficient amounts of O2 is being transported to body tissues and organs Types of Shock Respiratory Shock ▪ Results when the lungs are unable to supply enough O2 to circulating blood ▪ Trauma that may produce respiratory shock include: ▪ Pneumothorax ▪ Injury to the respiratory control center Types of Shock Neurogenic Shock ▪ Results due to the overall dilation of the blood vessels within the cardiovascular system ▪ Decreased blood pressure ▪ Insufficient amounts of O2 is being transported to body tissues and organs Types of Shock Psychogenic Shock ▪ Commonly known as “fainting” (syncope) ▪ Results due to a temporary dilation of the blood vessels in the body causing a decrease in the blood flow to the brain Types of Shock Cardiogenic Shock ▪ Results due to the inability of the heart to pump enough blood to the body ▪ Decreased cardiac output ▪ Decreased blood pressure ▪ Insufficient amounts of O2 is being transported to body tissues and organs Types of Shock Septic Shock ▪ Results due to a severe infection ▪ Usually a bacterial infection ▪ Toxins released by the bacteria cause dilation of the blood vessels within the cardiovascular system ▪ Decreased blood pressure ▪ Insufficient amounts of O2 is being transported to body tissues and organs Types of Shock Anaphylactic Shock ▪ Results due to a severe allergic reaction ▪ Allergic reaction may be caused by: ▪ Foods ▪ Insect bites ▪ Drugs ▪ Inhaling dusts, pollens, etc… Types of Shock Metabolic Shock ▪ Results due to a severe illness that goes untreated ▪ For example, untreated diabetes ▪ Results due to an extreme loss of bodily fluid ▪ For example, excessive urination, diarrhea, or vomiting Psychological Impact ▪ Shock can be compounded, or produced by the psychological reaction to an injury or a situation ▪ Fear is the common ▪ Provide reassurance and comfort Immediate Management Immediate Management ▪ Maintain normal body temperature ▪ In most cases, elevate the feet and legs above the level of the heart ▪ Exceptions include: ▪ Neck injury – immobilize in the position found ▪ Head injury – elevate the head and shoulders ▪ Leg fracture – splint and elevate Secondary Management Secondary Management Vital Signs ▪ Pulse ▪ Pupils ▪ Respiration ▪ Level of ▪ Blood pressure consciousness ▪ Temperature ▪ Movement ▪ Skin color ▪ Abnormal nerve response Pulse ▪ A direct extension of the functioning of the heart ▪ Normal pulse rate for adults ▪ 60 – 80 bpm ▪ Normal pulse rate in children ▪ 80 – 100 bpm Abnormal Pulse ▪ Rapid and weak ▪ Slow and strong ▪ Shock ▪ Skull fracture ▪ Bleeding ▪ Stroke ▪ Diabetic coma ▪ No pulse ▪ Heat exhaustion ▪ Cardiac arrest ▪ Rapid and strong ▪ Death ▪ Heatstroke ▪ Severe fright Respiration ▪ Normal respiration or not ▪ ▪ Rapid and shallow respiration is indicative of shock Blood Pressure ▪ Normal systolic blood pressure in adults ▪ Males: 115 – 120 mm Hg ▪ Females: 105 – 110 mm Hg ▪ Normal diastolic blood pressure in adults ▪ Males: 75 – 80 mm Hg ▪ Females: 65 – 70 mm Hg Blood Pressure ▪ High Blood Pressure ▪ Systolic BP > 140 mm Hg ▪ Diastolic BP > 90 mm Hg ▪ Low Blood Pressure ▪ Systolic BP < 100 mm Hg ▪ Diastolic BP < 60 mm Hg Temperature ▪ Normal body temperature ▪ Or not ▪ Core temperature is most accurately measured at the tympanic membrane of the ear ▪ Changes in body temperature are reflected in the skin 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 skin colors ▪ Red skin color are commonly ▪ Heatstroke identified in medical ▪ High blood pressure emergencies: ▪ Elevated body ▪ Red temperature ▪ White ▪ Blue Skin: Color ▪ White skin color ▪ Blue skin color ▪ Shock ▪ Airway obstruction ▪ Insufficient circulation ▪ Respiratory ▪ Fright insufficiency ▪ Hemorrhage ▪ Heat exhaustion ▪ Insulin shock Pupils ▪ Pupils are extremely sensitive to changes in the nervous system ▪ If one or both pupils are dilated… ▪ Shock ▪ Head injury ▪ Heatstroke ▪ Hemorrhage ▪ CNS stimulant drug ▪ One constricted pupil… ▪ CNS depressant drug Pupils ▪ If one or both pupils fail to respond to light… ▪ Brain injury ▪ Alcohol ▪ Drug poisoning ▪ Pupil response to light is more critical than the evaluation of pupil size Level of Consciousness ▪ In normal conditions, … ▪ Alert ▪ Aware of the surrounding environment ▪ Responds quickly to vocal stimulation ▪ Abnormal levels of consciousness may result due to… ▪ Shock ▪ Head injury ▪ Heatstroke Summary ▪ May not be able to determine the type of shock ▪ Immediate management of shock is universal ▪ Provide reassurance and comfort ▪ Maintain normal body temperature ▪ In most cases, elevate the feet and legs above the level of the heart