EASY Shock Review for NREMT — Transcript

Full transcript

1. 0:00We're talking about shock. Shock by
2. 0:02definition is one of the worst states
3. 0:04that we can be in. Why is that? It's
4. 0:07because all the cells in our body need
5. 0:11blood, need perfusion, need nutrients
6. 0:15like oxygen in order to survive. In
7. 0:18shock, we have something called
8. 0:21hypoperfusion.
9. 0:23Simply put, your body is not getting
10. 0:26enough oxygen to the cells. So, here it
11. 0:30is. Shock is inadequate
12. 0:33cellular perfusion. The cells are
13. 0:36starving for what they need.
14. 0:39Oxygen, blood, nutrients. This process
15. 0:43is called hypoperfusion.
16. 0:46Now, the next part. There are three
17. 0:49components to adequate, good perfusion
18. 0:54in the body.
19. 0:55So, I'm standing in front of you now. If
20. 0:57I'm saying I have good perfusion right
21. 0:59now, there are three main things our
22. 1:02body's doing.
23. 1:03Number one, my heart as a pump. What
24. 1:07this means. Now, the main function of
25. 1:10the heart as a pump is to pump blood
26. 1:13around the body. The heart allows all
27. 1:17the nutrients, all the oxygen, all the
28. 1:19blood to be pumped around the body.
29. 1:21That's what the heart's primary job is.
30. 1:24So, in order to have adequate, good
31. 1:26perfusion, I need my heart to be working
32. 1:29properly. If my heart is in heart
33. 1:31failure or I have a heart attack, I'm at
34. 1:34risk of going into shock cuz I can't get
35. 1:38nutrients around my body cuz my pump is
36. 1:41failing. Second piece, the blood vessels
37. 1:44themselves. So, you may have heard about
38. 1:45the blood vessel as the container. Well,
39. 1:48it is. The blood vessel is the container
40. 1:50for our blood, our circulatory system,
41. 1:53right? So, what this means,
42. 1:56if I am abnormally
43. 1:59vasodilated
44. 2:01which is one of the type of shocks that
45. 2:02we're going to talk about, right? If
46. 2:04that happens
47. 2:06my blood pressure is going down and my
48. 2:09ability to get blood to where I need it
49. 2:12to go
50. 2:14is not going to be as strong.
51. 2:15Right? Right. So, the blood vessel in
52. 2:18themselves as the container are they
53. 2:20constricted? Are they dilated? That can
54. 2:23be part of the issue of are we in shock
55. 2:26or not?
56. 2:27And the last step is the blood itself.
57. 2:30Do we have enough volume in our body?
58. 2:33What is the integrity of the blood that
59. 2:35we have? Is it lacking oxygen for
60. 2:38example, right? Uh are we bleeding out,
61. 2:41right? Do we have enough volume in the
62. 2:43body?
63. 2:44So, the way I like to look at it is
64. 2:46how is our ability to get blood around
65. 2:48the body?
66. 2:50What's going on inside my blood vessels
67. 2:53and how is the blood itself? These three
68. 2:55factors will determine
69. 2:57if
70. 2:58you are hypoperfused or not. Now, we're
71. 3:01just getting started. Come on, let's go.
72. 3:06Cardiogenic shock is pump failure.
73. 3:09So, what are the two main things? We can
74. 3:11have a heart attack. That is called in
75. 3:14medicine a myocardial
76. 3:16infarction. Myo, that's going to be
77. 3:19muscle.
78. 3:20Cardio, they cardiac, the heart.
79. 3:22Infarction means death. That's a heart
80. 3:24attack. That can cause cardiogenic
81. 3:26shock. The other we need to be thinking
82. 3:28about is diseases, right? We have an
83. 3:31acute injury, we talked about that, but
84. 3:32diseases.
