Shock

● Shock: a condition in which the circulatory system fails to provide sufficient circulation
to maintain normal cellular functions; also called hypoperfusion.
● Homeostasis: a balance of all systems in the body
● Perfusion: the flow of blood through body tissues and vessels
-Systemic Circulation: carries oxygenated blood throughout the body
-Pulmonary Circulation: lungs
-Carbon dioxide is transferred in 3 ways:
1. Dissolved in the plasma
2. Combined with water in the form of bicarbonate
3. Attached to hemoglobin
● Diffusion: passive process in which molecules move from an area of higher concentration
to an area of lower concentration
● Sensitization: Developing a sensitivity to a substance that initially caused no allergic
reaction.
● Aneurysm: a swelling or enlargement of a part of an artery, resulting from weakening of
the arterial wall.
Cardiovascular System:
● Consists of:
➔ A pump (the heart)
➔ A set of pipe (vessels)
➔ The contents of the pipe/container (blood)
● Blood contains:
➔ Red blood cells- transport oxygen and carbon dioxide away from the cells and
lungs
➔ White blood cells- help the body fight infection
➔ Platelets- helps form blood clots
➔ Plasma- contains electrolytes
● Systolic Blood Pressure: peak arterial pressure, or the pressure generated every time the
heart contracts
● Diastolic Blood Pressure: pressure maintained within the arteries while the heart rests
between heart beats
● Pulse Pressure: the difference between the systolic and diastolic pressures (systolic -
diastolic = pulse pressure)
● Sphincters: muscles that encircle and, by contracting, constrict a tube, duct, or opening.
● Autonomic Nervous System: The part of the nervous system that regulates involuntary
activities of the body, such as heart rate, blood pressure, and digestion of food.
➔ Sympathetic portion: releases hormones Epinephrine and Norepinephrine
-increases heart rate
-increases strength of cardiac contractions
 -Peripheral Vasoconstriction- vasoconstriction in nonessential areas (skin &
gastrointestinal tract)

Causes of Shock:
Cardiogenic Shock:
● Cardiogenic Shock: A state in which not enough oxygen is delivered to the tissues of the
body, caused by low output of blood from the heart. It can be a severe complication of a
large acute myocardial infarction, as well as other conditions.
● Edema: The presence of abnormally large amounts of fluid between cells in body tissues,
causing swelling of the affected area.
● Cardiac Output = the volume of blood that the heart can pump per minute
➔ Myocardial Contractility: the ability of the heart muscle to contract
➔ Preload: the precontraction pressure in the heart as the volume of blood builds up
-as preload increases, blood volume in ventricles increases, and the heart muscle
stretches
-when stretched, the myocardial contractility increases = increased cardiac output
➔ Afterload: the force or resistance against which the heart pumps
-as afterload increases, cardiac output decreases
-high afterload = hypertension heart failure
Signs Include:
➔ Low blood pressure
➔ A weak, irregular pulse
➔ Cyanosis around lips and nose
➔ Anxiety
➔ Nausea
Obstructive Shock:
● Obstructive Shock: Shock that occurs when there is a block to blood flow in the heart or
great vessels, causing an insufficient blood supply to the body’s tissues.
● 3 Most Common Examples:
➔ Cardiac Tamponade
 -occurs when blood leaks into the space between the pericardium and the
pericardial sac
-Pericardial Effusion: collection of fluid between the pericardial sac and
myocardium
-Beck Triad: jugular vein distention, muffled heart sounds, narrowing pulse
pressure where systolic and diastolic start to merge
Treatment:
➔ Increase cardiac output
➔ Apply high-flow oxygen
➔ Surgery

