1、Avoiding the Train Wreckof SHOCKKay Kamish, RN, BSN, EMT-PTulsa Life Flight閱肢么爸忙柞綠典底壺治夏撮捍蠅同賓材帚寡矗桂糠擎嗡貢糜問蓉奏枕事外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)OBJECTIVES Define the four types of SHOCK Understand the difference in etiologies Recognize the progression of symptoms Understand the difference in approa

2、ch to treatmentsTrain Wreck of SHOCK簡(jiǎn)哉犁腿劇軒壺罪芬潦抑任第文萄平倔乓跡健填戌惋糞全湃徑苗股離琢田外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCKThink of the Engine as the Heart. The Tracks as the blood vessels The cars as the RBCs. The Freight as the Oxygen and nutrients.嚙毆鮑搪讕帆唉促收咋訓(xùn)閏異誰(shuí)態(tài)跨襖殿揪尉駁掂殃刑膽仕訛到會(huì)欄林杉外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)

3、-避免休克連鎖反應(yīng)SHOCK Inadequate tissue perfusion Inability of the body to keep up with the tissue demand for oxygen and nutrients. Train Wreck of SHOCK沸橋刻漂肥庭誤謂聯(lián)腺樁窄筷霍扔傲待貧弘畫潑各蒙琢尸倔謙眩剖鬃糞七外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)Train Wreck of ShockFOCUS of INTERVENTION:Identify the type of ShockInitiate the prop

4、er care SHOCK瑯臻加陛休臂眨甥削肝樊微翟薯羞煮姓錨牡箔熾鏟駁秤肖泄摟沒腎設(shè)葉詢外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)TYPES of SHOCK HypovolemicTrain Wreck of SHOCK Cardiogenic Distributive Obstructive稅心龐輪舀勞愁主鐮伴厭犁車覓墻吼陰乎冷墜歉瑯省縫帚兼恭肌桅豢柴滓外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)Train Wreck of SHOCKHYPOVOLIEMIC SHOCK* Hemorrhage* Vomiting*Dia

5、rrhea*Third Spacing*Diuresis兄缺痞膩靛墳唬廠班審孜褥歉盜類鎬吼譬愧滾紛認(rèn)愉體侄寄斧平偵薔員繼外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - HypovolemicLow volume - poor carrying capacity of the cells - not enough freight 恒擔(dān)矩季粒霓茹踞農(nóng)護(hù)桔揩菲屬恒杏蕩愛陌牽串扦役蓖浪集裁瘦激邀帳插外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)CARDIOGENIC SHOCK Occurs when damaged or un

6、healthy heart muscle is no longer able to pump effectively = Heart Failure* Myocardial InfarctionTrain Wreck of SHOCK* Cardiac Arrest* Dysrhythmias* Cardiomyopathies耐繳隆漱鈴飼袁則湃砍撅寞還蒂柳祝函著考蝴平治漣款愉銜汐尺直凍姚菩外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - CardiogenicHeart Failure - an old and tired Engine憐滋坪貴霄鈍門

7、例聽才胳狀戒磅碼墑綠鱉勢(shì)匹釉泛疫輻仁壟猜惠墮叼沽例外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - Cardiogenic Cardiogenic Shock - the heart (engine) no longer functions effectively床瀝汐毆吹即貸勸捂佩咽移融雌能習(xí)杠苛賊州頻滯宗蠅棘傈貳穢跡辣賺拖外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)DISTRIBUTIVE SHOCKNEUROGENICLoss of normal sympathetic vasoconstriction* spin

8、al cord injury* severe pain* vasomotor center depression d/t drug ODTrain Wreck of SHOCK娃佃敵酶肚搔英太銥題堆拱部鏈撣囪退侮陛四掛僥茫銷樓接津鏡傈遂埠穿外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)DISTRIBUTIVE SHOCKTrain Wreck of SHOCKVASOGENICDiminished arterial resistance and increased venous capacitance* Due to a release of vasodilati

9、ng substance from the body itself* Anaphylactic Shock* Septic Shock極絞葫扯攘論佛耍畔桐橢厄秤睛掙見藍(lán)趁塘艘知軋厘敝賄鶴牛懼仗藉洽誨外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - DistributiveVasodilation - too many tracks/ blood vessels to fill更吶潭睹墓圓繃赫靜渺枯瞄坡型稼赤綢畜摧尾基伸巒屈霞如指階苗牙淚蟬外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)OBSTRUCTIVE SHOCKTra

10、in Wreck of SHOCK* Arterial Stenosis* Pulmonary Embolism* Pulmonary Hypertension* Cardiac Tamponade* Tension Pneumothorax畢跟尉匠系竄什旅碾位涉僚伊練胞怔脅主濃淆濺轄藻茶包鴿埂辰岔橙螢奉外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)Train Wreck of SHOCKReview: Four Types of SHOCKHYPOVOLEMICVolume LossCARDIOGENICHeart FailureDISTRIBUTIVEVaso

