Shock (Hypoperfusion) "Inability of the body (heart, blood vessels, and blood) to adequately circulate blood to the body's cells to supply them with oxygen and other nutrients. (617)"
Hypovolemic (Hemorraghic) Shock - Blood volume is inadequate for perfusion. This can be due to internal bleeding (fracture), external bleeding (laceration), burns and crush injuries (loss of plasma), or a combination (632).
Signs and Symptoms
see "Stages of Shock
Treatment - ABCs. AB = High concentration oxygen via BVM or NRB. C = Bleed control. Keep warm. Immediate Transport - Trendelenburg (unless otherwise indicated; i.e. suspected aneurysm)
Cardiogenic Shock - The pumping of the heart is inadequate to circulate blood (perfusion). This may have several causes: 1. the heart's contractions may be decreased 2. the heart is beating too slow, too fast, or irregularly due to its electrical system malfunctioning or 3. congestive heart failure. Patients suffering a myocardial infarction may suffer from cardiogenic shock.
Signs and Symptoms
Congestive heart failure: pedal edema, abdominal distention, pulmonary edema, dyspnea, jugular vein distention, etc. (403)
Myocardial infarction: Intense crushing chest pain which radiates to neck and left shoulder, pain in Right Upper Quadrant, dyspnea, diaphoresis,
see "Stages of Shock"
Treatment- A&Ox4: AB-Hi-con O2 and Tx. Unconscious: A - OPA B - NRB or BVM C - Trendelenburg, keep warm and Tx. Pulseless and Apneic: CPR and AED protocol. Hx of Angina or MI: see Protocol for Administration of Nitroglycerine (398)
Neurogenic Shock - Shock due to sudden, uncontrolled dilation of blood vessels due to nerve paralysis.
Signs and Symptoms
Venous pooling, priapism,
Treatment - AB - NRB or BVM. C-Trendelenburg Position.
Causes of Shock in Pediatrics (835-836)
- Diarrhea and/or vomiting with the resulting dehydration
- Infection
- Trauma (especially abdominal injuries)
- Blood loss
- Allergic reactions
- Poisoning
- Cardiac events (rare)
