Bleeding-and-Shock出血与休克课件.ppt

1、1SHOCKInadequate perfusion (blood flow)leading to inadequate oxygen delivery to tissues2PhysiologylBasic unit of life=celllCells get energy needed to stay alive by reacting oxygen with fuel(usually glucose)lNo oxygen,no energylNo energy,no life3Cardiovascular SystemlTransports oxygen,fuel to cellslR

2、emoves carbon dioxide,waste products for elimination from bodyCardiovascular system must be able to maintain sufficient flow through capillary beds to meet cells oxygen and fuel needs4Flow=PerfusionAdequate Flow=Adequate PerfusionInadequate Flow=Inadequate Perfusion(Hypoperfusion)Hypoperfusion=Shock

3、5What is needed to maintain perfusion?lPumplPipeslFluid HeartBlood VesselsBlood6How can perfusion fail?lPump FailurelPipe FailurelLoss of Volume7Types of Shock and Their Causes8 Cardiogenic ShocklPump failurelHearts output depends on How often it beats(heart rate)How hard it beats(contractility)lRat

4、e or contractility problems cause pump failure9 Cardiogenic ShocklCauses Acute myocardial infarction Very low heart rates(bradycardias)Very high heart rates(tachycardias)Why would a high heart rate caused decreased output?Hint:Think about when the heart fills.10Neurogenic ShocklLoss of peripheral re

5、sistancelSpinal cord injuredlVessels below injury dilateWhat happens to the pressure in a closed system if you increase its size?11Hypovolemic ShocklLoss of volumelCauses Blood loss:trauma Plasma loss:burns Water loss:Vomiting,diarrhea,sweating,increased urine,increased respiratory lossIf a system t

6、hat is supposed to be closed leaks,what happens to the pressure in it?12Psychogenic ShocklSimple fainting(syncope)lCaused by stress,pain,frightlHeart rate slows,vessels dilatelBrain becomes hypo-per fusedlLoss of consciousness occursWhat two problems combine to produce hypoperfusion in psychogenic s

7、hock?13Septic ShocklResults from bodys response to bacteria in bloodstreamlVessels dilate,become“leaky”What two problems combine to produce hypoperfusion in septic shock?14Anaphylactic ShocklResults from severe allergic reactionlBody responds to allergen by releasing histaminelHistamine causes vesse

8、ls to dilate and become“leaky”What two problems combine to produce hypoperfusion in anaphylaxis?15Shock:Signs and SymptomslRestlessness,anxietylDecreasing level of consciousnesslDull eyeslRapid,shallow respirationsWhy are these signs and symptoms present?Hint:Think hypoperfusionlNausea,vomitinglThir

9、stlDiminished urine output16Shock:Signs and SymptomslHypovolemia will cause Weak,rapid pulse Pale,cool,clammy skinlCardiogenic shock may cause:Weak,rapid pulse or weak,slow pulse Pale,cool,clammy skinlNeurogenic shock will cause:Weak,slow pulse Dry,flushed skinlSepsis and anaphylaxis will cause:Weak

10、,rapid pulse Dry,flushed skinCan you explain the differences in the signs and symptoms?17 Shock:Signs and SymptomslPatients with anaphylaxis will:Develop hives(urticaria)Itch Develop wheezing and difficulty breathing(bronchospasm)What chemical released from the body during an allergic reaction accou

11、nts for these effects?18Shock:Signs and SymptomsShock is NOT the same thing as a low blood pressure!A falling blood pressure is a LATE sign of shock!19TreatmentlSecure,maintain airwaylApply high concentration oxygenlAssist ventilations as neededlKeep patient supinelControl obvious bleedinglPrevent l

12、oss of body heat20TreatmentlElevate lower extremities 8 to 12 inches in hypovolemic shocklDo NOT elevate the lower extremities in cardiogenic shockWhy the difference in management?21TreatmentlAdminister nothing by mouth,even if the patient complains of thirst22Bleeding SignificancelIf uncontrolled,c

13、an cause shock and death23Identification of External BleedinglArterial Bleed Bright red SpurtinglVenous Bleed Dark red Steady flowlCapillary Bleed Dark red Oozing What is the physiology that explains the differences?24Control of External BleedinglDirect Pressure gloved hand dressing/bandagelElevatio

14、nlArterial pressure points25Arterial Pressure PointslUpper extremity:BrachiallLower extramity:Femoral26Internal BleedinglCan occur due to:Trauma Clotting disorders Rupture of blood vessels Fractures(injury to nearby vessels)27Internal BleedingCan result in rapid progression to hypovolemic shock and

15、death28Internal BleedinglAssessment Mechanism?Signs and symptoms of hypovolemia without obvious external bleeding29Internal BleedinglSigns and Symptoms Pain,tenderness,swelling,discoloration at injury site Bleeding from any body orifice30Internal BleedinglSigns and Symptoms Vomiting bright red blood or coffee ground material Dark,tarry stools(melena)Tender,rigid,or distended abdomen31Internal BleedinglManagement Open airway High concentration oxygen Assist ventilations Control external bleeding Stabilize fractures Transport rapidly to appropriate facility