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

1. SHOCK AND
HAEMORRHAGE
HARSHITA
INTERN
A.B.C.O.N

2. SHOCK

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.

4. CAUSES
• Severe or extension injuries
• Severe burns
• Severe pain ; heart attack
• Electric shock

5. CAUSES
• Loss of blood
• Exposure to extreme heat and cold
• Poison taken internally
• Bites or stinges of poisonous snakes and
insects

6. EFFECTS OF SHOCK
• Early loss of consciousness that mainly
involves the nervous system and that may be
fatal.
• Progressive loss of blood from active circulation
which may leading to failing heart output and
insufficient oxygen to that are vital for survival.
• Sustained lower blood pressure which may
lead to liver and kidney failure.

7. HYPOVOLEMIC
Due to decreased circulating blood volume in
relation to the total vascular capacity and
characterized by a reduction of diastolic filling
pressures.

8. CAUSES
• Hypovolemic shock results from significant
blood or fluid losses in our body. Blood loss
of this magnitude can occur because of:
• Bleeding from cuts or wounds
• Bleeding from blunt traumatic injuries due to
accidents or seizure activity
• Internal bleeding from the
gastrointestinal tract or ruptured ectopic
pregnancy

9. CAUSES
In addition to actual blood loss, the loss of body
fluids can cause a decrease in blood volume.
blood in your body to drop. This can occur in
cases of:
• Excessive diarrhea
• Severe burns
• Protracted and excessive vomiting
• Excessive sweating

10. CLINICAL
MANISFESTATION
• Anxiety
• Blue lips and fingernails
• Low or no urine output
• Profuse sweating
• Shallow breathing
• Dizziness

11. CLINICAL
MANISFESTATION
• Confusion
• Chest pain
• Loss of consciousness
• Low blood pressure
• Rapid heart rate
• Weak pulse

12. CARDIOGENIC SHOCK
Due to cardiac pump failure related to loss of
myocardial contractility myocardium or
structural failure of the cardiac anatomy and
characterized by elevations of diastolic filling
pressures and volumes.

13. CAUSES
• Cardiogenic shock occurs whenever the heart
is unable to pump as much blood as the body
needs.
• The most common causes are serious heart
complications. Many of these occur during or
after a heart attack(myocardial infarction).

14. CAUSES
These complications include:
• A large section of heart muscle that no longer
moves well or does not move at all
• Breaking open (rupture) of the
heart muscle due to damage from the heart
attack
• Dangerous heart rhythms, such as ventricular
tachycardia, ventricular fibrillation,
or supraventricular tachycardia

15. CAUSES
• Pressure on the heart due to a build up of fluid
around it (pericardial tamponade)
• Tear or rupture of the muscles or tendons that
support the heart valves, especially the mitral
valve

16. CAUSES
• Tear or rupture of the wall (septum) between
the left and right ventricles (lower heart
chambers)
• Very slow heart rhythm (bradycardia) or
problem with the electrical system of the
heart (heart block)

17. CLINICAL
MANISFESTATION
• Chest pain or pressure
• Coma
• Decreased urination
• Fast breathing
• Fast pulse
• Heavy sweating, moist skin
• Light headedness

18. CLINICAL
MANISFESTATION
• Loss of alertness and ability to concentrate
• Restlessness, agitation, confusion
• Shortness of breath
• Skin that feels cool to the touch
• Pale skin color or blotchy skin
• Weak (thready) pulse
• Dysarrythmia

19. CIRCULATORY SHOCK
It is an inadequate blood flow throughout the
body. In the absence of mechanisms that
function to maintain blood pressure within a
normal range of values, blood pressure
decreases dramatically.

20. CIRCULATORY SHOCK
As a consequence, tissues can suffer from
damage as a result of too little delivery of
oxygen to cells. Severe circulatory shock can
damage vital body tissues to the extent that
death of the individual occurs.
This is divided into three types:

21. SEPTIC SHOCK
Septic shock is a medical condition as a result
of severe infection and sepsis, though the
microbe may be systemic or localized to a
particular site

22. CAUSES
• When bacteria or viruses are present in the
bloodstream, the condition is known
as bacteremia or viremia.
• Sepsis is a constellation of symptoms
secondary to infection that manifest as
disruptions in heart rate, respiratory rate,
temperature and WBC.

23. CLINICAL
MANISFESTATION
• High Cardiac Output
• Tachycardia
• Hyperthermia
• Nausea
• Vomiting
• Diarrhea
• Confusion
• Agitation

24. RISK FACTORS
• AGE (<1 and >65yrs.)
• Malnourishment
• Chronic illness
• Invasive procedure

25. NEUROGENIC SHOCK
Neurogenic shock is a distributive type
of shock resulting in hypotension, occasionally
with bradycardia, that is attributed to the
disruption of the autonomic pathways within the
spinal cord.

