SHOCK (صدمة)

OBJECTIVES

By the end of this lecture, the students would be able to:

Define shock. Identify types of shock.Determine stages of shock. Identify general signs and symptoms of

shock. Identify care management for the types of

shock.

INTRODUCTION

Shock is a state of inadequate delivery of blood (oxygen) and glucose (nutrients) to the cells.

Shock is fatal (قاتل) if left untreated ( غير .(معالج

In other words, Shock is a life-threatening condition that occurs when the body is not getting enough blood flow as a result of severe hypotension.

 

Shock requires IMMEDIATE (فوري) medical treatment. If not properly managed the tissue damage

becomes irreversible ( السابق لوضعه يرجع (الand finally leads to multi-organ failure

( أعضاء عدة في .(فشلThe body cells most sensitive to lack of

oxygen are in the heart, brain, and lungs.

BASIC CAUSES OF SHOCK

Heart attack or heart failure to pump blood effectively.

Severe or sudden blood loss. Large drop in body fluids [often from burns or

dehydration (جفاف)]. Blood vessels dilate, causing blood to pool in

extremities (األطراف) and non-vital areas Major infections. Long exposure to extreme heat or cold.

TYPES OF SHOCK

Hemorrhagic (Hypovolemic) Shock

Non-Hemorrhagic Shock1. Cardiogenic Shock2. Septic/Toxic Shock3. Neurogenic Shock4. Anaphylactic/Vasogenic Shock5. Psychogenic Shock6. Metabolic Shock

STAGES OF SHOCK

A progressive process that can be either gradual (تدريجي) or rapid (سريع).

Throughout (خالل) the progression ( األمر (تعاقبof shock, the victim’s condition constantly changes1. Compensated Shock ضةkعوlم The body :صدمة

works to overcome developing hypotension and hypoperfusion ( الدم توزيع  .(قلة

2. Uncompensated Shock: Defense mechanisms are unable to compensate for the systemic decline ( الجسم بأجهزة شامل وضعف caused (ترّدkيby poor circulation.

3. Irreversible ( ّدائمة – معكوسة The body is :(غيرunable to overcome the effects of anaerobic metabolism ( هوائي غير The death of vital .(أيضorgans occur.

CYCLE OF TRAUMATIC SHOCK

SHOCK’S GENERAL SIGNS AND SYMPTOMS

HEMORRHAGIC (HYPOVOLEMIC) SHOCK

A sudden decrease in the volume of blood, resulting in decreased blood return.

Most common cause is hemorrhage (نزيف) due to: (1) stab wounds , طعنات عن ناتجة جروح

(2) gunshot wounds, and (3) motor vehicle accidents.

Other causes for hypovolemic shock are: (1) dehydration (caused by: excessive vomiting and diarrhea), and (2) burns.

 

Without sufficient blood or fluid replacement, hypovolemic shock syndrome may lead to irreversible cerebral and renal damage ( وكلوي ّدماغي في ) cardiac arrest ,(ضرر توقف

القلب ) and, ultimately (عضلة المطاف نهاية ,(فيdeath.

NON-HEMORRHAGIC SHOCKS

1. Cardiogenic Shock المنشأ قلبية صدمة2. Septic Shock ) تسممية ) إنتانية صدمة3. Neurogenic Shock ( بالجهاز المنشأ عصبية صدمة

العصبي(4. Anaphylactic Shock تحسسية Vasogenic/ صدمة

Shock وعائية صدمة5. Psychogenic Shock المنشأ نفسية صدمة6. Metabolic Shock أيضية صدمة

1. CARDIOGENIC SHOCK

It is a shock due to a decrease in contractions/contractile ability of the myocardium ( القلب .(عضلة

The most common cause is myocardial infarction ( موتها ) القلب عضلة with greater احتشاءthan 40 percent muscle necrosis (موت), in which the heart fails to circulate blood efficiently.

Reduction in cardiac output results in: (1) decreased circulating blood supply, and (2) decreased oxygen delivery.

2. NEUROGENIC SHOCK

It is a shock that results due to the failure of nervous system to control the diameter of blood vessels leading to decreased arterial resistance and peripheral vasodilatation.

  Common causes are: (1) nerve paralysis

(spinal cord or brain injuries), (2) severe blows شديدة to the abdomen, (3) hot ضرباتbath or hot vapor bath, (4) certain drugs, and (5) hypoglycemia causing vasomotor center depression ( الحركي المركز عمل .(ترّدي

3. ANAPHYLACTIC/VASOGENIC SHOCK

It is a shock that results from an extreme and generalized allergic antigen-antibody reaction ( مستضد ضد that may bring on (تفاعلvascular collapse ( المنشأ وعائي عمل .(انهيارWithin 30 minutes, these changes usually

occur: (1) diffuse متفشي vasodilation (2) increase size of vascular bed ( التقاء منطقة

يدات والوlر� ينات ر� l3) ,(الش( the blood is trapped )in small vessels and viscera and (4) ,(أحشاء

temporary loss in total circulatory volume.

