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Hemorrhage & Shock CMSgt John Jonckers, RN, NREMT-P Superintendent 141 st  MDG SMEE - Thailand
Review of Hemorrhage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Review of Hemorrhage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Review of Hemorrhage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of Hemorrhage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock Inadequate peripheral perfusion leading to failure of tissue oxygenation    may lead to anaerobic metabolism
Shock ,[object Object],[object Object],[object Object],[object Object]
Fick Principle Air’s gotta go in and out. Blood’s gotta go round and round. Any variation of the above is not a good thing!
Shock ,[object Object],[object Object],[object Object]
AEROBIC METABOLISM Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid Oxidative phosphorylation: Each pyruvic acid is converted into 34 ATP 6 O 2 GLUCOSE METABOLISM 6 CO 2 6 H 2 O 36 ATP HEAT (417 kcal)
ANAEROBIC METABOLISM Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid GLUCOSE METABOLISM 2 LACTIC ACID 2 ATP HEAT (32 kcal)
Anaerobic Metabolism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maintaining perfusion requires: ,[object Object],[object Object],[object Object],[object Object]
Shock Classifications ,[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Compensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Compensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Compensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Compensated Shock ,[object Object],[object Object],[object Object]
Compensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Decompensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Decompensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Decompensated Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Irreversible Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Irreversible Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Shock Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Shock Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Key Issues In Shock ,[object Object],[object Object],[object Object],[object Object],Resuscitate Critical Tissues First!
Key Issues In Shock ,[object Object],Best indicator of resuscitation effectiveness = Level of Consciousness Restlessness, anxiety, combativeness = Earliest signs of shock
Key Issues In Shock ,[object Object],[object Object],[object Object]
Key Issues In Shock Isolated head trauma does  NOT  cause shock (“possible” in peds)
General Shock Management ,[object Object],[object Object],[object Object]
General Shock Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Shock Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Shock Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypovolemic Shock ,[object Object],[object Object],[object Object],[object Object]
Hypovolemic Shock ,[object Object],[object Object],[object Object]
Hypovolemic Shock ,[object Object],[object Object],Where does stabilization of critical trauma occur?
Cardiogenic Shock ,[object Object],[object Object]
Cardiogenic Shock ,[object Object],[object Object],[object Object]
Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock Management ,[object Object]
Vasogenic Shock ,[object Object],[object Object],[object Object]
Vasogenic Shock ,[object Object],[object Object],[object Object],[object Object]
Vasogenic Shock ,[object Object],[object Object]
Vasogenic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shock in Children ,[object Object],[object Object],[object Object],[object Object],[object Object]
Shock in Children ,[object Object],[object Object],[object Object],[object Object]

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Shock

  • 1. Hemorrhage & Shock CMSgt John Jonckers, RN, NREMT-P Superintendent 141 st MDG SMEE - Thailand
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  • 6. Shock Inadequate peripheral perfusion leading to failure of tissue oxygenation  may lead to anaerobic metabolism
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  • 8. Fick Principle Air’s gotta go in and out. Blood’s gotta go round and round. Any variation of the above is not a good thing!
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  • 10. AEROBIC METABOLISM Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid Oxidative phosphorylation: Each pyruvic acid is converted into 34 ATP 6 O 2 GLUCOSE METABOLISM 6 CO 2 6 H 2 O 36 ATP HEAT (417 kcal)
  • 11. ANAEROBIC METABOLISM Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid GLUCOSE METABOLISM 2 LACTIC ACID 2 ATP HEAT (32 kcal)
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  • 39. Key Issues In Shock Isolated head trauma does NOT cause shock (“possible” in peds)
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