Shock - polytrauma/high School (nurse)

Shock is caused by an imbalance between the supply and demand for nutrients and oxygen and the ability to remove pollutants from the cells.
 * Shock from circulatory failure → hypovolemic, hemorrhagic, burn, etc. → volume loss.
 * Shock from vascular disorder → neurogenic, septic anaphylactic → excessive vasodilatation.
 * Pump failure shock → cardiogenic shock → heart damage.

Pathophysiology

 * Compensation of BP decrease → increase in sympathetic tone → centralization of circulation.
 * Volume compensation → movement of interstitial fluid into capillaries, formation of ADH → vasoconstriction of the periphery and GIT and water retention → drop in BP in the kidneys → activation of the renin-angiotensin-aldosterone system.
 * Manifest shock → hypoxia → organ involvement → MOS (ARDS, DIC).

Symptoms

 * Compensation phase:
 * Thirst.
 * Hypotension.
 * Tachycardia.
 * Cold sweat.
 * Pallor.
 * Oliguria - anuria.
 * Tachypnea.
 * Impairment of consciousness.


 * Decompensation phase:
 * Severe metabolic acidosis.
 * Violation of the intestinal barrier → penetration of intestinal bacteria into the circulation.
 * The retreat of centralization of circulation.
 * Unconsciousness..
 * DIC.

Shock index

 * Estimation of fluid loss.
 * Heart rate / systolic pressure.
 * Standard = 0.5 → loss up to 10%.
 * Start of shock (compensation) = 1 → loss up to 30%.
 * Severe shock (decompensation) = 2 or more → loss over 30%.

Patient examination

 * The ABC system
 * A = DC throughput.
 * B = respiration (oxygen demand).
 * C = circulation (reimbursement of losses).
 * D = consciousness system BHBN.
 * Alert and oriented.
 * Responds to voice.
 * Responds to AP.
 * He doesn't respond.
 * E = exposure and surroundings.
 * Investigate, cover up.
 * F = FF
 * Complete assessment of FF, SaO2, ECG, MK, NGS, laboratory, presence of family.
 * G = comfort.
 * Soothing P/k, pain management.
 * H = head to toe examination.
 * I = Examination of hindquarters.

Basic medications

 * Infusion, transfusion.
 * Sympathomimetics.
 * Adrenaline, Noradrenaline.
 * Dopamine (increases blood pressure and blood flow to organs).
 * Dobutamine (acts on the myocardium).


 * Cardiotonics.
 * Inamrinone, Milrinom (increasing tissue perfusion and beta-receptor activity).


 * Cardiac glycosides (Digoxin).
 * Nitrates.
 * NTG, Nitroprusside.


 * Vasopressin (ADH).
 * ATB.

Polytrauma

 * Combination of impairment of organ systems.
 * Impairment of one or more vital functions.
 * Early development of traumatic shock.
 * The severity of the condition is proportional to the frequency of affected systems.
 * Typical injury mechanisms cause typical injuries.

P/K Investigation

 * Anamnesis brief ..
 * Symptoms - difficulties.
 * What happened and how.
 * Allergy.
 * Medicines used.
 * Previous illnesses.
 * When and what did he last eat?


 * After stabilization of the condition.
 * Blood transfusion.
 * Vaccination.
 * General examination.

Treatment principles

 * Triage.
 * Investigation and stabilization of FF.
 * Immobilization of the cervical spine.
 * Preparation for transport – for surgery.


 * 1) Stop bleeding.
 * 2) Provision of FF.
 * 3) Immobilization of the cervical spine.
 * 4) Monitoring.
 * 5) Immobilization of fractures.
 * 6) Neurological higher.
 * 7) Two large venous inlets.
 * 8) Blood and urine sampling.
 * 9) Check for wounds, bruises.
 * 10) Fulfillment of surgeries.
 * 11) Calming down loved ones.

Trauma team

 * Ingredients:
 * Traumatologist.
 * Anesthesiologist, intensivist.
 * Surgeon.
 * Radiographer.
 * Neurosurgeon, neurologist, orthopedist, ENT, urologist, dental surgeon...


 * Prepared when handing over P/K ZZS!!!

Related articles

 * Polytrauma
 * Rival
 * Disseminated intravascular coagulation