General Discussion

Cells make up tissues and tissues make up organs!!!!!

Need 2 things to survive

1. oxygenated blood

2. Glucose

Shock

• A rapid degeneration of the body's vital functions due to an INSUFFICIENT amount of oxygenated blood to the cells, tissues, and organs

• Hypoperfusion!!!

• Biproduct of Hypoperfusion=LACTIC ACID=Metabolic Acidosis

4 main types of shock

Hypovolemic Shock (A FLUID Problem)

• Internal/external bleeding (Hemorrhagic Shock)

• Sweating=Heat related

• Excessive urination

• Burns

• Vomiting

• Diarrhea

• Poor fluid intake

Cardiogenic Shock (A PUMP Problem)

1. Most common cause=Myocardial infarction

2. CHF

3. Dysrhythmias

4. Cardiac arrest

Distributive Shock (A VESSEL Problem)

• The blood vessels become damaged, they leak, and become permeable, MASSIVE VASODILATION

• Septic Shock

• Anaphylactic Shock

• Neurogenic Shock-only type of shock, that the pt. CANNOT COMPENSATE

Obstructive Shock

• Something is obstructing the heart's ability to pump, BUT it is NOT a problem within the heart

• Pulmonary Embolism

• Cardiac tamponade

• Tension PTX

3 main stages of shock

How does the body & brain know to start compensating

• Activation of the Sympathetic NS

• Receptors

• Kidneys will hold onto urine

Sympathetic NS

• Epi=Adrenaline

• Nor-epi

• Dopamine

Baroreceptors (Baro=Pressure)

• Located in the Aorta & carotid arteries

• Detect changes in pressure and then notify the brain

Chemoreceptors (Chemo=Chemicals)

• Located in the aorta, carotids, and the lungs

• Detect changes in chemicals (Co2 & o2) and notify the brain

Compensated Shock

• Tachycardia

• Tachypnea

• The BP will be Normal or slightly elevated

• Pale/Cool due to shunting

• Anxiety/Restlessness

• Delayed CR

• Oliguria (Decreased urine output)

Decompensated Shock

• Tachycardia

• Tachypnea

• Hypotension****

• AMS or ALOC

• temps decrease

• Pale/cool

• Anaerobic metabolism=Lactic Acid

• metabolic acidosis

• Weak pulses

• Narrowed pulse pressure

Irreversible Shock

• Bradycardia

• Bradypnea

• Unresponsive/Coma

• Profound Hypotension (60-70s)

• Hypothermia

• MODS (Multi organ dysfunction syndrome)-2 or more organs have failed!!!

• DEATH!!!!!!!

Triad of Death (3 things that will kill your trauma/Bleeding patient)

Allergic Reaction vs Anaphylaxis vs Anaphylactic Shock

Allergen vs Pathogen

Pathogen (A foreign bug)

• Bacteria

• Virus

• Fungus

Allergen

• Pet hair

• Food

• Dyes

• Smoke

• Meds

3 Blood cells (Bone marrow)

1. RBCs (Erythrocytes)-carry hemoglobin & Oxygen

2. WBCs (Leukocytes)-Immune response, fights pathogens

3. Platelets (Thrombocytes)-Blood clotting

WBCs (Leukocytes)

5 Types of WBCs

Allergic Reaction

• causes the WBCs to produce an inflammatory response due to the release of HISTAMINES

• Urticaria=Hives

• Pruritus'=Itching

• Redness/swelling=Erythema

• Watery eyes

• Mild SOB

• Wheezing

• NO Hypotension

• NO Stridor

Anaphylaxis

• Full blown systemic reaction to the allergen. histamine damages the blood vessels, they start to leak, and there is massive vasodilation

• Urticaria=Hives

• Pruritus'=Itching

• Redness/swelling=Erythema

• Watery eyes

• Severe SOB

• Laryngeal spasms=STRIDOR!!!!!!

• AMS or ALOC

• Distributive shock

Paramedic Treatment

• ABCs & oxygen as needed

• IV

• High flow oxygen

• Epinephrine 0.3 mg 1:1000/1 mg/mL IM

• Albuterol (presence of wheezing)

• Antihistamine=Diphenhydramine (Benadryl)

• Fluid Bolus of NaCl 0.9% (250-500 mL)

Toxidromes

• Poisonings & Overdoses

• Opioid OD

• TCA OD

• Cholinergic toxicity

• Anticholinergic toxicity (Antihistamine)

• Stimulant OD (Sympathomimetic)

• Beta Blocker OD

• Cyanide Poisoning

• Carbon monoxide Poisoning

• Benzo (Sedative) OD

• Dystonic Reaction

• Alcohol Toxicity

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Nervous System (3 branches)

CNS-Central NS

1. Brain

2. Spinal Cord

PNS-Peripheral NS

1. 12 Cranial Nerves

2. 33 Spinal Nerves

ANS-Autonomic NS

1. Sympathetic NS

2. Parasympathetic NS

Sympathetic NS (Fight or Flight)

Neurotransmitters

1. Epi

2. Nor-epi

3. Dopamine

Parasympathetic NS (Rest & Digest)

Neurotransmitter

• Acetylcholine

!!!!!!When we are in a parasympathetic state, we are VERY MOIST!!!!

• Mucus

• Saliva

• urine

• gastric juices

• Feces

• Tears

  
  

Cholinergic=Organophosphate=Nerve agent=Pesticide=Insecticide

• Goes with and activates the Parasympathetic NS

• SLUDGE M

Salivation

Lacrimation (excessive tearing)

Urination

Defecation

GI Upset

Emesis

Miosis (Constricted pupils)

Treatment

1. Atropine

2. 2-pam chloride (pralidoxime)

Duo-dote

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Anticholinergics (Blocking the parasympathetic NS)

• Antihistamines (Benadryl)

• Nausea meds

• Antidepressants

• Blind as a BAT=Mydriasis=Dilated pupils

• Hot as a HARE=Spikes the temp

• Dry as a DESERT

• Mad as a HATTER

Carbon Monoxide Poisoning

• Causes internal asphyxiation & suffocation

• Headache

• Dizziness

• rapid unconsciousness

• It prevents hemoglobin from attaching to the RBCs, preventing them from carrying oxygen

• Spo2 will always read 100% or very high

• Skins=CHERRY RED!!!!!! FLUSHED

• Severe SOB & Dyspnea

• Severe Hypoxia!!!!!

Paramedic Treatment

• Remove from the environment

• HIGH FLOW 100% oxygen

• IV

• Hyperbaric Chamber