26. CAUSES
• Severe central nervous system damage (brain
injury, cervical or high thoracic spinal cord).
• In more simple terms: the trauma causes a
sudden loss of
background sympathetic stimulation to the
blood vessels. This causes them to relax
(vasodilation) resulting in a sudden decrease in
blood pressure (secondary to a decrease
in peripheral vascular resistance)

27. CLINICAL
MANISFESTATION
• Dry skin
• Hypo tension with bradycardia
• Hypothermia
• Central venous pressure is low due to
decreased systemic vascular resistance

28. ANAPHYLACTIC SHOCK
• An acute systemic allergic reaction
• The result of a re-exposure to an antigen that
elicits an IgE mediated response
• Usually caused by a common environmental
protein that is not intrinsically harmful

29. CAUSES
• Medication
• Foods
• Insects Stings
• Anti-bodies

30. CLINICAL
MANISFESTATION
• Peripheral vasodilation
– vascular permeablility (edema)
• Bronchospasm
• Cardiac arrhythmias
• Smooth muscle contractions

31. FACTORS INFLUENCING
SHOCK
• PAIN:- It increase severity of shock
• PHYSICAL CONDITION:-People who are
starved or exposed to extremes of cold or heat
go into shock easily.
• FATIGUE:- It increase severity of shock.
• DISEASES:-People having chronic disease
develop shock easily.

32. FACTORS INFLUENCING
SHOCK
• IMPROPER CARE/MOVEMENT:-Shock may
be increased by rough and by delay in
treatment

33. SIGNS
• Causality is anxious and restless.
• Weakness ; fatigue or giddiness
• Shallow ; rapid and gasping breathing
• Nausea; vomiting or extreme thirst
• Skin become pale ; cold calming sweating may
develop.

34. SYMPTOMS
• Pulse rate increases; but become weaker
• Shaking trembling arms and legs
• Blood pressure fail
• Unconsciousness may develop
• Any external or internal injury

35. MANAGEMENT
• FLUID REPLACEMENTTO RESTORE INTRA
VASCULAR VOLUME
FLUID REPLACEMENT IS ADMINISTER IN ALL
TYPE OF SHOCK.
THIS TYPE OF FLUID ADMINISTERED AND
THE SPEED OF DELIVERY VARY BUT
FLUIDS ARE ADMINISTERED TO IMPROVE
CARDIAC TISSUE OXYGENATION.

36. MANAGEMENT
• THE FLUID ADMINISTERED MAY BE
CRYSTALLOIDS
COLLOIDS
• COMMON IV FLUIDS USED ARE FOR
RSUSCITATION IN HYPOVOLEMIC SHOCK
INCLUDES 0.9%.

37. COMPLICATION
• CARE MUST BE TAKEN WHEN RAPID
ADMINISTRING ISOTONIC CRYSTALLOIDS
TO AVOID EXCESS EDEMA ;
PARTICULARLY PULMONARY EDEMA.
• CLOSE MONITRING OF PATIENT DURING
FLUID REPLACEMENTS NECESSARY TO
IDENTIFY SIDE EFFECTS .

38. COMPLICATION
• ADVENTITIOUS LUNG SOUNDS SUCH A
CRACKLES MAY INDICATE PULMONARY
EDEMA.

39. MANAGEMENT
VASO ACTIVE MEDICATION THERAPY
• ADMINSTERD IN ALL FORMS OF SHOCK TO
IMPROVE THE PATIENT HAEMODYNAMIC
STATUS.
• SELECTED FOR THEIR ACTION ON
RECEPTORS OF THE SYMPATHETIC
NERVOUS.

40. MANAGEMENT
• THESE RECEPTOR ARE RECEPTOR ARE :-
a)ALPHA- ADRENERGIC RECEPTOR
b)BETA-ADRENERGIC RECEPTOR

41. MANAGEMENT
• OTHER MEDICATION:-
I. ANTA ACIDS
II.H2 BLOCKERS
III.RANITIDINE
IV.PROTON PUMP INHIBITOR TO PREVENT
ULCERS

42. NUTRITIONAL THERAPY
• INCREASE ENERGY REQIREMENT AND
THERFORE CALORIE REQUIREMENT.
• PARENTRAL OR ENTERAL NUTRITIONAL
SUPPORT SHOULD BE INITIATED AS SOON
AS POSSIBLE.

44. EMERGENCY
MANAGEMENT
•REASSURE THE
CASUALITY

45. BODY POSITIONING

46. INCASE OF HEAD
INJURIES

47. •THE HEAD MAY NOT BE
ELEVATED IN CASE OF IF THERE
IN CASE OF MUCUS IN THROAT

49. 102;108 FOR AMBULANCE

50. DO NOT
• APPLY HOT WATER BOTTLE
• MOVE THE CASUALITY UNNECESSARILY
.THIS WILL INCREASE THE SHOCK.
• LET THE CASUALITY SMOKE
• GIVE CASUALITY BY MOUTH

52. HAEMORRHAGE

53. HAEMORRHAGE
BLEEDING TECHNICALLY KNOWN AS
HAEMORHAGING;IS THE LOSS OF BLOOD
ESCAPING FROM THE CIRCULATORY
SYSTEM. BLEEDING CAN OCCUR
INTERNALLY OR EXTERNALLY…….

