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Alexander ch10 lecture
1.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Advanced EMT A Clinical-Reasoning Approach, 2nd Edition Chapter 10 Pathophysiology: Selected Impairments of Homeostasis
2.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • The Advanced EMT applies comprehensive knowledge of the pathophysiology of respiration and perfusion to patient assessment and management. Advanced EMT Education Standard
3.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 1. Define key terms introduced in this chapter. 2. Explain the importance of understanding basic pathophysiology. 3. Give examples of mechanisms that cause disease and injury in the human body. 4. Describe the composition of ambient air as it relates to ventilation and respiration. 5. Explain how changes in the compliance of the lungs and chest wall and in airway resistance can affect ventilation. Objectives (1 of 6)
4.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 6. Explain how common disease processes can interfere with ventilation and with external and internal respiration. 7. Describe the homeostatic mechanisms that attempt to correct for changes in ventilation and perfusion. 8. Explain the consequences of impaired tidal volume, respiratory rate, and minute volume, as well as increases in anatomical dead space. 9. Explain the concept of ventilation–perfusion mismatch. 10.Explain the pathophysiology of shock (hypoperfusion), including the consequences of cellular hypoxia and death. Objectives (2 of 6)
5.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 11.Compare and contrast aerobic and anaerobic cellular metabolism, including consideration of the amount of ATP produced and the removal of byproducts of energy metabolism. 12.Describe the consequences of failure of the cellular sodium/potassium pump. 13.Describe how inadequate vascular volume, inadequate heart function, and decreased peripheral vascular resistance can each lead to shock. Objectives (3 of 6)
6.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 14.Give examples of conditions that can lead to loss of vascular volume, inadequate heart function, and decreased peripheral vascular resistance. 15.Explain the mechanisms and pathophysiology of each of the following types of shock: hypovolemic (hemorrhagic and nonhemorrhagic), distributive (anaphylactic, septic, neurogenic), cardiogenic, and obstructive. 16.Explain how mechanisms such as exposure to carbon monoxide and cyanide can lead to shock. Objectives (4 of 6)
7.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 17.Explain the body’s compensatory reactions to hypoperfusion and how they manifest in the early signs and symptoms of shock. 18.Describe the progression of shock through the compensated, decompensated, and irreversible stages. 19.Discuss the rationales behind the priorities and goals of prehospital management of patients with hypoperfusion. 20.Given a series of scenarios, recognize patients who are at risk for shock and explain the influence of age on the assessment and management of patients with hypoperfusion. Objectives (5 of 6)
8.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 21.Describe the pathophysiology of cardiac arrest. 22.Differentiate among the electrical, circulatory, and metabolic phases of cardiac arrest. 23.Explain the dependence of cells upon glucose as a source of energy. 24.Explain the consequences of untreated hypoglycemia. 25.Explain how disruptions of electrolyte balance and pH affect body functions. 26.Explain the consequences of inadequate temperature regulation in the body. Objectives (6 of 6)
9.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Homeostasis – a physiologic steady state achieved by the body’s complex regulatory mechanisms. • When disease, environmental conditions, or trauma disrupts homeostasis, the body responds, correcting the disruption. Introduction (1 of 3)
10.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Body’s compensatory mechanisms respond, but they are not sufficient. • Signs and symptoms appear, but they are superficial indications. • AEMT must recognize signs and symptoms, and understand what causes them. Introduction (2 of 3)
11.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Physiology • Pathology • Pathophysiology • All diseases and injuries affect the body at cellular level. • Body responds in predictable ways to specific threats to homeostasis. Introduction (3 of 3)
12.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • What problems require immediate attention? • What are potential underlying causes of the problems? • How can looking for underlying causes of the problems be important in making decisions about treatment? Think About It
13.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Mechanisms of homeostasis can be disrupted – Hypoxia – Nutritional imbalance – Genetic diseases – Cancer – Physical injury – Toxins – Infections Mechanisms of Disease and Injury (1 of 2)
14.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Table 10-1 (1 of 2) Selected Mechanisms of Disease Disease Mechanism Example Pathophysiology Hypoxia A narcotic overdose depresses the respiratory centers in the central nervous system. Decreased respiratory center function causes slow, shallow ventilations. An inadequate amount of air reaches the alveolar level for gas exchange, resulting in poor oxygenation of the blood returning to the lungs. Inadequately oxygenated red blood cells cannot deliver sufficient oxygen at the cellular level. Without oxygen, the cells engage in anaerobic metabolism, producing less ATP. Without ATP, cellular mechanisms fail, and cell death occurs. Nutritional imbalance A patient with diabetes takes insulin but does not eat. The increased amount of insulin quickly facilitates the entry of the available glucose into cells. Without an additional source of glucose from the digestive tract, the blood glucose level quickly falls. The remaining glucose is inadequate to fuel the metabolic needs of the cell. ATP is not produced, and cellular mechanisms begin to fail. Physical trauma A patient falls from a second-story roof. When he lands, a screwdriver in his tool belt impales him in the right side, lacerating his liver. The liver begins to bleed profusely. With a decreased number of red blood cells, inadequate oxygen and glucose are delivered to the cells to fuel metabolism, and cellular mechanisms begin to fail. Unless the bleeding is stopped quickly and red blood cells are restored, the patient will die.
