NSP-OEC- Chapter

10 Classroom Shock

NSP-OEC- Chapter 10 Classroom - Shock

Shock
NSP OEC - Training
Oct. 02, 2013

Overview (SET) Shock

Materials

The human body is a remarkable machine composed

of a marvelous and complex web of interacting
systems that produce a relatively consistent internal
environment known as homeostasis. When one or
more of these systems becomes seriously impaired
through injury or illness the results can be lifethreatening. One of the most serious threats to life is
a conditions is shock or hypo perfusion. shock is
defined the failure of the circulatory system to
maintain adequate blood flow to tissues resulting in a
state of inadequate tissue perfusion in which cells do
not receive sufficient amount of oxygen and nutrients
to meet their mediated metabolic needs.

OEC Chapter 7

Although the potential shock causes are numerous,

shock occurs when one or more components of the
cardiovascular system fail.
This failure sets into motion a series of events that
unless corrected because other body systems to fail
and death to ensue.

Concluding Objectives
At the end of this lesson the participants will be able
to:

1. Identify the structure and function of the

cardiovascular system.
2. Define shock.
3. Explain the shock mechanism and the bodys
defense mechanisms.
4. Describe the pathophysiology of hypovolemic,
cardiogenic, and neurogenic shock.
5. Recognize the signs and symptoms of shock.
6. Discuss the proper method of assessing the
patient in shock.
7. Identify abnormal findings during the assessment

NSP-OEC- Chapter 10 Classroom - Shock

Exam gloves,
Teaching tools as described

Other Resources
Attentive listening skills for both
students and instructors. ;-)

of patients in shock.
8. In a given situation, properly treat a patient in
shock.
9. In a given situation, be able to determine where
the patient should be transported.

Content Delivery

5 minutes - Quiz on patient assessment.

20 minutes

Review of the cardiovascular system.

Pathophysiology of shock
Signs and symptoms of shock.

Understand the severity of shock how it

can rapidly affect patient.

20 minutes o Classifications of shock - define types of

shock / nature of causes (Hypervolemic.
Cardiogenic, Distributive- (3 sub types
septic, anaphylactic, neurogenic) and
Obstructive (Tension pneurothorax,
pericardial tamponade, pulmonary
embolism).

20 minutes - Includes 6 minute You tube Video

on Shock (if Available)
o Assessment of patients in shock demonstrate how to recognize the signs ,
symptoms and stages of shock at the
same time manage the ABCD's.

10 minute break.

5 minutes - Review of quiz.

20 minutes demonstration -

NSP-OEC- Chapter 10 Classroom - Shock

o Assessment and field treatment and

transport decisions for shock patients demonstrate how to manage a shock
victim and how to keep patients who are
in trouble from going into shock.

3 x 30 minutes each scenario trauma medical

vital sign station with each instructor to
students per group.

5 minute wrap up.

Learning Activities
Learning activities or output.
Group presentation.
Hands-on practice with scenarios.
Demonstration and practice with gathering of
patients vital signs and shock symptoms.

Materials
Flip chart-whiteboard
Blood pressure cuffs (if available)
Back Board to simulate toboggan
Exam gloves
and Stethoscopes ( Students should be encouraged to
buy their own)
Video projection equipment and computer (If
available)

Student summary
Group discussion and hands-on learning and
demonstrations throughout the session

NSP-OEC- Chapter 10 Classroom - Shock

Monitoring & Evaluation

Consistent monitoring of presentations to ensure the
correct information is presented to the group.

Heart (the pump)

Hollow muscular organ, which functions as a pump to circulate

blood throughout the blood vessels.
Right side of the heart receives unoxygenated blood from the venous
system and pumps it to the lungs where it exchanges oxygen and
waste products.
Left side of the heart receives the oxygen enriched blood and pumps
it to the organs and peripheral tissues via the arterial system.
Stroke Volume (SV): Volume of blood ejected with each ventricular
contraction; normal stroke volume = 60-130 ml
Heart Rate (HR): Number of heart beats per minute
Cardiac Output (CO): Amount of blood pumped by the heart in one
minute; expressed in liters per minute (L/min)

Stroke volume x heart rate = cardiac output

SV x HR = CO

Example: (SV) 70ml x (HR) 75/min = 532 ml/min or 5.3 L/min

NSP-OEC- Chapter 10 Classroom - Shock

Blood vessels (the containers or pipes)

Comprised of a complex network of veins, arteries, and capillaries.

Diameter of the smaller arteries is controlled by the sympathetic
nervous system and determines the peripheral vascular resistance
(PVR).
As the arterial vessels narrow, resistance to blood flow increases;
conversely, the more they dilate the lower the resistance will be.

Blood pressure

Average pressure in the arteries throughout the cardiac cycle.

