Bleeding-and-Shock出血与休克课件

SHOCKInadequateperfusion(bloodflow)leadingtoinadequateoxygendeliverytotissues1SHOCKInadequateperfusionPhysiologyBasicunitoflife=cellCellsgetenergyneededtostayalivebyreactingoxygenwithfuel(usuallyglucose)Nooxygen,noenergyNoenergy,nolife2PhysiologyBasicunitoflife=CardiovascularSystemTransportsoxygen,fueltocellsRemovescarbondioxide,wasteproductsforeliminationfrombodyCardiovascularsystemmustbeabletomaintainsufficientflowthroughcapillarybedstomeetcell’soxygenandfuelneeds3CardiovascularSystemTransportFlow=PerfusionAdequateFlow=AdequatePerfusionInadequateFlow=InadequatePerfusion(Hypoperfusion)Hypoperfusion=Shock4Flow=PerfusionAdequateFlowWhatisneededtomaintainperfusion?PumpPipesFluidHeartBloodVesselsBlood5WhatisneededtomaintainperHowcanperfusionfail?PumpFailurePipeFailureLossofVolume6Howcanperfusionfail?PumpFaTypesofShockandTheirCauses7TypesofShockandTheirCauseCardiogenicShockPumpfailureHeart’soutputdependsonHowoftenitbeats(heartrate)Howharditbeats(contractility)Rateorcontractilityproblemscausepumpfailure8CardiogenicShockPumpfailureCardiogenicShockCausesAcutemyocardialinfarctionVerylowheartrates(bradycardias)Veryhighheartrates(tachycardias)Whywouldahighheartratecauseddecreasedoutput?Hint:Thinkaboutwhentheheartfills.9CardiogenicShockCausesWhywoNeurogenicShockLossofperipheralresistanceSpinalcordinjuredVesselsbelowinjurydilateWhathappenstothepressureinaclosedsystemifyouincreaseitssize?10NeurogenicShockLossofperiphHypovolemicShockLossofvolumeCausesBloodloss:traumaPlasmaloss:burnsWaterloss:Vomiting,diarrhea,sweating,increasedurine,increasedrespiratorylossIfasystemthatissupposedtobeclosedleaks,whathappenstothepressureinit?11HypovolemicShockLossofvolumPsychogenicShockSimplefainting(syncope)Causedbystress,pain,frightHeartrateslows,vesselsdilateBrainbecomeshypo-perfusedLossofconsciousnessoccursWhattwoproblemscombinetoproducehypoperfusioninpsychogenicshock?12PsychogenicShockSimplefaintiSepticShockResultsfrombody’sresponsetobacteriainbloodstreamVesselsdilate,become“leaky”Whattwoproblemscombinetoproducehypoperfusioninsepticshock?13SepticShockResultsfrombody’AnaphylacticShockResultsfromsevereallergicreactionBodyrespondstoallergenbyreleasinghistamineHistaminecausesvesselstodilateandbecome“leaky”Whattwoproblemscombinetoproducehypoperfusioninanaphylaxis?14AnaphylacticShockResultsfromShock:

SignsandSymptomsRestlessness,anxietyDecreasinglevelofconsciousnessDulleyesRapid,shallowrespirationsWhyarethesesignsandsymptomspresent?Hint:ThinkhypoperfusionNausea,vomitingThirstDiminishedurineoutput15Shock:

SignsandSymptomsRestlShock:

SignsandSymptomsHypovolemiawillcauseWeak,rapidpulsePale,cool,clammyskinCardiogenicshockmaycause:Weak,rapidpulseorweak,slowpulsePale,cool,clammyskinNeurogenicshockwillcause:Weak,slowpulseDry,flushedskinSepsisandanaphylaxiswillcause:Weak,rapidpulseDry,flushedskinCanyouexplainthedifferencesinthesignsandsymptoms?16Shock:

SignsandSymptomsHypo

Shock:SignsandSymptomsPatientswithanaphylaxiswill:Develophives(urticaria)ItchDevelopwheezinganddifficultybreathing(bronchospasm)Whatchemicalreleasedfromthebodyduringanallergicreactionaccountsfortheseeffects?17Shock:Shock:

SignsandSymptomsShockisNOTthesamethingasalowbloodpressure!AfallingbloodpressureisaLATEsignofshock!18Shock:

SignsandSymptomsShocTreatmentSecure,maintainairwayApplyhighconcentrationoxygenAssistventilationsasneededKeeppatientsupineControlobviousbleedingPreventlossofbodyheat19TreatmentSecure,maintainairwTreatmentElevatelowerextremities8to12inchesinhypovolemicshockDoNOTelevatethelowerextremitiesincardiogenicshockWhythedifferenceinmanagement?20TreatmentElevatelowerextremiTreatmentAdministernothingbymouth,evenifthepatientcomplainsofthirst21TreatmentAdministernothingbyBleedingSignificanceIfuncontrolled,cancauseshockanddeath22BleedingSignificanceIfuncontIdentificationofExternalBleedingArterialBleed

