Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
In 2017, the number of road traffic accidents (RTA) deaths in India was at 150k. 50% die because of haemorrhage and 100% die within 24 hrs. if not intervened. A guide to manage such incidents in pre-hospital scenario and in an ED.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
In 2017, the number of road traffic accidents (RTA) deaths in India was at 150k. 50% die because of haemorrhage and 100% die within 24 hrs. if not intervened. A guide to manage such incidents in pre-hospital scenario and in an ED.
Respiratory obstruction / Airway Obstruction Aby Thankachan
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Respiratory obstruction / Airway Obstruction, and its management. Highly recommended for II B.Sc Nursing Students.
Respiratory obstruction / Airway Obstruction Aby Thankachan
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Respiratory obstruction / Airway Obstruction, and its management. Highly recommended for II B.Sc Nursing Students.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
Hemorrhagic shock occurs when the body begins to shut down due to large amounts of blood loss. People suffering injuries that involve heavy bleeding may go into hemorrhagic shock if the bleeding isn't stopped immediately. Common causes of hemorrhagic shock include: severe burns.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Objectives
• Understand the definition and major types of shock,
• Recognize signs and symptoms of shock,
• Recognize types of external bleeding (arterial, venous,
capillary),
• Recognize signs and symptoms of internal bleeding,
• Initiate treatment of shock by appropriately positioning
the patient and by stopping hemorrhage when
possible,
• Treat external hemorrhage
2
3. SHOCK
Shock is a syndrome that results from
a decrease in effective circulating
blood volume or fluid in the body as
a result of any injury or illness.
Shock is inadequate tissue perfusion
with oxygenated blood.
4. PRINCIPLE MECHANISMS
• Not enough blood volume in body
• Circulatory Pump failure
• Abnormalities of peripheral circulation (when
all small blood vessels dilate)
• Mechanical blockage of outflow from the
heart
5. TYPES OF SHOCK
Hypovolemic Shock
• Results from trauma in which there is blood
loss
• Decreased blood volume causes a decrease in
blood pressure
• Insufficient amounts of O2 is being
transported to body tissues and organs
6. TYPES OF SHOCK
Respiratory Shock
• Results when the lungs are unable to supply
enough O2 the circulating blood
• Trauma that may produce respiratory shock
include:
– Pneumothorax
– Injury to the respiratory control center
7. TYPES OF SHOCK
Neurogenic Shock
• Results due to the overall dilation of the blood
vessels within the cardiovascular system
• Decreased blood pressure
• Insufficient amounts of O2 is being
transported to body tissues and organs
8. TYPES OF SHOCK
Psychogenic Shock
• Commonly known as “fainting” (syncope)
• Results due to a temporary dilation of the
blood vessels in the body causing a decrease
in the blood flow to the brain
9. TYPES OF SHOCK
Cardiogenic Shock
• Results due to the inability of the heart to
pump enough blood to the body
• Decreased cardiac output
• Decreased blood pressure
• Insufficient amounts of O2 is being
transported to body tissues and organs
10. TYPES OF SHOCK
Septic Shock
• Results due to a severe infection
– Usually a bacterial infection
• Toxins released by the bacteria cause dilation
of the blood vessels within the cardiovascular
system
• Decreased blood pressure
• Insufficient amounts of O2 is being
transported to body tissues and organs
11. TYPES OF SHOCK
Anaphylactic Shock
• Results due to a severe allergic reaction
• Allergic reaction may be caused by:
–Foods
–Insect bites
–Drugs
–Inhaling dusts, pollens, etc…
12. TYPES OF SHOCK
Metabolic Shock
• Results due to a severe illness that goes
untreated
– For example, untreated diabetes
• Results due to an extreme loss of bodily fluid
– For example, excessive urination, diarrhea, or
vomiting
13. SIGN AND SYMPTOMS
• Anxiety, restlessness,
altered mental state
• Hypotension
• Rapid, weak, thready
pulse
• Cool, clammy skin
• Capillary refill > 3 seconds
• Rapid and deep
respirations
•Hypothermia
• Fatigue
• Cold and mottled skin
• Thirst and dry mouth
• Vasoconstriction
• Low urine output
14.