Depends on the elastic properties of the arterial walls and blood
volume in the arterial system; therefore, it depends on the cardiac
output and the peripheral vascular resistance.
Constantly regulated to maintain tissue perfusion during a wide
range of conditions, i.e., exercise, change in position, change in
blood volume, etc.
BP = CO x PVR

Blood (the fluid)

Delivers oxygen and nutrients to tissues; carries waste products

away from tissues to be eliminated.
Cardiovascular system (a closed system) must contain an adequate
volume of blood to fill its structures as well as supply an adequate
amount of blood cells to assure oxygenation.
Normal circulating blood volume = 4.5 - 5 liters (L) or 70 ml/kg of
body.

PATHOPHYSIOLOGY OF SHOCK
Shock

Inadequate perfusion or inadequate blood flow to body tissues.

Can lead to decreased cellular function and ultimately cell death.

NSP-OEC- Chapter 10 Classroom - Shock

Caused when any component of the cardiovascular system fails.

Compensatory mechanisms
The body attempts to compensate and restore perfusion by:

Increasing cardiac output

Stimulation of the sympathetic nervous system causes an

increase in heart rate, stroke volume, and PVR.
Redistributing the circulating blood volume to vital organs

Vasoconstriction

Release of antidiuretic hormone (ADD) and renin to decrease

urine production.
Increasing oxygen delivery to cells

Stimulation of sympathetic nervous system causes

bronchodilation, increased respirations, and tidal volume.

SIGNS AND SYMPTOMS OF SHOCK

Early Stage (compensated shock): Compensatory mechanisms are able to maintain
perfusion of vital organs
Heart Rate: mild tachycardia; bounding pulse

Level of Consciousness: lethargy, confusion, comb

Skin: delayed capillary refill; cool and clammy
Blood Pressure: normal or slightly elevated
Respirations: rapid and shallow

NSP-OEC- Chapter 10 Classroom - Shock

Middle Stage (uncompensated shock): Compensatory mechanisms are unable to

maintain perfusion
moderate tachycardia; weak and thready pulse
confusion or unconsciousness

ed capillary refill; cold, clammy, and cyanotic

Respirations: rapid and shallow

Late Shock
Heart Rate: bradycardia; severe dysrhythmias

NSP-OEC- Chapter 10 Classroom - Shock

Level of Consciousness:
Skin: pale, cold, marked diaphoresis
Blood Pressure: marked hypotension
Respirations: decreased rate and tidal volume

CLASSIFICATIONS OF SHOCK

Hypovolemic
Cardiogenic
Neurogenic
Anaphylactic
Septic

Hypovolemic Shock

NSP-OEC- Chapter 10 Classroom - Shock

NSP-OEC- Chapter 10 Classroom - Shock

Cardiogenic Shock

NSP-OEC- Chapter 10 Classroom - Shock

Field Management
BLS Procedures
High-flow oxygen
Shock position
Assist with ALS

NSP-OEC- Chapter 10 Classroom - Shock

ALS Procedures
Advanced airway PRN
Monitor
Venous access
Consider fluid challenge (monito
Dopamine PRN
Dysrhythmias; cardioversion or m
Tension pneumothorax; needle th

Neurogenic Shock

Pathophysiology
Vasomotor para
Sympathetic im
vasodilation
Blood collects i

Causes
Severe spinal co
Central nervous

Additional Signs and Symptoms

Skin often flushed and warm, rather than pale; this t

NSP-OEC- Chapter 10 Classroom - Shock

Typically, heart rate does not increase due to loss of

Field Management
BLS Procedure
High-flow oxygen
Spinal immobilization
Consider Trendelenburg position if no head trau
Assist with ALS Procedures

NSP-OEC- Chapter 10 Classroom - Shock

ALS Procedures
Advanced airway PRN (using manual in-line axial i
Monitor
Venous access
Consider fluid challenge (monitor lung sounds)
Dopamine PRN
Consider Atropine for bradycardia with hypotension

Anaphylactic Shock (Severe Allergic Reaction)

NSP-OEC- Chapter 10 Classroom - Shock

Septic Shock

GOL
The greatest chance for surviv
of shock.

NSP-OEC- Chapter 10 Classroom - Shock

INITIAL ASSESSMENT AND FOCUSED HISTORY AND DETAILED

PHYSICAL EXAMINATION OF THE PATIENT IN SHOCK
Initial Assessment
1) Assess Environment: (may need to manipulate the environment)
Safety of rescuers and environment
Environmental Factors
Patient Location (home, street, convalescent, etc.)
Weapons (may indicate trauma mechanism)
NSP-OEC- Chapter 10 Classroom - Shock

Medications (may offer clues to past medical history)

Witnesses (may help to explain circumstances)
Mechanism of Injury
Number of Patients

NSP-OEC- Chapter 10 Classroom - Shock

NSP-OEC- Chapter 10 Classroom - Shock

NSP-OEC- Chapter 10 Classroom - Shock

Focused History and Detailed Physical Examination

1) Elicit
Helps to
Determin
See sectio

2) Elicit
H
m
A
a
M
m
3) Vital

Freque

NSP-OEC- Chapter 10 Classroom - Shock

Considerations for BLS Transport

4) Special Questions:
NSP-OEC- Chapter 10 Classroom - Shock

Ask questions specific to chief complain

NSP-OEC- Chapter 10 Classroom - Shock