85. 3:33So, the disease like you can have in
86. 3:35your history, congestive heart failure,
87. 3:38and have a flare-up of that, cause you
88. 3:40to call 911, right? So, what this means
89. 3:44cardiogenic shock, inadequate heart
90. 3:46function, pump failure, can be caused by
91. 3:49disease, CHF, or acute injury for
92. 3:52example, now what do we get
93. 3:55when we have an acute injury, when we
94. 3:57have CHF occur? What is it we get? We're
95. 3:59going to hear rails, aka crackles,
96. 4:02bilaterally. Here's a heart is failing
97. 4:04as a pump. This is what heart failure
98. 4:06looks like. We get pulmonary edema. What
99. 4:08that is. Pulmonary edema is fluid
100. 4:11accumulating
101. 4:13on the same area, the alveoli,
102. 4:16where gas exchange occurs, where the
103. 4:18carbon dioxide leaves and oxygen comes
104. 4:22in. So we have poor gas exchange. Well,
105. 4:24think about it. We know that our SPO2 is
106. 4:26going to be much lower, right?
107. 4:29The other thing we will see is, again,
108. 4:30this is a big key. We're talking about
109. 4:31heart blood flow. Remember this. Blood
110. 4:34backs up. Blood is backing up into, in
111. 4:39this case, the fluid on the alveoli.
112. 4:42Poor gas exchange. JVD. Some other signs
113. 4:45you'll see, right?
114. 4:46Now, remember this here.
115. 4:48It when this happens, cardiogenic shock,
116. 4:50we're having a decrease in our cardiac
117. 4:54output. And when we look at cardiac
118. 4:56output, we're thinking about how good is
119. 4:58our preload?
120. 5:00What's going on with our afterload? And
121. 5:02also the contractility. What is the
122. 5:04strength of the heart? In this case, we
123. 5:07have a failing heart.
124. 5:11Obstructive shock means we have a
125. 5:15process, an event going on in the body
126. 5:17that is causing circulation
127. 5:21to be obstructed. That's all it is.
128. 5:24There's three main events, three main
129. 5:27emergencies that cause obstructive shock
130. 5:31you got to know. The first is cardiac
131. 5:35tamponade.
132. 5:36Cardiac tamponade is when we have an
133. 5:39accumulation of fluid of injury around
134. 5:44the outside of the heart, where the
135. 5:46heart basically, it doesn't have enough
136. 5:49room to make its normal contraction.
137. 5:53It's being squeezed, being tight. So,
138. 5:55instead of pumping normally, it has less
139. 5:57space and it can't pump effective. If we
140. 6:00fix the cardiac tamponade, the injury,
141. 6:03the event, then guess what? Blood flow
142. 6:06will go back to normal. Next is tension
143. 6:08pneumothorax.
144. 6:09In tension pneumothorax, we have one of
145. 6:12our lungs that is collapsed and there's
146. 6:16air
147. 6:17around due to the injury, due to trauma,
148. 6:20usually due to trauma.
149. 6:23We have air surrounding a collapsed
150. 6:24lung.
151. 6:25And this is causing circulation issue in
152. 6:28our body. Now, the next one other
153. 6:32obstructed is pulmonary embolism, which
154. 6:35is a large obstruction to our pulmonary
155. 6:39artery tracts.
156. 6:42So, with these, if we can fix these,
157. 6:46then our blood flow will be restored. We
158. 6:48don't fix it,
159. 6:50shock will continue. So, the main thing
160. 6:52with obstructive, remember,
161. 6:55it is obstructing blood flow
162. 6:57of the normal circulation. There it is.
163. 7:02Now, distributive shock is the one with
164. 7:05the four subtypes. So, here it is.
165. 7:08Distributive shock has four main
166. 7:10subtypes and I'm going to break them
167. 7:11down for you.
168. 7:12The biggest thing to remember about
169. 7:13distributive shock is
170. 7:16this is the type of shock
171. 7:19with vasodilation.
172. 7:22Abnormal,
173. 7:23extensive vasodilation.
174. 7:26This is why you may have heard about a
175. 7:31patient who is septic and they're giving
176. 7:34and they're going to give them
177. 7:35epinephrine to help raise their blood
178. 7:37pressure. Cuz the body cannot compensate
179. 7:41like in other shocks like in hypovolemic
180. 7:45when it has a distributive shock problem
181. 7:48going on. This is the big key.