15. SHOCK STAGES BY FINDINGS
• Compensated - Early
– Initial stage, body progressively compensated for
blood loss
• ↑ pulse, vasoconstriction
• Weak pulse, cool clammy skin, anxiety, thirst, weak
• Decompensated – Late
– Body’s compensatory mechanisms no longer
maintain system
• Loss of radial pulse, ↓ BP, loss of consciousness, ↓
respirations
17. SOURCES OF BLOOD LOSS
• Arterial bleeding
– Bright red in color, Rich in oxygen
– Often profuse and spurting
– Often hard to control - continuous direct pressure required
• Venous bleeding
– Dark red/maroon in color, does not contain much oxygen
– Usually easy to control because veins are under low pressure
– Venous bleeding in neck can draw in air and cause further
complications
• Capillary bleeding
– Usually slow, oozing, small size and low pressure
– Generally minor and easy to control
19. MANAGEMENT
• STOP the bleeding
• Supportive care
measures
– Positioning of victim
– Ensuring A-B-C’s
– Maintenance of body
temp
• Definitive management
21. Apply direct pressure:
• with gloved hand,
• sterile dressing(s).
Bleeding stopped? YesNo
Elevate extremity:
• above victim’s heart,
continue direct pressure
Locate pressure point,
apply pressure:
• maintain direct pressure
over wound
Treat for shock:
• care for wound,
• seek definitive care
Bleeding stopped?
Bleeding stopped?
No
Bleeding from
extremity?
No
Apply tourniquet
(last resort)
Yes
No
Definitive therapy
21
22. Direct pressure
• Apply pressure directly to wound
site:
– Gloved hand, dressing
– If dressing soaks thru, add
more gauze on top and press
harder
22
Apply direct pressure:
• with gloved hand,
• sterile dressing(s).
Bleeding stopped? YesNo
Elevate extremity:
• above victim’s heart,
continue direct pressure
Locate pressure point,
apply pressure:
• maintain direct pressure
over wound
Treat for shock:
• care for wound,
• seek definitive care
Bleeding stopped?
Bleeding stopped?
No
Bleeding from
extremity?
No
Apply tourniquet
(last resort)
Yes
No
Definitive therapy
23. Elevate wound site
• If possible, raise wound site
above level of victim’s heart
23
Apply direct pressure:
• with gloved hand,
• sterile dressing(s).
Bleeding stopped? YesNo
Elevate extremity:
• above victim’s heart,
continue direct pressure
Locate pressure point,
apply pressure:
• maintain direct pressure
over wound
Treat for shock:
• care for wound,
• seek definitive care
Bleeding stopped?
Bleeding stopped?
No
Bleeding from
extremity?
No
Apply tourniquet
(last resort)
Yes
No
Definitive therapy
24. Pressure points
• Find proximal “pressure point”
and press on it
(radial, ulnar, brachial, axillary, femoral
arteries—not carotid)
• Apply direct pressure to site
24
Apply direct pressure:
• with gloved hand,
• sterile dressing(s).
Bleeding stopped? YesNo
Elevate extremity:
• above victim’s heart,
continue direct pressure
Locate pressure point,
apply pressure:
• maintain direct pressure
over wound
Treat for shock:
• care for wound,
• seek definitive care
Bleeding stopped?
Bleeding stopped?
No
Bleeding from
extremity?
No
Apply tourniquet
(last resort)
Yes
No
Definitive therapy
25. Tourniquet
• Apply band above injury site,
tighten to stop bleeding:
– Last resort—risky
– Note time of application
– Reassess frequently
25
Apply direct pressure:
• with gloved hand,
• sterile dressing(s).
Bleeding stopped? YesNo
Elevate extremity:
• above victim’s heart,
continue direct pressure
Locate pressure point,
apply pressure:
• maintain direct pressure
over wound
Treat for shock:
• care for wound,
• seek definitive care
Bleeding stopped?
Bleeding stopped?
No
Bleeding from
extremity?
No
Apply tourniquet
(last resort)
Yes
No
Definitive therapy
26. EMERGENCY DEPARTMENT CARE
• Three goals exist in the emergency department
treatment of the patient with hypovolemic shock as
follows:
(1) Maximize oxygen delivery - completed by
ensuring adequacy of ventilation, increasing oxygen
saturation of the blood, and restoring blood flow,
(2) Control further blood loss, and
(3) Fluid resuscitation.