15.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Table 10-1 (2 of 2) Selected Mechanisms of Disease Disease Mechanism Example Pathophysiology Infection A patient develops pneumonia. Cellular debris and fluid fill the alveoli in the affected lobe, preventing oxygen from diffusing across the respiratory membrane and into the blood. Less oxygen reaches the cellular level, impairing cellular metabolism. Toxin A faulty gas furnace releases carbon monoxide into a residence. Carbon monoxide binds to hemoglobin, preventing oxygen from binding to it. Oxygen is not delivered to the cellular level, impairing cellular metabolism. Environment A person locks his keys in his car and is unable to get back into his car or into his house. It is 2 degrees Fahrenheit with a 20-mph wind. His closest neighbor is three miles away. The body loses heat to the cold air, and this effect is increased substantially by the wind. Despite shivering and the exercise of walking to get help, the body is unable to generate enough heat to maintain the core temperature. The electrical system of the heart becomes irritable, the nervous system begins to malfunction, and less oxygen is released to the cells in the tissues.
16.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Mechanisms of Disease and Injury (2 of 2) • Category of mechanisms – Hypoxic cellular injury – Shock – Impaired glucose metabolism – Electrolyte and pH disturbance – Environmental disorders • Considerable overlap among mechanisms
17.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Body capable of remarkable adaptation under stress. – withstand significant challenges to homeostasis. • Long term, cells adapt to variety of conditions. Compensation and Adaptation
18.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Table 10-2 Types of Cellular Adaptation Adaptation Description Atrophy Reduction in the size of cells of a tissue. For example, skeletal muscle atrophy occurs when an extremity has been immobilized in a cast for several weeks. Cells adapt to the lack of use by decreasing in size. Metaplasia A change in the type of cells that comprise a tissue into a different type of cell that is not normal for that tissue in order to adapt to changes in the environment. For example, cells that line the esophagus (squamous epithelium) can change into a different type (columnar epithelium) to adapt to chronic exposure to stomach acids (Barrett’s esophagus). Hyperplasia Increase in the number of cells of a tissue. An example is benign prostatic hypertrophy in middle- age men. The prostate increases in size and can obstruct the urethra, interfering with urine flow. Hypertrophy Increase in the size of cells of a tissue. The best example of this is the growth of a muscle following weight lifting. The number of skeletal muscle cells remains constant, but cell size increases. Anaplasia Loss of cellular differentiation. This is an indication of malignant tumors. Dysplasia Cell maturation and differentiation are delayed, resulting in the loss of uniformity of cells within a certain tissue. This is often a precursor to cancer. For example, a Pap smear may show dysplasia of cells of the cervix, indicating a need for further examination and treatment to prevent cancer. Neoplasia New or expanded growth in an area of the body where it is not expected. Neoplasia can be accompanied by anaplasia. This, and the degree to which the neoplasm invades normal tissues, determines whether or not the tumor is benign or malignant. An example of a benign neoplasm is uterine fibroid tumors. An example of a malignant neoplasm is osteosarcoma, a cancerous bone tumor. Apoptosis The genetic instructions provided by DNA can command cellular self-destruction, either as part of a normal process or to destroy damaged cells that are a threat to the body.