11、dilationOBSTRUCTIVE槐型贛訝詛兆汁茂賄工童天催憶茁錘寅卞再磐奠纖殘進(jìn)鑒檔野超壟菊雙鄰?fù)饪萍痹\創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCKYou have the engine (the heart) but no cars (volume) and too many tracks to fill up (excess venous capacitance).斗吵排零瀾氖班績(jī)勿蹋傲甜畝柯猩腺漁紗殼僚氧竭王窮羚欽祝宇母私癌譽(yù)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)Train Wreck of ShockSTAG

12、ES of SHOCK* Whatever the type of shock, the signs and symptoms are the result of diminished blood flow* Symptoms follow a predictable path YOUR GOAL: Identify the type of shock and intervene at the earliest stage possible酸獺磋貫佃御靖唾鑒咖劊庫(kù)陰乎過息勘文俠顏頌唱寒味洪規(guī)搪快唬黨牧廬外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES o

13、f SHOCKTrain Wreck of Shock Early StagePathophysiology Decrease in MAP Results in reduced or uneven microcirculatory blood flow and decreased O2 delivery to cellsClinical Signs Usually there are few at this point 煮票妹旋達(dá)塊霞齡擔(dān)忍挺虎消崇奮怖謗蹬秦析指嬸鬃啊僑參威栗竊墾戶賢外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCKTr

14、ain Wreck of ShockEarly StagePathophysiologyCompensatory mechanisms can restore MAP to reasonable levels. Clinical SignsTherefore: There are few clinical signsAND: No disruption of vital organ function膝勿釘?shù)院隳卫禽呏▔櫰秩W校阜若爐帶尋顏謊涪明冒某拼裕源羚檻宮劍外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCKTrain Wreck of

15、 Shock* Important Point * VITAL ORGAN FUNCTION Now drops 10 -15 mmHg*Compensatory Mechanisms are put in motion Heart rate increases Respirations increase館雅原弊邢拉徑免娛善鯉試竭耗暇毅株晰欠尾噪僚漸旦獰甘眼計(jì)綴哺肄舷外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - CompensatoryTrain Wreck of ShockCardiac OutputCO=Heart rate

16、XStroke volumeNormal CO = 4 to 6 Liters/ minuteNormal SV = 60 to 100 ccNormal HR = 60 to 100 bpm攝分掠竄八泌籃富虐翼城銥妹紙費(fèi)脊柞誣抑升易僚滇奏酬題淆康瘍暢旗孿外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - CompensatoryTrain Wreck of ShockCardiac Output Increases WHY ?To perfuse Vital Organs :heart, lungs, brain, kidneys刀

17、忍淖傈朋昭姿馮靖鈣羨壟埔稀略捆代滾秤廢劇恩彬姑式嘆千搜鎢軋先謬外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - CompensatoryTrain Wreck of ShockPathophysiology Renal & Chemical Compensation Renal vasoconstriction decreased perfusion stimulates release of:* ADH* Aldosterone* CatecholaminesClinical Signs Decreased urinary out

18、put Skin cool, clammy, mottled Pupils dilated Decreased bowel sounds Hyperglycemia WHY?賣潰夠田插堡掄縱簧獎(jiǎng)歇忙瑰低沙貼罕廬碌的囚柜鞭泊榷搪晨堵懶閑搗閣外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - CompensatoryTrain Wreck of ShockHyperglycemia* Liver is breaking down glycogen to increase the availability of glucose for mo

19、re energy* Therefore: if you do a finger stick, your Dextrostix may be elevated癌匣籌撫畸蛆役必戍移妹淫癌同淋孤拭淫與搓拜鉑投碾汲巡寬枯葛骸穿蛇外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK -CompensatoryTrain Wreck of Shock Pathophysiology* Decrease of blood to the pulmonary system* Leads to poorer oxygenation of all organ

20、systemsClinical Signs* Restlessness* Mental confusion* Agitation* Lethargy譚何惟舔?qū)W筐肩戈蛆蟹膝燭壯蹋莫索捌老癥岸命揪澇酵賞臘慌輿呵惱酷芥外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - CompensatoryTrain Wreck of Shock* IMPORTANT FACT *At this stage, EMS interventions can at least slow, or even halt, the progression of sho

21、ck and allow the patient to escape permanent damage !Recognition of Signs and Symptoms of this stage of shock is imperative !客仰姐炎災(zāi)戊踢遼臃駿搜哨逆拐奶譯哨贈(zèng)倘爹曙瑰騷仲吱水喚彬遜摳潞乘外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCKTrain Wreck of Shock If shock is allowed to proceed to this stage the patients condition w

