Shock

Ecuador June 2004

Definition
Inadequate organ perfusion and tissue organisation
This may be haemorrhagic or nonhaemorrhagic The first step is to recognise its presence
Ecuador June 2004

Cardiac Physiology
Cardiac output = Rate x Stroke Volume
Stroke volume depends on:
Preload (venous return) Force of contraction of the heart Afterload

Ecuador June 2004

Shock
Recognition Tachycardia* Vasoconstriction* cardiac output Narrow pulse pressure mean arterial pressure blood flow respiratory rate
Ecuador June 2004

Shock
Recognition
Pale Sweaty

Altered level of consciousness

Ecuador June 2004

Ecuador June 2004

Shock
Any patient who is cool and tachycardic

is in shock until proven otherwise Pitfalls

Extremes of age Athletes Pregnancy Medication
Ecuador June 2004

Causes of Shock
Haemorrhagic
Non haemorrhagic
Cardiogenic Septic Neurogenic Anaphylactic

Ecuador June 2004

Haemorrhagic Shock
Haemorrhage is the acute loss of

circulating blood volume Normal blood volume 7% ideal body weight Approximately 5L in a 70kg man Child is 8 9%

Ecuador June 2004

Stages of Shock

Ecuador June 2004

Therapeutic Decisions
Patient response determines subsequent

therapy Haemodynamically normal v haemodynamically stable Recognise the need to resuscitate in a hospital

Ecuador June 2004

ATLS Approach to Shock

2 wide bore cannulae in the antecubital

fossae Resuscitate to normovolaemia

Ecuador June 2004

Rapid Response
<20% blood loss
Responds to fluid replacement Probable surgical opinion and monitor

Ecuador June 2004

Transient Response
20 40% blood loss
Deteriorate after initial fluids Need a surgeon Continue fluids to maintain radial pulse* Operation

Ecuador June 2004

Minimal to No Response
>40% blood loss
No response to fluids Need immediate surgical resuscitation

Ecuador June 2004

Pitfalls
Equating BP with cardiac output
Extremes of age Hypothermia Athletes Pregnancy

Medication
Pacemaker
Ecuador June 2004

Faculty of Pre-Hospital Care Consensus for Pre Hospital Fluids

Early cannulation is desirable but must not

delay transport 2 attempts only Isotonic saline is recommended as the fluid for pre-hospital resuscitation Fluid should not be administered to patients who have a radial pulse prior to haemostasis 250ml doses should be used to maintain the radial pulse
Ecuador June 2004

Keys to Success
Early control of bleeding
Appropriate fluid replacement Continual monitoring

Ecuador June 2004

Summary
Early recognition of shock
Oxygenate and ventilate Stop the bleeding Restore volume to a radial pulse Continually monitor

Anticipate problems

Ecuador June 2004

Questions

Ecuador June 2004