➔ Tension Pneumothorax
-caused by damage to the lung tissue that allows air normally held in the lung to
escape into the chest cavity
-tension pneumothorax is when the trapped air within the chest cavity begins to
shift the organs towards the uninjured side
Treatment:
➔ High-flow oxygen via nonrebreathing mask
➔ Decompression (ALS skill)
 ➔ Pulmonary Embolism
-blood clot that breaks off from a large vein and travels to the blood vessels in the
lungs
-can lead to complete pump failure
Distributive Shock:
● Distributive Shock: occurs when there is widespread dilation of small arterioles, small
venules, or both.
Types of Distributive Shock:
● Septic Shock: shock caused by severe widespread infection, usually a bacterial
infection
-toxins damage the vessel walls, causing increased permeability
-the vessel walls leak and are unable to contract well
Treatment:
➔ Administer high-flow oxygen
➔ Use blankets to conserve body heat
● Neurogenic Shock: usually the result of a high spinal injury; Circulatory failure
caused by paralysis of the nerves that control the size of the blood vessels, leading
to widespread dilation; seen in patients with spinal cord injuries.
➔ Characteristic Signs:
-the absence of sweating below the level of injury
-normal and low heart rate in the presence of hypotension
-normal warm skin
Treatment:
➔ Obtain and maintain proper airway
➔ Provide spinal stabilization
➔ Assist breathing
➔ Conserve body heat
➔ Ensure effective circulation
 ● Anaphylactic Shock (Anaphylaxis): occurs when a person reacts violently to a
substance to which they have been sensitized
➔ Substances:
-Injections
-Stings
-Ingestion
-Inhalation
Treatment:
➔ Administer epinephrine
➔ Provide high-flow oxygen

● Psychogenic Shock: shock caused by a sudden, temporary reduction in blood

supply to the brain that causes fainting (syncope)
-syncope occurs when blood pools in the dilated vessels, reducing blood supply to
the brain
Hypovolemic Shock:
 ● Hypovolemic Shock: A condition in which low blood volume, due to massive internal or
external bleeding or extensive loss of body water, results in inadequate perfusion.
-Hemorrhagic- involves bleeding
-Nonhemorrhagic- vomiting or diarrhea
● Dehydration: loss of water from the tissues of the body
The Progression of Shock:
● Compensated Shock: the early stage of shock, in which the body can still compensate for
blood loss
● Decompensated Shock: the late stage of shock where blood pressure starts falling
● Irreversible Shock: shock progresses to far and cannot be reversed
Expect Shock In:
➔ Massive internal or external bleeding
➔ Multiple severe fractures
➔ Abdominal or chest injury
➔ Spinal injury
➔ A severe infection
➔ A major heart attack
➔ Anaphylaxis
Treatment:
➔ Control all obvious breathing
➔ Keep patient warm, handle gently
➔ Secure and maintain an airway
➔ Start oxygen as soon as you suspect shock
➔ Rapidly transport
Emergency Medical Care for Shock:
● Control all obvious external bleeding
● Make sure patient has an open airway
● Maintain in-line stabilization
● Comfort, calm, and reassure the patient
● Do not delay transport
● Always provide oxygen
● Monitor breathing
● Place blankets over and under the patient
● Transport
● Reassess vital signs every 5 minutes
 Trauma
● Trauma Emergencies: result of physical forces applied to a patient's body
● Medical Emergencies: include illnesses not caused by an outside force
● Index of Suspicion: awareness that unseen life-threatening injuries may exist
when determining the MOI.
● Mechanism of Injury (MOI): the forces, or energy transmission, applied to the
body that cause injury
● Work: the measure of force over distance
● Kinetic Energy: the energy of a moving object
● Potential Energy: The product of mass, gravity, and height, which is converted
into kinetic energy and results in injury, such as from a fall.
● Blunt Trauma: An impact on the body by objects that cause injury without
penetrating soft tissues or internal organs and cavities.
● Penetrating Trauma: Injury caused by objects, such as knives and bullets, that
pierce the surface of the body and damage internal tissues and organs.
● Multisystem Trauma: trauma that affects more than one body system
Significant MOIs:
➔ Injury to more than one body system
➔ Falls from heights
➔ Motor vehicle and motorcycle crashes
➔ Car versus pedestrian
➔ Gunshot
➔ Stabbings
Vehicular Crashes:
● Classified as:
➔ Frontal (head-on)
➔ Rear-end
➔ Lateral (T-bone)
➔ Rollovers
➔ Rotational (spins)
 ➔ Car vs Pedestrian
➔ Car vs Bicycle
● Three Collisions:
➔ The collision of a car against another object
➔ The collision of a passenger with the interior of the car
➔ The collision of the passenger’s organs against the solid structures of the body
-Coup-contrecoup Brain Injury: a brain injury that occurs when force is applied to
the head and energy transmission through brain tissue causes injury on the
opposite side of original impact.
● Significant MOIs are suggested by:
➔ Death of an occupant of the vehicle
➔ Severe deformity of the vehicle or intrusion of the vehicle
➔ Severe deformities of the front of the vehicle
➔ T-bone intrusion
➔ Severe damage from rear
➔ Crashes where rotation is involved
Motorcycle Crashes:
● Types:
➔ Head-on crash
➔ Angular crash
➔ Ejection
➔ Controlled crash
Falls:
● Fall from more than 20 ft (6 m) is considered significant
● Suspect internal injuries
● Take the following into account:
➔ The height of the fall
➔ The type of surface struck
➔ The part of the body that hit first, followed by the path of energy displacement