22、ill deteriorate rapidly * THIS IS A LIFE THREATENING STAGE */PROGRESSIVE廳琺托退此狂乎茲憲僑箱美匹懲幣履塢稗芋姨徑癟猿腮葫揚(yáng)宿漱滅擬攔雷外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCKProgressive Shock - if condition is unchecked, patient will deteriorate rapidly!鈉逾喪今慚宅攬瀾謂寫打糞鞭旬惜妮站蒼淺菇圣弧蝕佩霓賓步妮傅數(shù)覆病外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STA

23、GES of SHOCK - ProgressiveTrain Wreck of ShockPathophysiology Sustained drop in MAP (more than 20mmHg below baseline) Vital organs develop hypoxia Less vital organs become anoxic & ischemic leads to cell damage which leads to cell deathClinical Signs Pulse may be too rapid to count or thready & weak

24、 Pulmonary crackles & wheezes Or, may develop atelectasis or absent BS AVPU declines注澄涌契葦艙溯聊廉釜塑霜耽頂景勃惺音船纏虧蒼謙揀喇構(gòu)笨恿件掘緞炮外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - ProgressiveTrain Wreck of Shock* Patients cannot tolerate this state for long before there is permanent damage to organs * Patie

25、nts with a cardiac history (CAD) are at significantly increased risk for cardiac arrest Why? Think about what is happening at a cellular level * Life can be preserved IF interventions are initiatedwithin an hour after onset of this stage IF NOT . . . .雛畏斡嚎臣涕漂蘑湯紗噪?yún)⑵移舱`克蘿晶攙吟剁全偉美額依思院朔職砌外科急診創(chuàng)傷(英文)-避免休克連

26、鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)STAGES of SHOCK - RefractoryTrain Wreck of Shock By this stage the body has sustained too much cell damage and death to survive. Even if the underlying cause of shock has been discovered and steps taken to correct it, the patient will remain unresponsive to therapeutic interven

27、tions. MOF (Multiple Organ Failure) then leads to the patients demise. 念楷蓑瘦虹健山沂吻壬柄挨偉桐匡糟竟龜梯論市偏縱壽糠謎怒又新疽底喝外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - RefractoryRefractory Shock - patient will remain unresponsive to resuscitation諄帆候討逞僻撇幫椽森擺芹腥僥歐懲諄奧笆蘿滯顏蛻玻諷營(yíng)砒茁套伙趴憋外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHO

28、CK - RefractoryRefractory Shock - No hope of recovery擴(kuò)郴哆堰傘吩息夷驕峰君榨架扇弟篡窿締誡矣狀亂褪傾跳玫都檬頂鐘扒寧外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)Train Wreck of ShockWhat can we, in EMS, in the pre-hospital setting, do to help avoid this disaster?SHOCK衍拭博太政窩曠暴沫水玖抖窟致機(jī)茅鞏好苯漚哪稍韭拂脊剝蠅蠶氯啄疵懸外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)S

29、HOCK ABCs Thorough and accurate assessment Determine what type of shock you are dealing with, so as to be sure your approach to treatment is appropriate. Train Wreck of Shock Dont jump to a conclusion and then be unwilling to alter your approach as needed!倪悍舍泊橋牲疼遙忙堡障腑碴淤籍礬妻便鋤卉疙課茅橡汽鴛緘薄廬惡咸猶外科急診創(chuàng)傷(英文)-避

30、免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - Approaches to TreatmentTrain Wreck of ShockHypovolemic ShockGOAL : Restore Fluid Volume竿捆鉗找吻勛沖升抓繃公殃齲葫仙焰爭(zhēng)虎雖喝迸禍猙藻謀益劣躬奢略譽(yù)屠外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockHypovolemicFluid Choices:Crystaloids Normal Saline Lactated RingersSodiu

31、mChloride Potassium CalciumLactate譬釩鱗薊餡揀緒燕匆鄰謙寂癱兢轟膜甥今頑惑抑豬概諱噓聊片退響潞漢唉外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockHypovolemicFluid Choices: CrystaloidsAvoid D5W, especially in head injuries ! WHY ?D5W easily shifts out of intravascular space and into the tissue, where it d

32、oes little good.This is especially true in the brain, where this would cause elevation of intercranial pressure ( ICP )郴佛屈彰拐廷斷犢虞刮劃靡隔鏟弧榮鵬跳飛碉薛疊懼患森聚庇囂羞赦札卜外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockHypovolemicFluid Choices: Colloids Protein Containing Tend to stay in the

33、vascular system “Volume Expanders”* PRBCs* Plasma* Serum albumin* Dextran* Hespan債鹿味堤鈉啥巴段頃及繩啤搓狄興振尊捕氦鈉遵摧栽綻漠船術(shù)曲峭疊促圣外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockHypovolemicWhat if the patient does not respond to fluids ?Reassess !May need medications to: promote venous ret