19.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-2 (1 of 2) (A) Aerobic metabolism. Glucose broken down in the presence of oxygen produces a large amount of energy (ATP).
20.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-2 (2 of 2) (B) Anaerobic metabolism. Glucose broken down without the presence of oxygen produces pyruvic acid, which converts to lactic acid and only a small amount of energy (ATP).
21.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (1 of 15) • Ischemia – lack of blood flow to tissues resulting in hypoxia • Can be reversed by – restoring perfusion – adequate ventilation and supplemental oxygen • Cells initially adapt by switching from aerobic to anaerobic metabolism – Only lasts for a limited time (as little as 5 minutes)
22.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Hypoxic cellular injury – occurs any time oxygen to cells is disrupted. • Oxygen required to produce energy – ATP that fuels cellular work. • Without ATP – cells cannot power their reactions and activities. Hypoxic Cellular Injury (2 of 15)
23.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Aerobic metabolism is the breakdown of oxygen and glucose to produce a large amount of energy. • Anaerobic respiration is the mechanism to produce ATP without oxygen. – Short-term adaptation Hypoxic Cellular Injury (3 of 15)
24.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-4 (A) Alveolar/capillary gas exchange. Oxygen moves from the lung alveolus into the capillary. Carbon dioxide moves from the capillary into the lung. (B) Capillary/cell gas exchange. Oxygen and nutrients move from the capillary into the cell. Carbon dioxide and other wastes move from the cell into the capillary.
25.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (4 of 15) • Needed for adequate oxygen delivery – Adequate onloading of oxygen onto hemoglobin in red blood cells. – Circulation of red blood cells through microvasculature to perfuse tissues of the body. – Adequate offloading of oxygen to tissues once red blood cells reach microvasculature.
26.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Components disrupted in four ways – Oxygen delivery to bloodstream – Oxygen transport within bloodstream – Oxygen transport from bloodstream to cells – Oxygen utilization by cells Hypoxic Cellular Injury (5 of 15)
27.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Oxygen delivery to the blood – The air we breathe contains 21% oxygen; 79% nitrogen; trace gases. – Ventilations must produce adequate tidal and minute volume to provide oxygen. – Body compensates for decreased tidal volume by increasing respiratory rate. Hypoxic Cellular Injury (6 of 15)
28.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Oxygen delivery to the blood (continued) – Shallow breathing results in inadequate ventilation. – Atmospheric pressure and partial pressure of oxygen decrease at high altitudes. – Symptoms of altitude sickness can develop at elevations over 8,000 feet. Hypoxic Cellular Injury (7 of 15)
29.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Airway must be unobstructed for oxygen to reach the alveoli. • Causes – Swelling from infection – Allergic reaction – Trauma – Relaxation of tongue and throat muscles – Foreign bodies lodged in airway Hypoxic Cellular Injury (8 of 15)
30.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-5 Nervous control of respiration.
31.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (9 of 15) • Respiratory centers in brain must function to stimulate inspiration and respiratory cycle. • Anything that blocks communication between the nervous and respiratory system can lead to hypoxia.
32.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (10 of 15) • Alveoli must be close to the capillaries for oxygen to diffuse. – Pulmonary edema, pneumonia • Bronchoconstriction – Asthma, COPD, and anaphylaxis result in constriction of bronchioles. • Surfactant – Keep the alveoli from collapsing
33.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (11 of 15) • Ventilation-perfusion (VQ) mismatch; decrease in ventilation, lung perfusion, or both. – If underlying problem not corrected, respiratory failure occurs. – Untreated, respiratory failure leads rapidly to respiratory arrest. – Untreated respiratory arrest leads to cardiac arrest and death.
34.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (12 of 15) • Oxygen transport in the blood – Anemia Number of red blood cells decreased with accompanying decrease in hemoglobin; reduced oxygen carrying capacity. – Acidosis and alkalosis alter ability of oxygen to bind with, and release from, hemoglobin.
35.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (13 of 15) • Oxygen transport in the blood (continued) – Cardiac arrest Heart stops beating, oxygen delivery to cells cease – Define each of the following terms CPR SCA Defibrillation
36.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (14 of 15) • AHA chain of survival – Immediate recognition of cardiac arrest and EMS notification – Immediate CPR with emphasis on chest compressions – Rapid defibrillation – Early advanced life support – Integrated postresuscitation management
37.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Hypoxic Cellular Injury (15 of 15) • Alkalotic states cause a diminished ability of hemoglobin to deliver oxygen to tissues that need it. • Cyanide is the substance that prevents cell from using oxygen. – Aerobic metabolism cannot occur; cells switch to anaerobic metabolism. – If untreated, cyanide poisoning rapidly causes death from asphyxia.
