Shock

Front 1

Cardiogenic Shock

Back 1

1. Assess ABCs. Patient will often have rales (fluid in the lungs).

2. Patient is often complaining of chest pain.

3. Administer high-flow oxygen via a nonrebreathing mask.

4. Place the patient in a sitting or semi-sitting position to assist breathing.

5. Do not administer nitroglycerin if blood pressure is low; contact medical control.

6. Keep the patient calm, request ALS if available, and transport promptly.

7. Keep alert for the need to assist ventilation, perform cardiopulmonary resuscitation, or defibrillate.

Front 2

Obstructive Shock

Back 2

This type of shock is usually caused by cardiac tamponade or tension pneumothorax. Patient requires management by ALS providers or more complex management at the hospital.

1. Request ALS.

2. In treating cardiac tamponade, weigh the need for positive-pressure ventilations against the possibility of hypoventilation. In treating tension pneumothorax, high-flow oxygen should be applied early to prevent hypoxia.

3. Prompt transport to the closest emergency department is essential.

Front 3

Septic Shock

Back 3

A systemic infection causes the blood vessels to become leaky and dilate, causing "the container" to enlarge. Patient requires complex management in the hospital.

1. Assess and manage life threats to the ABCs.

2. Administer high-flow oxygen.

3. Prevent heat loss.

4. Transport as promptly as possible.

Front 4

Neurogenic Shock

Back 4

This type of shock involves an injury to the central nervous system, causing the patient’s blood vessels to dilate (container gets bigger). Even though the blood pressure drops, there is no blood loss.

1. Suspect neurogenic shock if the MOI is suspicious.

2. Maintain cervical spine stabilization and airway control with a modified jaw-thrust.

3. Provide oxygen and assist breathing as necessary.

4. Provide spinal immobilization.

5. Elevate the foot end of the backboard slightly to help move blood into the vital organs.

6. Prevent body heat loss.

7. Transport promptly to a trauma center.

Front 5

Anaphylactic Shock

Back 5

Severe allergic reactions can rapidly progress to anaphylactic shock. The body’s response to the allergen causes widespread vasodilation.

1. Request ALS.

2. Be prepared to assist the patient with their prescribed epinephrine auto-injector.

3. Oxygenate and ventilate the patient as necessary.

4. Prompt transport to the closest emergency department is essential.

Front 6

Psychogenic Shock

Back 6

A sudden reaction of the nervous system causes a temporary vasodilation, resulting in syncope(fainting). It is important to investigate other possible causes of the syncopal episode. Once supine, the patient regains consciousness.

1. Perform a thorough primary assessment to identify any possible life-threatening causes of the syncope.

2. Administer oxygen, elevate the legs, and prevent heat loss.

3. Perform a secondary assessment to identify any injuries that may have occurred when the patient collapsed.

4. Patient should be transported for evaluation.

Front 7

Hypovolemic Shock

Back 7

This type of shock is caused by a loss of blood or body fluids. It should be suspected first whenever a patient presents with signs and symptoms of shock. Blood loss may be external or internal secondary to a traumatic injury. Body fluids can be lost due to burns, excessive vomiting, or diarrhea.

1. Management of a patient with hypovolemic shock focuses on preventing further blood or fluid loss.

2. Manage threats to the ABCs.

3. Control external bleeding with direct pressure, pressure dressings, and tourniquets. 4. Internal bleeding is difficult to manage. Splinting injured extremities may slow blood loss.

5. Place the patient on a long backboard. The Trendelenburg’s or the shock position may used to assist with perfusion.

6. High-flow oxygen should be administered all hypovolemic patients.

7. Prompt transport to a trauma center is required. Do not delay transport.

Front 8

Respiratory Insufficiency

Back 8

Patients in shock as a result of respiratory insufficiency require immediate airway maintenance and oxygen.

1. Clear obstructions, and suction airway as required.

2. Give supplemental oxygen and assist ventilations if necessary.

3. Transport promptly.