182. 7:52The blood vessels just picture the blood
183. 7:53vessels going
184. 7:55shh
185. 7:55and then what happens? Blood pressure
186. 7:58down, right? So, let's get into more
187. 8:01some details here. The four subtypes,
188. 8:04septic shock, neurogenic,
189. 8:07anaphylactic, psychogenic shock.
190. 8:11So, let me explain these. First,
191. 8:14septic shock has to do with a widespread
192. 8:18infection in your body. Some common ones
193. 8:22you'll see, pneumonia,
194. 8:24UTI,
195. 8:26very common pathways for sepsis to occur
196. 8:30and when it gets really bad, we end up
197. 8:32in
198. 8:33septic shock with that abnormal
199. 8:35vasodilation. And we have a widespread
200. 8:37infection throughout our entire
201. 8:38bloodstream. That's sepsis. Now, the
202. 8:41next piece we're going to talk about,
203. 8:43another type of distributive shock,
204. 8:45anaphylactic. Anaphylactic
205. 8:48shock is a severe allergic reaction.
206. 8:52If I have a simple allergic reaction,
207. 8:54let's just say one body system gets
208. 8:55affected. So, let's just say I have
209. 8:57hives
210. 8:58and nothing else is bothering me. That's
211. 9:00a simple allergic reaction. Let's say I
212. 9:03have wheezing and I'm vomiting and I
213. 9:06have hives. Why talk to you about my
214. 9:08skin, my lungs, and my GI system? That's
215. 9:12three body systems. So, the rule,
216. 9:16two or more body systems affected by an
217. 9:19allergen, that's anaphylaxis.
218. 9:22When it gets bad enough to be called
219. 9:24shock,
220. 9:26anaphylactic shock,
221. 9:28right? When we have
222. 9:30that hypoperfusion,
223. 9:32which obviously it's we all understand,
224. 9:34we have a low blood pressure, obviously,
225. 9:36in shock.
226. 9:37Now, psychogenic. What is that?
227. 9:41So, psychogenic shock.
228. 9:43These words need to be in your head.
229. 9:45When I say psychogenic shock, I'm
230. 9:47talking about someone who's
231. 9:49fainted, who's passed out, who it had a
232. 9:52syncope.
233. 9:54So, what this means. Usually, not always
234. 9:58though. If we have someone who is passed
235. 10:00out and they have a syncope, right? And
236. 10:02they've fainted. We want to evaluate
237. 10:05them for everything.
238. 10:06Right? Of course. Cuz there's so many
239. 10:08things that can cause you to pass out.
240. 10:09Yes.
241. 10:10But, in this particular case,
242. 10:12psychogenic shock
243. 10:15it could be someone receiving bad news.
244. 10:17It could be someone when they see a
245. 10:19needle, they pass out.
246. 10:21It's basically a flash of vasodilation
247. 10:24and they pass out. That's psychogenic.
248. 10:26And that's why I call psychogenic
249. 10:28event-related because usually it's bad
250. 10:31news, a bad event someone's life causing
251. 10:34them to pass out. That flash of
252. 10:36vasodilation. That's psychogenic. Now,
253. 10:39neurogenic is trauma.
254. 10:41Neurogenic is trauma meaning I have
255. 10:44severe trauma to my spinal cord. I have
256. 10:47a spinal cord injury. That's neurogenic.
257. 10:49So, that is how we define all
258. 10:52distributive shock.
259. 10:55Now, with hypovolemic shock, this is
260. 10:58your classic I'm bleeding out
261. 11:00hypovolemic shock. Right.
262. 11:03Now, but don't forget these sneaky ones.
263. 11:06What if I have a GI bleed?
264. 11:08What if I have a trauma and I have an
265. 11:10internal bleed?
266. 11:12What if I am severely dehydrated? That's
267. 11:15all under the hypovolemia pathway. Now,
268. 11:18here we go. Medical terminology. Hypo
269. 11:21what? It's going to be low, right?
270. 11:22Volemia, I have low volume.
271. 11:25Hypovolemic shock, low volume shock.