Bleeding
● Aorta: The main artery that receives blood from the left ventricle and delivers it to all the
other arteries that carry blood to the tissues of the body.
● Artery: A blood vessel, consisting of three layers of tissue and smooth muscle, that
carries blood away from the heart.
● Arterioles: The smallest branches of arteries leading to the vast network of capillaries.
● Capillaries: the small blood vessels that connect arterioles and venules; various
substances pass through capillary walls, into and out of the interstitial fluid, and then on
to the cells.
● Venules: very small, thin-walled vessels.
● Veins: the blood vessels that carry blood from the tissues to the heart.
● Hypoperfusion: a condition in which the circulatory system fails to provide sufficient
circulation to maintain normal cellular functions; also called hypoperfusion.
● Shock: a condition in which the circulatory system fails to provide sufficient circulation
to maintain normal cellular functions; also called shock.
● Perfusion: The circulation of blood within an organ or tissue in adequate amounts to meet
the current needs of the cells.
● Open-book Pelvic Fracture: a life-threatening fracture of the pelvis caused by a force that
displaces one or both sides of the pelvis laterally and posteriorly.
● Epistaxis: nosebleed
● Hemorrhage: bleeding
-the body cannot handle blood loss of greater than 20% or more than 2 pints (1 L)
-Adult male- 70mL per Kg
-Adult female- 65mL per Kg
External Bleeding:
● Bleeding is severe if:
➔ The patient has a poor general appearance and has no response to external stimuli
➔ Signs and symptoms of shock are seen
➔ Significant amount of blood loss
➔ Blood loss is rapid and ongoing
➔ You cannot control the bleeding
➔ It is associated with a significant MOI
● Arterial bleeding = bright red and spurting
● Venous bleeding = dark red (deoxygenated)
● Capillary bleeding = dark red and oozing (slow and steady)
● Coagulation: The formation of clots to plug openings in injured blood vessels and stop
blood flow.
 ● Vasoconstriction: The narrowing of a blood vessel, such as with hypoperfusion or cold
extremities.
● Hemophilia: A hereditary condition in which the patient lacks one or more of the blood’s
normal clotting factors.
● Issues that affect clotting:
➔ Movement
➔ Disease process
➔ Certain medications (blood thinners)
➔ Removal of bandages
➔ The external environment
➔ Body temperature
Internal Bleeding:
● Contusion: A bruise from an injury that causes bleeding beneath the skin without
breaking the skin
● Ecchymosis: A buildup of blood beneath the skin that produces a characteristic blue or
black discoloration as the result of an injury
● Signs and Symptoms:
➔ Hemoptysis: coughing up of blood
➔ Hematoma: A mass of blood that has collected within damaged tissue beneath the
skin or in a body cavity.
➔ Hematuria: blood in the urine
➔ Hematemesis: vomiting blood
➔ Melena: Black, foul-smelling, tarry stool containing digested blood.
➔ Pain tenderness, bruising, guarding, or swelling
● Later Signs and Symptoms:
➔ Tachycardia
➔ Weakness, fainting, or dizziness at rest
➔ Thirst
➔ Nausea and vomiting
➔ Cold, clammy skin
➔ Shallow, rapid breathing
➔ Dull eyes
➔ Slightly dilated pupils that are slow to respond
➔ Capillary refill time longer than 2 seconds
➔ Weak, rapid (thready) pulse
➔ Decreasing blood pressure
➔ Decreased LOC
Medical Care for External Bleeding:
● Methods:
➔ Direct pressure
➔ Pressure dressing and/or splints
➔ Tourniquet: The bleeding control method used when a wound continues to bleed
despite the use of direct pressure; useful if a patient is bleeding severely from a
partial or complete amputation.
➔ Junctional Tourniquet: A device that provides proximal compression of severe
bleeding near the axial or inguinal junction with the torso.
➔ Hemostatic dressing: A dressing impregnated with a chemical compound that
slows or stops bleeding by assisting with clot formation.
➔ Wound packing
➔ Pelvic Binder: A device to splint the bony pelvis to reduce hemorrhage from bone
ends, venous disruption, and pain.