38.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Through glycolysis, cells use glucose to produce ATP. • Briefly, some cells can adapt to alternative mechanisms of energy production. – Not as effective – Toxic byproducts Cellular Glucose Use (1 of 3)
39.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Insulin must be present to facilitate glucose passage across cell membrane. • Without insulin, glucose remains in blood. • Cells uses other sources to create energy. – Fatty acids – Ketones – Diabetic ketoacidosis Cellular Glucose Use (2 of 3)
40.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Normal glucose – 80–120 mg/dL • Influenced by insulin and glucagon • Hypoglycemia – Sympathetic signs and symptoms – Brain dysfunction Cellular Glucose Use (3 of 3)
41.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Table 10-3 Signs and Symptoms of Hypoglycemia Anxiety Sweating Tremor Extreme hunger Rapid heartbeat Irritability Confusion, difficulty thinking Anger Weakness Blurred vision Slurred speech Staggering, poor coordination Seizures Unresponsiveness (coma)
42.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Acid–Base and Electrolyte Disturbances (1 of 4) • Causes of acidosis – Hypoxia – Diabetic ketoacidosis (DKA) – Toxicity with acidic substances (aspirin, salicylates, and antifreeze solutions) • Metabolic acidosis – Arterial pH of less than 7.35; bicarbonate level less than 24 mmHg
43.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Acid–Base and Electrolyte Disturbances (2 of 4) • As pH decreases, hemoglobin becomes less effective at binding oxygen. • Forces cells to utilize anaerobic metabolism; produces less ATP. • Hypoxia further worsens acidosis.
44.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Acid–Base and Electrolyte Disturbances (3 of 4) • Metabolic Alkalosis – Antacids – Vomiting – Diuretics • Signs and symptoms vary but hypoventilation can occur in severe cases
45.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Acid–Base and Electrolyte Disturbances (4 of 4) • Electrolyte abnormalities may be present. • Electrolytes must be maintained within narrow ranges for normal cellular function and fluid balance. • Cardiac rhythm, electrical conduction, and contraction can be affected.
46.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-10 Progression of inadequate perfusion to cellular death.
47.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (1 of 17) • All forms of shock share final common pathway of inadequate cellular perfusion to meet metabolic needs. • Shock is inadequate oxygen supply to meet the demand for oxygen at cellular level. – What are the four general classifications of shock?
48.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-11 Progression of hypovolemic shock.
49.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (2 of 17) • Hypovolemic shock – Hypoperfusion from loss of blood volume Actual blood loss Loss of volume – Insufficient blood volume within the vascular space prevents tissues and organs from being perfused
50.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Hypovolemic shock (continued) – Compensated shock – Decompensated shock – Irreversible shock – Signs and symptoms Classic presentation of shock Tachycardia—early sign Decreased blood pressure—late sign Shock (3 of 17)
51.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Hypovolemic shock—vascular level – Ischemic phase – Stagnant phase – Washout phase Shock (4 of 17)
52.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Hemorrhagic shock – Type of hypovolemic shock. Due to blood loss – Blood loss may not be obvious. – Chest cavity, abdomen, pelvis, and thigh can hold enough blood to result in shock. Shock (5 of 17)
53.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Table 10-4 Stages of Hemorrhagic Shock Classification of Hemorrhage Class Blood Volume Loss in 70 kg Adult Signs Class I hemorrhage Up to 15 percent (750 mL) Usually well tolerated Can lead to mild tachycardia Class II hemorrhage 15–30 percent (750–1,500 mL) Moderate tachycardia Pale skin Delayed capillary refill Class III hemorrhage 30–40 percent (1,500–2,000 mL) Tachycardia Failure of compensation Hypotension Class IV hemorrhage 40–50 percent (2,000–2,500 mL) Profound hypotension End-organ failure (for example, bradycardia, anuria) Death
54.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-13 Progression of cardiogenic shock.
