Understand the definition and major types of shock,

Recognize signs and symptoms of shock,

Recognize types of external bleeding (arterial,
venous, capillary),
Recognize signs and symptoms of internal bleeding,
Initiate treatment of shock by appropriately
positioning the patient and by stopping hemorrhage
when possible,
Treat external hemorrhage appropriately by direct
pressure, elevation, pressure points, and/or
tourniquet, and
Apply a dressing and bandage.

2
Shock is inadequate
tissue perfusion with
oxygenated blood

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Not enough blood volume
Pump failure
Abnormalities of peripheral circulation (when
all small blood vessels dilate)
Mechanical blockage of outflow from the heart

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Most common type of shock
Insufficient circulating volume
Primary cause = loss of blood or body fluids from an
internal or external source
Hemorrhage, severe burns, severe dehydration

Scalp laceration 3rd degree/full thickness burn

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Failure of the heart to pump effectively
1. Due to damage to the heart muscle
2. Large myocardial infarction
3. Arrhythmias (too fast or too slow)
4. Cardiomyopathy
5. Congestive heart failure (CHF)
6. Cardiac valve problems

6
Mechanical block to hearts outflow
Pulmonary embolus
Cardiac tamponade
Tension pneumothorax

Pulmonary embolus Cardiac tamponade

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Similar to hypovolemic shock - insufficient
intravascular volume of blood or relative"
hypovolemia
result of dilation of all blood vessels so the
tank is much larger

Urticaria/anaphylaxis Meningococcic sepsis 8

Septic shock
Overwhelming infection leading to profound
systemic vasodilation
Anaphylactic shock
Severe reaction to an allergen, antigen, drug or
foreign protein, releasing histamine causing
widespread vasodilation, hypotension and
increased capillary permeability
Neurogenic shock
Rarest form of shock.
Trauma to spinal cord resulting in loss of
autonomic and motor reflexes below injury
level. Vessel walls relax uncontrolled,
decreasing peripheral vascular resistance,
result = vasodilation and hypotension
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 If shock is inadequate tissue
perfusion with oxygenated blood,
then . . .

. . . look at the tissues!

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Cardiovascular Global signs and
symptoms:
Respiratory Anxiety, restlessness, altered
mental state
Hypotension
Skin Rapid, weak, thready pulse
Cool, clammy skin
Capillary refill > 3 seconds
CNS Rapid and deep respirations
Hypothermia
Fatigue
Renal Cold and mottled skin
Thirst and dry mouth
Vasoconstriction
Low urine output
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Compensated - early
Initial stage, body progressively compensated for
blood loss
pulse, vasoconstriction
Weak pulse, cool clammy skin, anxiety, thirst, weak
Decompensated late
Bodys compensatory mechanisms no longer
maintain system
Loss of radial pulse, BP, loss of consciousness,
respirations

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All bleeding stops eventually

Rapid, simple interventions are highly

advantageous to the patient

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Internal
Blunt force trauma
Contusions, lacerations, shear, fractures
Penetrating trauma
Punctures

External
General trauma
Contusions, abrasions, lacerations, incisions,
avulsions, amputation

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 Arterial bleeding
Usually bright red in color, rich in oxygen
Often profuse and spurting
Often hard to control - continuous direct pressure required

Venous bleeding
Usually dark red/maroon in color, does not contain much
oxygen
Usually easy to control because veins are under low
pressure
Venous bleeding in neck can draw in air and cause further
complications

Capillary bleeding
Usually slow, oozing, small size and low pressure
Generally minor and easy to control
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STOP the bleeding
Supportive care measures
Positioning of victim
Ensuring A-B-Cs
Maintenance of body temp
Definitive management

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17
 Apply direct pressure:
with gloved hand,
sterile dressing(s).

No Bleeding stopped? Yes

Elevate extremity:
above victims heart,
continue direct pressure
No Bleeding stopped?

Locate pressure point,

apply pressure:
maintain direct pressure
over wound
No Bleeding stopped?

Bleeding from Treat for shock:

extremity? Yes
care for wound,
seek definitive care
Apply tourniquet
No (last resort)

Definitive therapy
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Apply pressure directly to Apply direct pressure:
with gloved hand,
sterile dressing(s).

wound site: No Bleeding stopped? Yes

Gloved hand, dressing Elevate extremity:

above victims heart,

If dressing soaks thru, add continue direct pressure

No Bleeding stopped?

more gauze on top and press Locate pressure point,

harder
apply pressure:
maintain direct pressure
over wound

No Bleeding stopped?

Bleeding from Treat for shock:

extremity?
Yes
care for wound,
seek definitive care
Apply tourniquet
No (last resort)

Definitive therapy

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If possible, raise wound Apply direct pressure:
with gloved hand,
sterile dressing(s).

site above level of victims No Bleeding stopped? Yes

heart Elevate extremity:

above victims heart,
continue direct pressure

No Bleeding stopped?

Locate pressure point,

apply pressure:
maintain direct pressure
over wound

No Bleeding stopped?

Bleeding from Treat for shock:

extremity?
Yes
care for wound,
seek definitive care
Apply tourniquet
No (last resort)

Definitive therapy

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Find proximal pressure
point and press on it Apply direct pressure:
with gloved hand,
sterile dressing(s).

(radial, ulnar, brachial, axillary, No Bleeding stopped? Yes

femoral arteriesnot carotid) Elevate extremity:

above victims heart,

Apply direct pressure to continue direct pressure

No Bleeding stopped?

site Locate pressure point,

apply pressure:
maintain direct pressure
over wound

No Bleeding stopped?

Bleeding from Treat for shock:

extremity?
Yes
care for wound,
seek definitive care
Apply tourniquet
No (last resort)

Definitive therapy

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Apply band above injury
site, tighten to stop
Apply direct pressure:
with gloved hand,
sterile dressing(s).

bleeding: No Bleeding stopped? Yes

Last resortrisky Elevate extremity:

above victims heart,
continue direct pressure

Note time of application No Bleeding stopped?

Reassess frequently Locate pressure point,

apply pressure:
maintain direct pressure
over wound

No Bleeding stopped?

Bleeding from Treat for shock:

extremity?
Yes
care for wound,
seek definitive care
Apply tourniquet
No (last resort)

Definitive therapy

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Goal: improve perfusion of brain and heart
Position patient: Have patient lie down and
elevate legs (moves blood into chest and
head)
Keep warm if blanket available
Give nothing by mouth if any possibility of
internal injuries (may need emergency
surgery)

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Administer supplemental oxygen
Obtain vascular access
Administer fluid/blood to fill up the tank
Wound closure/management
Immobilization
Special situations
Release cardiac tamponade
Tension pneumothorax
Find hidden sources of bleeding

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BP 90, P < 120
O2 saturation > 92%
Warm, moist skin, < 2 sec capillary refill
Consciousness, no agitation
Urine output 0.5 cc/kg/hr

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Shock = inadequate tissue perfusion

Find shock by looking at tissue perfusion

Categories of shock
Hypovolemic
Obstructive
Distributive
Cardiogenic

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Most common source of shock = hemorrhage

Management of hemorrhagic shock

Stop the bleeding
Vascular access
Volume
Reassess

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Chance favors the prepared mind.
Louis Pasteur
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