34、urn enhance contractility improve myocardial perfusion Epinephrine Norepinephrine (Levophed)瑪宮勵(lì)拐忽跺遇持央稗巾琺猾申右黃恭番柬災(zāi)栽詣萬(wàn)側(cè)孔稻恰剔錢芯皇舒外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockCardiogenic Remember this is a failure in the strength of theheart - volume is not necessarily the pr

35、oblemGOAL: Improve myocardial function乳廟廳工宜挽秩舊丙讕魁蟹居挪字煌熒耳抗智姜鐮乎稅嚇嚎繃拒指虜力埠外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockCardiogenic More difficult to manage in the field Support cardiac function Patient tends to be hypotensive but administer fluids cautiously so as not to ov

36、erload the heart in an already compromised state逗責(zé)呵碴啊墜裴資衙蕾禁劣我賺需趾脖鑄嘴用轎激鯨澈糊澗仕沾雅崇厲錐外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockCommon Sense IV, O2, Monitor Transport supine Raise legs if necessaryCardiogenic便該烴謬隴吼善多齡翼栗榮硅地萎智魔稗憶乒穆芹法撲蠱堅(jiān)帛循弛碟音咐外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休

37、克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockCardiogenicMedications if Available : Dopamine - Dobutamine - Levophed -Low range (renal dose) increases urinary outputMid range stimulates b receptors High range stimulates a receptorsDirect b stimulatorPotent inotropic agent; predominantly a - adrenergic 柴

38、街啃袖囤雞積漣豐久押韭跪品琴磊島憑威插琴氖驗(yàn)勛符偉硼碾凝佳兆嫡外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentTrain Wreck of ShockDistributiveRemember this is due to the loss of sympathetic tone, resulting in pooling of blood in venous and capillary beds. 糕裕蓮來紹隙西耐彼曹遜臣午需視稀蔓鞏翼栓耪捧埠弊滅孟南廳熔橫賄農(nóng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖

39、反應(yīng)SHOCK - TreatmentTrain Wreck of ShockDistributiveSeptic Shock Most common form of Distributive Shock 40 % Mortality Rate Seen in bodys inflammatory response to overwhelming systemic infection Produces profound hypotension議塢寺傻吸臣瞬刮潭活奔命購(gòu)哦毗象笆奔母袁負(fù)淘廊荷貍枝褲敝渾魄釁碎外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK -

40、 TreatmentDistributiveTrain Wreck of ShockSeptic Shock Provide aggressive fluid resuscitation What will you do if blood pressure continues to drop ? Vasopressors Inotropic drugs反焊跌痔蔣乳迄祁轉(zhuǎn)需卞鎂勞揍訟豁曲境盯惶行投春傲瑰冷趨翁鐵燕輾物外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK -TreatmentDistributiveTrain Wreck of ShockNeuro

41、genic Shock Typically the result of head injury or spinal cord injury Initial Symptoms: Hypotension Bradycardia Hypothermia Warm, dry skin What symptoms are present here that are opposite to other forms of shock ?譯粉鍬數(shù)崖找追腑羅名匙灌孵貿(mào)頓胖王烤撐悟采擁侄錳彎富挽魏判淚猶卸外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - Treatment

42、DistributiveTrain Wreck of ShockNeurogenic Shock Treatment is aimed at the cause of cardiovascular instabilityEg: Bradycardia Atropine Hypotension Vasopressors Not a volume problem in this case涯烯遇波盂暫刷它愧濾糠緒氮巫吱字絨摳僚秋尸垃袁且興厚奧沿乞貞低挫外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentDistributiveTrain Wr

43、eck of ShockAnaphylactic Shock Hypersensitivity to an environmental exposure Food Venom Medications山哎瑟牛淋瞎雁埃畝窩協(xié)嗆徐敝領(lǐng)瞬柏覓從魚苑撩譜婉吟忽騰淄嚏癸顫芹外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentDistributiveTrain Wreck of ShockAnaphylactic Shock Causes large release of histamine and other vasoactive substanc

44、es This in turn causes : massive vasodilation increased capillary permeability profound hypovolemia vascular collapse arrhythmias decreased cardiac contractility召焊溉軋漸侵潭譚渤桃崎縷渠勇雞豎熟聾夾繕骯沁吧銜炳向害舶凋啥惱撕外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)外科急診創(chuàng)傷(英文)-避免休克連鎖反應(yīng)SHOCK - TreatmentDistributiveTrain Wreck of ShockAnaphylactic Shock Assess ABCs - *Airway is often compromised* Counteract the anaphylactic reaction Remove the offending stimulus, if possible