SN-ShockObj

SHOCK OBJECTIVES : 

Illinois EMSC 1 Upon completion of this lecture, you will be better able to: Define shock Describe key differences between the pediatric and adult circulatory system and how they affect assessment and treatment of shock in children Explain how to assess for pediatric shock List appropriate interventions for pediatric shock SHOCK OBJECTIVES

SHOCK : 

Illinois EMSC 2 SHOCK

SHOCK : 

Illinois EMSC 3 SHOCK Insufficient delivery of oxygen and nutrients to the cells due to decreased perfusion or blood flow

CAUSES OF SHOCK : 

Illinois EMSC 4 CAUSES OF SHOCK Hemorrhage Dehydration Burns Heat stroke Hypoglycemia Anaphylaxis

CAUSES OF SHOCK : 

Illinois EMSC 5 CAUSES OF SHOCK Drug ingestion or overdose Sepsis Congenital heart defects Traumatic head or spinal injury

CARDIAC OUTPUT : 

Illinois EMSC 6 CARDIAC OUTPUT Cardiac Output = Heart Rate x Stroke Volume

EARLY SHOCK COMPENSATION : 

Illinois EMSC 7 EARLY SHOCK COMPENSATION SYMPATHETIC NERVOUS SYSTEM Increased heart rate (one of the first responses to shock) VASOCONSTRICTION Maintains perfusion to vital organs INCREASED RESPIRATORY RATE Increased oxygen to vital tissues

LATE SHOCK DECOMPENSATION : 

Illinois EMSC 8 LATE SHOCK DECOMPENSATION Decreased blood pressure (often falls rapidly) Decreased respiratory rate Significant alteration in level of consciousness: Stuporous/Coma

Shock Assessment in Compensated and Decompensated Hypovolemic Shock : 

Illinois EMSC 9 Shock Assessment in Compensated and Decompensated Hypovolemic Shock Compensated Decompensated Pulse Tachycardia Marked tachycardia; can progress to bradycardia Skin White, cool, moist White, “waxy”, cold, marked diaphoresis Blood Pressure Normal range Lowered Level of Consciousness Unaltered Altered, ranging from disoriented to coma Source: Prehospital Trauma Life Support Manual, 3rd Edition. National Assn of EMT’s, 1994

BLOOD PRESSURE BY ITSELF IS NOT A GOOD INDICATOR OF THE PRESENCE OF SHOCK!!!! : 

Illinois EMSC 10 BLOOD PRESSURE BY ITSELF IS NOT A GOOD INDICATOR OF THE PRESENCE OF SHOCK!!!!

DIFFERENCES IN THE PEDIATRIC CIRCULATORY SYSTEM : 

Illinois EMSC 11 DIFFERENCES IN THE PEDIATRIC CIRCULATORY SYSTEM Healthier circulatory system Less muscle mass than adults Higher metabolic rate, increased oxygen demand Greater circulating blood volume per weight Greater ability to compensate

TYPES OF SHOCK : 

Illinois EMSC 12 TYPES OF SHOCK HYPOVOLEMIC Decrease in circulating blood volume DISTRIBUTIVE Massive vasodilatation, causing decreased blood flow to heart CARDIOGENIC Inadequate heart muscle function or obstruction of flow

ASSESSMENT OF THE CHILD IN SHOCK : 

Illinois EMSC 13 ASSESSMENT OF THE CHILD IN SHOCK Across-the-room assessment Skin Perfusion Color Moisture Temperature

CAPILLARY REFILL TIME : 

Illinois EMSC 14 CAPILLARY REFILL TIME Normal equals < 2 seconds Assess on distal extremity and keep limb level with heart

VITAL SIGNS : 

Illinois EMSC 15 VITAL SIGNS Assess TPR and BP *Increase in heart rate is the earliest sign of shock Assess quality of pulses Blood pressure may not fall until 20% of blood volume is lost!! Level of consciousness

AVPU : 

Illinois EMSC 16 AVPU ALERT VERBAL PAIN UNRESPONSIVE

PLAN AND INTERVENTIONS : 

Illinois EMSC 17 PLAN AND INTERVENTIONS Goal is recognition of shock and restoring student’s perfusion to normal ABC’s Keep child warm Call EMS and parent/guardian

TRIAGE AND TRANSPORT : 

Illinois EMSC 18 TRIAGE AND TRANSPORT Student suspected to be in shock is EMERGENT Call EMS as soon as shock is suspected!!

SPECIAL NEEDS STUDENTS : 

Illinois EMSC 19 SPECIAL NEEDS STUDENTS History of previous illness Congenital defects Surgery

PREVENTION : 

Illinois EMSC 20 PREVENTION Prevention of injuries Knowledge of signs and symptoms of shock. Be aware that they may be subtle Knowledge of local EMS system

SUMMARY : 

Illinois EMSC 21 Shock is a life-threatening condition, particularly in children. It is crucial to recognize shock early and initiate appropriate interventions. Students who are experiencing shock may initially look well because of their effective compensatory mechanisms, but their condition can deteriorate rapidly. SUMMARY

ANY QUESTIONS?? : 

Illinois EMSC 22 ANY QUESTIONS??