Identification BLS Treatment ALS AssistanceChapin Area Rescue Squad/February 2013/B. McCormick EMT-P
What is Shock• Shock, also called Hypoprefusion, is a state that leads to inadequate cellular oxygenation to meet metabolic needs.• As the cells of the body go without oxygen they attempt to compensate and will eventually die if not oxygenated.• There are several causes of shock, with trauma being one of the largest contributors we will see in the field.• A full patient assessment is still required, even if shock is suspected, paying careful attention to the ABCs.• Since shock is a state of decreased oxygen in the blood, application of oxygen is the initial and primary treatment for BLS providers.
Types of Shock• Since Shock is a failure of the cardiovascular system to deliver oxygen, we can identify three main types: • Pump Failure- Heart cannot pump enough blood • Pipe Failure- Capillaries dilate (expand) up to 4 times normal • Fluid Loss- Bleeding, Dehydration, or other problem decreases amount of blood• Technical terms for these types of shock are: Cardiogenic, Distributive and Hypovolemic. A fourth, Obstructive, is a physical blocking of blood flow, seen in neonates, and without removal can lead to death.• Hypovolemic Shock is the most common for trauma patients• Cardiogenic Shocks is most commonly seen as a myocardial infarction, or heat attack.• Distributive Shock is most commonly seen as anaphylaxis.
Shock Recognition• The identification and recognition of shock is the most important step of the treatment of shock.• In addition to vital sign changes, mental status changes are a major identifier of shock.
BLS Care• If you suspect your patient is in shock, and ALS has not been dispatched, call of paramedic care immediately.• A baseline set of vitas is of paramount importance to trend the patients condition• Application of high concentration of Oxygen via NRB or assist ventilations via BVM• Maintain the patients ABCs• Position the patient in the trendelenburg position of no trauma• Treat the cause if possible (anaphylaxis-EpiPen)• Keep the patient warm• Rapidly transport to appropriate facility
****PATIENT DIFFERNCES****• Shock has three major stages: Compensating, Decompensating and Irreversible.• Adults will move through all three stages giving providers time to assess what stage the patient is in.• Children will compensate for a longer period of time and plateau, dropping from compensating to irreversible in a very short period of time.• Due to this rapid decline, EMS providers must always assume a child could be in compensated shock and treat appropriately.
Types of Bleeding• Bleeding can be internal or external, and both can be life threatening.• Surgeons are the only ones that can effectively treat life threatening internal bleeding, so reduction of on scene times is the EMTs greatest treatment.• External Bleeding is broken into three major types: • Arterial • Venous • Capillary
Bleeding Control• Direct Pressure is the number one treatment for controlling external blood loss• Application of a ‘pressure dressing’ is simply a dressing with a bandage used to hold it in place• Never remove a blood soaked bandage or dressing. Just add to it.• Elevation of the limb or positioning will assist with bleeding control.• Ice or Cold packs and Pressure Points can also be used to assist.• Tourniquets can be used to control life threatening bleeding not controlled by another method. • Mark the time the tourniquet is put in place on the patients limb.
Assisting ALS• For major bleeding and shock, paramedic care is essential.• Loading the patient and obtaining vitals every 5 minutes will be the main duties for the BLS crew. The patient should already be on oxygen and maintenance of the ABCs is crucial.• ALS will place the patient on the cardiac monitor, if not done by CARS members already.• Assistance with IVs will be at the discretion of the paramedic treating.• Direct Pressure for external bleeding will continue through transport, and may require multiple people to assist with treating the patient.
Conclusion• Shock and Bleeding are major life threats that all levels must be able to recognize• Oxygen, positioning, warming and ensuring ABCs will be the EMTs primary treatment for shock• Bleeding can be both internal and external, use of MOI will assist with internal bleeding assessment• Methods to control external bleeding include: Direct Pressure, Elevation, Pressure Points, Cold Packs, and Tourniquets.• iPad training manuals are in each rig, and can be emailed upon request.