Soft Tissue Injuries

● Epidermis: The outer layer of skin, which is made up of cells that are sealed together to
form a watertight protective covering for the body.
● Dermis: The inner layer of the skin, containing hair follicles, sweat glands, nerve
endings, and blood vessels.
● Mucous Membranes: The linings of body cavities and passages that are in direct contact
with the outside environment.

● Three Types of Soft-Tissue Injuries:

➔ Closed Injuries: Injuries in which damage occurs beneath the skin or mucous
membrane but the surface of the skin remains intact.
➔ Open Injuries: Injuries in which there is a break in the surface of the skin or the
mucous membrane, exposing deeper tissue to potential contamination.
➔ Burns: Injuries in which soft-tissue damage occurs as a result of thermal heat,
frictional heat, toxic chemicals, electricity, or nuclear radiation.
● Types of Closed Injuries:
➔ Contusion: A bruise from an injury that causes bleeding beneath the skin without
breaking the skin.
➔ Hematoma: A mass of blood that has collected within damaged tissue beneath the
skin or in a body cavity.
➔ Crushing Injury: Occurs when significant force is applied to the body
➔ Crush Syndrome: significant metabolic derangement that develops when crushed
extremities or body parts remain trapped for prolonged periods. This can lead to
renal failure and death.
➔ Compartment Syndrome: swelling in a confined space that produces dangerous
pressure; may cut off blood flow or damage sensitive tissue.
● Contamination: The presence of infective organisms or foreign bodies such as dirt,
gravel, or metal.
● Soft Tissue Wounds:
➔ Abrasion: Loss or damage of the superficial layer of skin as a result of a body part
rubbing or scraping across a rough or hard surface.
➔ Laceration: A deep, jagged cut in the skin
➔ Incision: sharp, smooth cut
 ➔ Avulsion: an injury in which soft tissue is torn completely loose or is hanging as a
flap
➔ Amputation: an injury in which part of the body is completely severed
➔ Penetrating Wound: An injury resulting from a piercing object, such as a knife, ice
pick, splinter, or bullet
● RICES: Rest, Ice, Compression, Elevation, and Splinting
● Evisceration: the displacement of organs outside the body
● Occlusive Dressing: air and watertight medical dressing