55.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Cardiogenic shock – Heart cannot pump sufficiently enough to maintain cardiac output. – Signs and symptoms Anxiety Pale and diaphoretic skin Chest pain (if due to myocardial infarction) Pulmonary edema Fast or slow heart rate Shock (6 of 17)
56.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Cardiogenic shock (continued) – Prehospital treatment Supporting airway, breathing, and circulation – Treatment Medications, electrical therapies, interventions to correct underlying cause – Mortality rate high Shock (7 of 17)
57.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-14 Progression of neurogenic shock.
58.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Distributive shock – Uncontrolled vasodilation, creating vascular container too large for amount of blood in body – Three mechanisms of distributive shock Neurogenic Anaphylactic Septic Shock (8 of 17)
59.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Neurogenic Shock – Loss of sympathetic tone results in uncontrolled vasodilatation below injury site; result can be sudden onset of hypotension. – Different signs and symptoms than other types of shock. Skin warm, dry, and pink Heart rate normal Possible impaired ventilation Shock (9 of 17)
60.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Neurogenic Shock (continued) – Prehospital treatment Cervical collar and position to manage spinal injury per protocol Airway management; supporting ventilations Supplemental oxygen; keep patient warm Administer IV fluids according protocol Shock (10 of 17)
61.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-15 Progression of anaphylactic shock.
62.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Anaphylactic shock – Result of severe allergic reaction – Common causes Antibiotics, hymenoptera (bee or wasp) stings, and peanuts Shock (11 of 17)
63.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (12 of 17) • Anaphylactic shock (continued) – Can progress quickly, leading to death in minutes – Signs and symptoms Hives, itching in throat, stridor, wheezing, abdominal cramping, and airway swelling – Treatment Epinephrine, IV fluids (per protocol), diphenhydramine (per protocol)
64.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-16 Progression of septic shock.
65.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (13 of 17) • Septic shock – Result of systemic inflammatory response to a pathogen – Signs and symptoms high fever (may be absent in elderly), tachycardia, respiratory distress, decreased mental status, and hypotension. – Prehospital treatment Manage airway, ventilation, circulation, and body temperature.
66.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 10-17 Causes of obstructive shock. (A) Pulmonary embolism. (B) Tension pneumothorax. (C) Pericardial tamponade.
67.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (14 of 17) • Obstructive shock – Physical obstruction blocking forward flow of blood through circulatory system – Causes Pulmonary embolism, tension pneumothorax, and pericardial tamponade
68.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (15 of 17) • Pathophysiology of shock – Regardless of cause, initial signs and symptoms of shock are external manifestations of the body’s compensatory reactions to hypoperfusion. – As shock progresses, signs and symptoms reflect failure of compensatory mechanisms.
69.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (16 of 17) • Pathophysiology of shock (continued) – Many signs and symptoms due to the release of epinephrine and norepinephrine Anxiety Pale, cool, sweaty skin Tachycardia Nausea, vomiting Thirst Decreased urine output Increased respiratory rate
70.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Shock (17 of 17) • Pathophysiology of shock (continued) – Your role is to Anticipate and recognize shock quickly Provide appropriate field interventions Provide transportation to the closest facility capable of providing care the patient needs
71.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Think About It • Children and geriatric patients do not exhibit the same signs of shock as an adult. • How do the signs and symptoms of shock differ in children? • How do the signs and symptoms of shock differ in geriatric patients?
72.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Body constantly adjusts to changes in internal and external environment. • Normal core body temperature 98.6°F (37°C). • Increased physiologic activity generates heat. • When core temperature drops, body adjusts to increase heat production and decrease heat loss. Heat and Cold Emergencies (1 of 2)
73.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Shivering uses energy and generates heat. • When the body cannot compensate for environmental extremes, or temperature regulation mechanisms are impaired, death can occur. Heat and Cold Emergencies (2 of 2)
74.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Chapter Summary (1 of 2) • Diseases and injuries often present as emergencies when pathophysiology results in inadequate cellular energy production to maintain cell functions. • Prehospital treatment – Ensure delivery of oxygen and glucose to cells; maintain normal body temperature.
75.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Chapter Summary (2 of 2) • AEMT provides general, supportive treatments to maintain patient’s airway, breathing, and circulation. • AEMT must understand the pathophysiology of patient’s problem.
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