3. MEDICAL EMERGENCIES
3.11 SHOCK (HYPOPERFUSION) OF UNKNOWN ETIOLOGY
Shock is defined as a condition of inadequate tissue perfusion and oxygenation resulting in abnormal tissue metabolism at the cellular level. Multiple causes of shock exist and include: hypovolemia (hemorrhage, burns, dehydration, anaphylaxis); cardiogenic (myocardial infarction, congestive heart failure, dysrhythmias); obstructive (pericardial tamponade, pulmonary embolism, aortic dissection); distributive (infection, sepsis, poisonings, spinal cord injuries).
The patient with severe decompensated shock will present with hypotension and changes in mental status (agitation, restlessness) eventually leading to confusion and coma.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
2. Administer high concentration oxygen via non-rebreather mask.
3. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
4. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse or Trauma.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
5. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
6. Place patient in supine position with legs elevated unless suspected respiratory compromise.
7. Basic EMT-MASTs contact MEDICAL CONTROL. Medical control may authorize use of a PASG/MAST.
8. Activate ALS intercept, if deemed necessary and if available.
9. Initiate transport as soon as possible with or without ALS.
10. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
5. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
6. Place patient in supine position with legs elevated unless suspected respiratory compromise.
7. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate transport as soon as possible with or without ALS.
c. Initiate IV Normal Saline while in transport. Administer a 250 cc bolus and contact medical control.
8. MEDICAL CONTROL may order:
a. administration of additional fluid
b. application/inflation of PASG/MAST.
9. Activate Paramedic intercept, if deemed necessary and if available.
10. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
2. Administer high concentration of oxygen by non-rebreather mask.
3. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
4. Control/stop any identified life threatening hemorrhage ( direct pressure, pressure points, etc.)
5. Place patient in supine position with legs elevated unless suspected respiratory compromise.
6. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate transport as soon as possible.
c. Initiate IV Normal Saline. Administer 250-500 cc fluid bolus and titrate to systolic BLOOD PRESSURE >90.
d. Cardiac Monitor: manage dysrhythmias per protocol.
7. Attempt to identify the cause of shock and contact MEDICAL CONTROL: The following may be ordered:
a. Repeat fluid bolus(es).
b. Establish a second IV of Normal Saline /Lactated Ringers
c. Vasopressors: unless contraindicated. Infusion rates determined by Medical Control.
- Dopamine infusion 2-20 mg/kg/minute*
- Dobutamine infusion 2-20 mg/kg/minute*
- Norepinephrine infusion 0.5 to 1.0 mg/minute*
d. Application/inflation of PASG/MAST.
8. Notify receiving hospital.
* NOTE: Vasopressor medications are contraindicated for patients in hypovolemic shock. Primary efforts must be directed toward replacing circulatory volume and improving oxygenation.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
This is only a small sample of educational materials and products available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
MoonDragon's Health & Wellness: Manufacturers & Distributors
Mountain Rose Aromatherapy Oils
 
Click Here To Visit Herbal Remedies Product Page |
A Source For Medicinal & Ritual Herbs & Supplies  |
MoonDragon's Nutrition Information Index
MoonDragon's Health & Wellness: Nutrition Basics Index
MoonDragon's Health & Wellness: Therapy Index
MoonDragon's Nutrition Therapy Index
MoonDragon's Alternative Health Information Index
MoonDragon's Aromatherapy Information Index
MoonDragon's Health & Wellness Index
MoonDragon's ObGyn Information Index by Subject Order
MoonDragon's ObGyn Information Index by Alphabetical Order
MoonDragon's Main Indexlisting
MoonDragon's Home Page