27. GENERAL TREATMENT FOR SHOCK
• Goal: improve perfusion of brain and heart
• Position patient: Have patient lie down and
elevate legs (moves blood into chest and
head)
• Keep warm if blanket available
• Give nothing by mouth if any possibility of
internal injuries (may need emergency
surgery)
30. THE HEAD MAY NOT BE ELEVATED
IN CASE OF IF THERE IN CASE OF
MUCUS IN THROAT
31.
32. WATCH FOR :-
Vital Signs
• Pulse
• Respiration
• Blood pressure
• Temperature
• Skin color
• Pupils
• Level of
consciousness
• Movement
• Abnormal nerve
response
33.
34. DEFINITIVE CARE
• Administer supplemental oxygen
• Obtain vascular access
– Administer fluid/blood to “fill up the tank”
• Wound closure/management
• Immobilization
• Special situations
– Release cardiac tamponade
– Tension pneumothorax
• Find hidden sources of bleeding
35. AIRWAY
• The patient's airway should be assessed
immediately upon arrival and stabilized if necessary.
• The depth and rate of respirations, as well as
breath sounds, should be assessed.
• High-flow supplemental oxygen should be
administered to all patients, and ventilatory support
should be given, if needed.
• Excessive positive-pressure ventilation can be
detrimental for a patient suffering hypovolemic
shock and should be avoided.
36. FLUID MANAGEMENT
• Two large bore IV line access
• Blood products and fluids via the intravenous
route.
• This is to replenish what is lost and to significantly
improve the circulation of blood in the body.
• Fluids are given to restore what was lost.
• Medications are given to strengthen and improve
the condition of the heart and other vital organs in
the body.
37. Following fluids and medications should be
given:
• Intravenous crystalloids/colloids
• Whole blood transfusion
• Blood plasma transfusion
• Red blood cell / Platelet transfusion
• Dopamine
• Epinephrine
• Dobutamine
• Norepinephrine
• Antibiotics to prevent infection and septic shock
38. • Initial fluid resuscitation is performed with an
isotonic crystalloid, such as Ringer lactate solution
or Normal Saline.
• An initial bolus of 1-2 L is given in an adult (20
mL/kg in a pediatric patient), and the patient's
response is assessed.
• 3% and 7.5% Hypertonic Saline Solutions
• Fresh frozen plasma, Hetastarch and Dextran 40/70.
• Type O Rh-negative blood / Cross matched blood
• IV Antibiotics – In case of Open Wounds
40. HYPOVOLEMIC SHOCK IN CHILDREN
• In children, hypovolemic shock is the leading cause
of morbidity and mortality.
• Thorough physical examination, vital signs
monitoring, and gathering of important laboratory
data.
• Severe dehydration, injury, and blood disorders are
the leading causes of hypovolemic shock in
children.
41. HYPOVOLEMIC SHOCK IN OLDER ADULTS
• Hypovolemic shock is very dangerous in older
adults.
• They have a higher mortality rate than the younger
ones.
• Older adults have less tolerance for shock.
• Hence, Older patients should be treated right away
to prevent further complications.
42. RECOVERY TIME
• Depends on the patient’s age, degree of shock, and
medical condition.
• Patient with mild degree of shock tend to recover more
easily than those with severe shock.
• Patients with severe organ damage may take some time
to fully recover.
• A course of extensive medications should be given to
help the patient recover from the shock.
• In fact, there are instances wherein the organ damage
is irreversible.
• Severe hypovolemic shock could lead to death,
especially in the case of older adults.
43. COMPLICATIONS
• Heart attack
• Gangrene of the arms or legs due to lack of
blood supply
• Damage to vital organs of the body like the
brain and kidney
• Death
44. SUMMARY
• Determine the type of shock
• Immediate management of shock is universal
• Provide reassurance and comfort
• Maintain normal body temperature
• In most cases, elevate the feet and legs above
the level of the heart
• Control Bleeding
• Fluid Resucsitation
• Monitoring