Shock

patient may need to be stimulated with medications or evaluated for intubation. The respiratory rate is too high, the critical care physicians should worry about the patients tiring out and progressing to respiratory arrest. A low pulse oximetry, less than 90%, can be the result of damage to the lung tissue, infection, a low respiratory rate, or a combination of factors.

Circulation is then evaluated buy checking a patient’s blood pressure, peripheral pulse, and peripheral capillary refill. A pulse-less patient requires immediate chest compressions. Patients with a low blood pressure or delayed capillary refill may require intravenous fluids or pharmacologic vasopressors. Commonly used vasopressors include intravenous dopamine and intravenous norepinephrine. Vital signs monitored during this phase of evaluation include the pulse and blood pressure. Additionally, a patient’s capillary refill can be evaluated. Elevated blood pressure, or hypertension, can cause damage to the brain, kidneys, and heart. Low blood pressure can cause hypoperfusion of peripheral organs and lead to tissue damage. Similarly, both a fast heart rate and a slow heart rate can be dangerous for a patient and cause organ damage or failure.

Complete the evaluation by evaluating a patient’s disability. The evaluation and treatment of disability includes evaluation for injuries, neurological deficits, and hypothermia (low temperature) or hyperthermia (high temperature). In addition to checking the patient’s temperature, they should be completely undressed to look for wounds, infections, or foreign bodies. A complete neurological exam should be performed. The neurological exam should include an evaluation of the patient’s level of alertness, movement in all extremities, mental status, and pupils.

SHOCK

This section will discuss the concept of shock. Shock is a life-threatening condition whereby circulation is inadequate to ensure blood flow to peripheral organs. All types of shock are characterized by low blood pressure which leads to hypoperfusion. This results in end organ damage and the buildup of waste

products like lactic acid in the bloodstream. Shock requires immediate recognition and rapid treatment, otherwise it can be fatal.

Hypovolemic shock is caused by low body levels of blood or fluid. It can be caused by severe dehydration or blood loss associated with injuries for gastrointestinal bleeding. Treatment of hypovolemic shock depends on fluid resuscitation and the administration of blood products if needed. In patients who are actively bleeding, the source of the bleeding must also be found and dealt with to treat the patient’s underlying condition.

Anaphylactic shock occurs as a result of exposure to allergens including foods, medications, and insect bites or stings. Common signs and symptoms include redness, rash, swelling, and dizziness. Treatment includes removal of exposure to the offending agent and intramuscular epinephrine, also known as adrenaline. Additional treatments include diphenhydramine, intravenous fluids, and steroids. Anaphylactic shock is a medical emergency is can lead to death if not treated rapidly. In the United States alone up to one thousand people die per year from an anaphylactic reaction. Prevention efforts include providing susceptible patients epinephrine auto injectors and proper food labeling to avoid inadvertent exposures.

Cardiogenic shock occurs when the heart is unable to pump blood to peripheral organs. It is commonly associated with weakened cardiac muscles. This often occurs as a result of heart attacks or irregular heart rhythms known as arrhythmias. Treatment for cardiogenic shock includes intravenous fluids to increase the preload, or fuel in the tank, and vasopressor medications to stimulate the heart and contract peripheral blood vessels. Medications can also be provided to reverse arrhythmia when present.

Neurogenic shock occurs as a result of injuries to the spinal cord or brain. It is caused by a disruption in the autonomic nervous system’s regulation of the heart and peripheral blood vessels. This results in a decreased heart rate and dilation of peripheral blood vessels, which together result in low blood pressure and poor perfusion or peripheral organs.