54. TYPES
• ARTERIAL BLEEDING
• VENOUS BLEEDING
• CAPILLARY BLEEDING

55. ARTERIAL BLEEDING
• BLOOD IS BRIGHT RED IN COLOUR.
• IT SPURTS AT EACH CONTRACTION.
• FLOW IS PULSATIVE.

56. VENOUS BLEEDING
• BLOOD IS DARK RED IN COLOUR.
• IT DOES NOT SPURTS.
• SLOW BUT EVEN FLOW

57. CAPILLARY BLEEDING
• BLOOD IS RED IN COLOUR
• IT DOES NOT SPURTS
• SLOW BUT EVEN FLOW

59. EFFECT OF HEMORRHAGE
• LOSS OF RBC CAUSE LACK OF OXYGEN.
• A DECREASE IN BLOOD VOLUME CAUSE A
DECREASSE IN BP.
• THE HEART PUMPING RATE INCREASES
TO COMPENSATE FOR BLOOD PRESSURE.
• THE FORCE OF THE HEART BEAT IS
REDUCED SINCE THERE IS BLOOD TO
PUMP.

60. CLASSIFICATION
• EXTERNAL BLEEDING
• INTERNAL BLEEDING

61. EXTERNAL BLEEDING
EXTERNAL BLEEDING CAN BE OCCUR
EITHER THROUGH A NATURAL OPENING
SUCH AS THE MOUTH , NOSE , EAR ,
URETHRA, VAGINA, OR ANUS THROUGH A
BREAK IN THE SKIN.

63. SIGN AND SYMPTOMS
• THIRST
• BLURRING OF VISION
• FAINTING
• GIDDINESS
• PULSE BECOME FASTER BUT WEAKER
• RESTLESSNESS

64. SIGN AND SYMPTOMS
• BREATHING BECOME SHALLOW
• UNCONCIOUSNESS MAY OCCUR
• FACE AND LIPS BECOME PALE SKIN FEELS
COOL AND CALMMY

66. INTERAL BLEEDING
• HISTORY OF SUFFICIENT INJURY TO
CAUSE INTERNAL BLEEDING.
• WOUNDS THAT HAVE PNETRATED SKULL ;
CHEST; ABDOMEN.
• PAIN AND TENDERNESS AROUND THE
AFFFECTED AREA; SWELLING AND
TENSION MAY BE FELT.

67. SIGN AND SYMPTOMS
• BLOOD MAY APPEAR FROM ONE BODY
ORIFICES NOSE; EAR; MOUTH; RECTUM
etc.
• FRACTURE OF LONG BONE (ARM AND
THIGH)
• BLOOD OUTSIDE THE CIRCULATORY
SYSTEM IS VERY IRRITATING TO TISSUE.

68. SIGN AND SYMPTOMS
• INTR CRANIAL BLEEDING
• INTRA ABDOMINAL BLEEDING

70. GENERAL TREATMENT
• LIE THE VICTIM ; FLEX THE LEGIN SEMI-
FLEXED POSITION:-
I. MAINTAIN AIRWAY
II.CONTROL THE BLEEDING
• PREVENT LLOSSS OF BODY HEAT
• VICTIM SHOULD BE AT REST

71. BODY POSITIONING

72. MINOR EXTERNAL INJURY
• WASH YOUR HAND BEFORE DEALING WITH
WOUND(IF POSSIBLE)
• IF IT IS DIRTY LIGHTLY RINSE IT WITH
RUNNING WATER IF AVAILABLE
• SECURE WITH STERILE DRESSING(IF
POSSIBLE)
• ELEVATE THE INJURED PART

73. MAJOR EXTERNAL
INJURY
• DO NOT WASTE TIME HUNTING FOR A
DRESSSING
• APPLY PRESSURE BY A CLEAN CLOTH
• ELEVATE THE PART
• ARTERIAL BLEEDING CAN BE
CONTROLLED BY THUMB OR FINGER
PRESSURE

74. INTERNAL BLEEDING
• KEEP CASUALITY DOWN WITH HEAD LOW
• IF INJURY ALLOW RAISE THE LEG TO AID
THE RETURN OF BLOOD FLOW TO VITAL
ORGAN
• LOOSEN ANY CONSTRICTION CLOTHING
AROUND NECK; CHEST; AND WAIST.
• MINIMISE SHOCK

75. INTERNAL BLEEDING
• CHECK FOR
a) BREATHING
b) PULSE
c) LEVEL OF RESPONSIVENESS AT 10
MINUTES INTERVAL
• KEEP CASUALITY COVER

76. INTERNAL BLEEDING
DO NOT GIVE ANYTHING BY
MOUTH…………