272. 11:28Means our circulating blood, where is
273. 11:31it?
274. 11:32We're low. That's all what it is. That
275. 11:34breaks down.
276. 11:35If you as long as you remember these
277. 11:38pathways, that don't always remember
278. 11:41about could this be internal bleed,
279. 11:42could this be dehydration, you know,
280. 11:44what's that what's the history of the
281. 11:46event? As long as you remember those,
282. 11:47you'll be good.
283. 11:51Now to paint a picture for you, there's
284. 11:54three main stages of shock, but we can
285. 11:57really only see two of them. Compensated
286. 12:00shock then leads to decompensated shock.
287. 12:03Then there's something called
288. 12:03irreversible shock. Let me explain.
289. 12:06So we our body first enters shock,
290. 12:09there's a compensation stage where the
291. 12:11body tries to compensate for the bad
292. 12:14event that's going on to the body. So
293. 12:17what's going to happen? Our respirations
294. 12:19increase. We get agitated. We get
295. 12:22anxious. We're maybe feeling doom and
296. 12:24gloom, right? That's what the patient
297. 12:26will be going through.
298. 12:27Restlessness, right? Now what else?
299. 12:30Heart rate up, respirations up, right?
300. 12:33What's the big key here?
301. 12:35Altered mental status. This is
302. 12:37compensated shock. So at this point our
303. 12:40blood pressure hasn't completely failed
304. 12:41us yet. We're not hypotensive yet. We're
305. 12:44headed that way very soon.
306. 12:46In decompensated shock, all this stuff
307. 12:49to try to keep our blood volume
308. 12:50together, keep the heart pumping,
309. 12:53like maintain our volume, it fails.
310. 12:55Decompensated shock,
311. 12:58the big hallmark sign is the blood
312. 13:00pressure being hypotensive.
313. 13:04At this stage, instead of being altered,
314. 13:06we're starting to slipping into
315. 13:07unresponsiveness,
316. 13:09right? We're on that right on the edge
317. 13:11here and decompensated.
318. 13:13Now, irreversible shock, there's no way
319. 13:15to know when someone has crossed that
320. 13:16line. One thing that I will say is you
321. 13:19may be feeling this patient is going to
322. 13:21be near arrest
323. 13:23or in a coma-like state, that would be
324. 13:26irreversible shock, right? So, these are
325. 13:29the three stages of shock you're going
326. 13:30to hear about. I just want to give you a
327. 13:32quick overview on that there.
328. 13:34Now, the final point I want to make
329. 13:35about treatment with shock, the
330. 13:38treatment of shock is going to determine
331. 13:40what kind of shock that you have. So,
332. 13:42for example,
333. 13:44if we're in cardiogenic shock and
334. 13:46someone's having a heart attack, we fix
335. 13:48the shock by fixing the heart attack and
336. 13:50going through that pathway.
337. 13:52If we're in anaphylaxis, for example, we
338. 13:54have to do something to fix their
339. 13:55anaphylaxis, right? So, for example,
340. 13:58with anaphylaxis, we're going to need to
341. 13:59do EpiPen, right? We don't give aspirin
342. 14:01to somebody having a heart attack. You
343. 14:02see what I'm saying? So, the big thing
344. 14:04with shock to remember is figuring out
345. 14:06what type of shock do we think that
346. 14:08we're in, then try to pinpoint, well,
347. 14:10why are they in this shock, and then
348. 14:12using that EMS treatment plan that we
349. 14:15have
350. 14:17to try to fix and combat that problem.
351. 14:20And then the shock will then with it if
352. 14:23they're in this state of compensated or
353. 14:25decompensated, hopefully we can get them
354. 14:27out of it. And the biggest thing with
355. 14:29shock
356. 14:30is early recognition so you don't enter
357. 14:33here. And there it is.
358. 14:35Now, a lot of you asked in the comments
359. 14:37about how to prepare for school, how to
360. 14:39get through school, and how to pass
361. 14:41NREMT. The first link in the description
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367. 15:01practice quizzes, our community group.
368. 15:04What I do in the video vault is take all
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370. 15:09school at NREMT, and I break them down
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