The document discusses policies and procedures for managing patients who arrive dead or in shock at the Silver Crescent Dispensary in Khobar, Saudi Arabia. It defines dead on arrival as a person brought to the hospital lifeless and confirmed dead by a physician. The policies for dead on arrival patients include examining and providing resuscitative measures before confirming death, notifying the police department, and exhausting all resuscitation efforts. The document also defines and classifies shock, and outlines the initial priorities, materials, and management steps for patients in shock, including assessing consciousness, monitoring vitals, administering oxygen, drawing blood samples, and initiating IV fluid therapy.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
ER POLICYER POLICY
DEAD ON
ARRIVAL
MANAGEMENT OF
SHOCK

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITION
A person brought to a hospital lifeless
and confirmed dead after
the physician legally pronounced it.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To examine and confirm death.
2. To give immediate resuscitative measures
before confirming death.
3. To inform police department.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. "Dead- on- Arrival" patients must be examined and
resuscitative measures must be given before
confirming death.
2. Police department must be informed by information
personnel.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. All emergency resuscitative measures will be
carried out to save the patient's life.
4. Vital signs are obtained and monitored
continuously.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. When all resuscitation efforts
have been exhausted,
the physician will
examine and confirm the death.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MANAGEMENT OF
SHOCK

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITION
Shock is a complex life-threatening condition (or
syndrome) characterized by inadequate blood flow to the
tissues and cells of the body.
OBJECTIVE
1. To ensure rapid recognition and prompt intervention to
increase the chance of survival.
2. To initiate priorities in the assessment for all types of
shock.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. To restore and maintain tissue
perfusion
4. To correct physiological
abnormalities
5. To restore the patient to a
stable physical condition.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. The nurse must have the knowledge of the classification of shock and comparisons.
Hypovolemic results in reduced circulating vascular volume, water, plasma or whole
blood.
Cardiogenic when the heart muscles lose its contractive power or when cardiac
output is insufficient to meet the metabolic demands of the body, resulting in
inadequate tissue perfusion.
Septic results of bacteria and their products circulating in the blood.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Spinal Shock
Neurogenic
shock
Anaphylactic
shock
Hypoglycemic
shock

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
The initial priorities in the assessment are the
same for all types of shock.
Is the airway open
Is the patient breathing
Is there a circulation problem

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS & EQUIPMENT
1. Crash cart – Emergency drugs
Emergency equipments
Suction machine
Oxygen
Cardiac monitor
BP cuff and stethoscope
3. Intravenous equipment plus fluid
4. Urinary catheter equipment
5. Emergency room flow sheet

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
INITIAL MANAGEMENT
OF SHOCK

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
1. Assess level or consciousness:
1.1Confusion
1.2 Irritability
1.3 Anxiety
1.4 Agitation 1. Important indicator of shock
because it reflects cerebral
perfusion.
1.5 Inability to concentrate
1.6 Increased lethargy, progressing to coma, indicating
progression of shock.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. Draw blood samples for investigations.
2. As data baseline.
3. Monitor arterial blood pressure.
3. The blood pressure may
initially rise approximately
20%. If the patient is
compensating for shock.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
4. Assess urinary output. 4.
Urine output should be 50
ml/hour. An output less
than 25 ml./hour may
indicate shock

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. Administer 02 to maintain
the Pa02 at 80-100 Torr.
5. This will augment oxygen-
carrying capacity of arterial
blood.
5.1 100% oxygen by non-
breather face mask.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.2 Intubation if the patient is
unable
to manage or is
ventilating poorly.
5.3 If intubated, the
patient may be
hyperventilated to
help control
acidosis.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6. Initiate I.V. fluid therapy
6.1 Two large-bore I.V. lines
should
be established.6. To
restore intravascular
volume. To improve cardiac
and tissue oxygenation.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6.3 Fresh whole blood is
infused when
there is
massive blood loss.
6.3 Rate of flow
depends on
severity of loss and
clinical
evidence of
hypovolemia.