The allergic antigen-antibody reaction causes widespread histamine release, which results in swelling of the lips and tongue, bronchioles constriction ( هوائية قصيبات (تضيق(causing wheezing, stridor), decreased cardiac output and hypoxia, flushing, and pruritus (حكة).

Common causes are: (1) exposure to sensitive drugs or other substances (serum, vaccines enzymes, hormones, penicillin and other antibiotics, local anesthestetics, salicylates), (2) exposure to diagnostic chemicals (radiographic contrast dye), (3) sensitivity to certain food (legumes, nuts, berries, seafood, eggs), and (4) exposure to insect venom سم (honeybees, mosquitoes, certain spiders).

4. PSYCHOGENIC SHOCK

It is a shock that results from a sudden dilation of the blood vessels takes place in response to an emotional or traumatic situation causing the patient to faint ( يصاب.(باإلغماء

  Stimulation of the vagus nerve ( الحائر (العصب

causes the heart to slow down (bradycardia).

When the bradycardia is severe enough, insufficient blood flow to the brain results and the patient loses consciousness (faints).

Several conditions may cause psychogenic shock including: (1) severely scared situations, (2) severe exhaustion ( شديد ,(إعياءand (3) hearing bad news (e.g.: death of someone, failure in an exam).

5. SEPTIC OR TOXIC SHOCK

It is a condition that shows vascular dilatation due to a major infection. The biochemical mediators (such as the inflammatory mediators cytokines) cause a damage to the blood vessels walls, which lose their ability to constrict.

Diseases and conditions that predispose a patient to septic shock include: (1) liver disease, and (2) immune suppression (AIDS, drug therapy for cancer).

6. METABOLIC SHOCK

This shock occurs due to a change in blood chemistry.

The change in the chemistry might be due to: (1) salt and acid-base balance, (2) failure of the adrenaline ( – للغدة هرمون األّدرينالين هرمون) thyroid glands ,(الكظرية ّدرقية and (غدّدpituitary glands ( نخامية and (3) ,(غدّدdiabetes mellitus ( السكري .(ّداء

MANAGEMENT OF SHOCK

Check Responsiveness. Activate the EMS system immediately. Check the person's circulation, airway, and

breathing. If necessary, begin cardiopulmonary

resuscitation (CPR) to prevent irreversible organ damage and death.

Note: Even if the person is able to breathe on his or her own, continue to check rate of breathing at least every 5 minutes until help arrives.

Place the victim in a comfortable position. If the victim DOES NOT have an injury to

the head, neck, or spine فقري ,عموّدelevate the victim legs 30 cm (Trendelenburg’s position), with the head turned to one side. DO NOT elevate the head.

Careful! Do NOT reposition the victim if there is a

possibility of spinal or neck injuries. In Cardiogenic Shock: Place the victim

flat. In case the victim complains of

difficulty breathing, place the victim in semi-Fowler’s position.

Give appropriate first aid for any wounds, injuries, or illnesses.

Keep the victim warm (but not hot). Prevent hypothermia. Minimize effect of shock.

Loosen tight clothing. Provide oxygen therapy, if available.

TREATMENT HINTS

Fluid therapy and drug therapy should be provided as soon as possible by trained health professionals.

In Anaphylactic/Vasogenic Shock: More attention should be paid to:

Securing the airway. Assessing for dyspnea ( تنفس ,(ضيق

respiratory difficulty, cyanosis, wheezing ( التنفس خالل -can be life) (الصفيرthreatening).

Observing for vertigo (ّدوار), decreased blood pressure, and increased pulse.

Terminating the exposure to causative agent.

First-line therapies, during acute stage: (1) epinephrine, (2) IV fluids, and (3) oxygen.

Second-line therapies include: (1) antihistamines, and (2) corticosteroids.

POSITIONING VICTIMS ONA LONG BACKBOARD

Three or more rescuers needed.1. Position long backboard beside the victim.2. One rescuer maintains head in line while

other rescuers take position.3. On cue from rescuer at the victim’s head,

other rescuers roll the victim toward them as a unit.

4. Slide backboard next to the victim.5. On cue ( اإلشارة ,from rescuer at head (عند

other rescuers roll the victim as a unit. 6. The victim is secured to backboard using

straps ( ربط وأحزمة (روابط