BrightredSpurtingVenousBleedDarkredSteadyflowCapillaryBleedDarkredOozing

Whatisthephysiologythatexplainsthedifferences?23IdentificationofExternalBleControlofExternalBleedingDirectPressureglovedhanddressing/bandageElevationArterialpressurepoints24ControlofExternalBleedingDiArterialPressurePointsUpperextremity:BrachialLowerextramity:Femoral25ArterialPressurePointsUpperInternalBleedingCanoccurdueto:TraumaClottingdisordersRuptureofbloodvesselsFractures(injurytonearbyvessels)26InternalBleedingCanoccurdueInternalBleedingCanresultinrapidprogressiontohypovolemicshockanddeath27InternalBleedingCanresultinInternalBleedingAssessmentMechanism?Signsandsymptomsofhypovolemiawithoutobviousexternalbleeding28InternalBleedingAssessment28InternalBleedingSignsandSymptomsPain,tenderness,swelling,discolorationatinjurysiteBleedingfromanybodyorifice29InternalBleedingSignsandSymInternalBleedingSignsandSymptomsVomitingbrightredbloodorcoffeegroundmaterialDark,tarrystools(melena)Tender,rigid,ordistendedabdomen30InternalBleedingSignsandSymInternalBleedingManagementOpenairwayHighconcentrationoxygenAssistventilationsControlexternalbleedingStabilizefracturesTransportrapidlytoappropriatefacility31InternalBleedingManagement31Bleeding-and-Shock出血与休克课件Bleeding-and-Shock出血与休克课件SHOCKInadequateperfusion(bloodflow)leadingtoinadequateoxygendeliverytotissues34SHOCKInadequateperfusionPhysiologyBasicunitoflife=cellCellsgetenergyneededtostayalivebyreactingoxygenwithfuel(usuallyglucose)Nooxygen,noenergyNoenergy,nolife35PhysiologyBasicunitoflife=CardiovascularSystemTransportsoxygen,fueltocellsRemovescarbondioxide,wasteproductsforeliminationfrombodyCardiovascularsystemmustbeabletomaintainsufficientflowthroughcapillarybedstomeetcell’soxygenandfuelneeds36CardiovascularSystemTransportFlow=PerfusionAdequateFlow=AdequatePerfusionInadequateFlow=InadequatePerfusion(Hypoperfusion)Hypoperfusion=Shock37Flow=PerfusionAdequateFlowWhatisneededtomaintainperfusion?PumpPipesFluidHeartBloodVesselsBlood38WhatisneededtomaintainperHowcanperfusionfail?PumpFailurePipeFailureLossofVolume39Howcanperfusionfail?PumpFaTypesofShockandTheirCauses40TypesofShockandTheirCauseCardiogenicShockPumpfailureHeart’soutputdependsonHowoftenitbeats(heartrate)Howharditbeats(contractility)Rateorcontractilityproblemscausepumpfailure41CardiogenicShockPumpfailureCardiogenicShockCausesAcutemyocardialinfarctionVerylowheartrates(bradycardias)Veryhighheartrates(tachycardias)Whywouldahighheartratecauseddecreasedoutput?Hint:Thinkaboutwhentheheartfills.42CardiogenicShockCausesWhywoNeurogenicShockLossofperipheralresistanceSpinalcordinjuredVesselsbelowinjurydilateWhathappenstothepressureinaclosedsystemifyouincreaseitssize?43NeurogenicShockLossofperiphHypovolemicShockLossofvolumeCausesBloodloss:traumaPlasmaloss:burnsWaterloss:Vomiting,diarrhea,sweating,increasedurine,increasedrespiratorylossIfasystemthatissupposedtobeclosedleaks,whathappenstothepressureinit?44HypovolemicShockLossofvolumPsychogenicShockSimplefainting(syncope)Causedbystress,pain,frightHeartrateslows,vesselsdilateBrainbecomeshypo-perfusedLossofconsciousnessoccursWhattwoproblemscombinetoproducehypoperfusioninpsychogenicshock?45PsychogenicShockSimplefaintiSepticShockResultsfrombody’sresponsetobacteriainbloodstreamVesselsdilate,become“leaky”Whattwoproblemscombinetoproducehypoperfusioninsepticshock?46SepticShockResultsfrombody’AnaphylacticShockResultsfromsevereallergicreactionBodyrespondstoallergenbyreleasinghistamineHistaminecausesvesselstodilateandbecome“leaky”Whattwoproblemscombinetoproducehypoperfusioninanaphylaxis?47AnaphylacticShockResultsfromShock:

SignsandSymptomsRestlessness,anxietyDecreasinglevelofconsciousnessDulleyesRapid,shallowrespirationsWhyarethesesignsandsymptomspresent?Hint:ThinkhypoperfusionNausea,vomitingThirstDiminishedurineoutput48Shock:

SignsandSymptomsRestlShock:

SignsandSymptomsHypovolemiawillcauseWeak,rapidpulsePale,cool,clammyskinCardiogenicshockmaycause:Weak,rapidpulseorweak,slowpulsePale,cool,clammyskinNeurogenicshockwillcause:Weak,slowpulseDry,flushedskinSepsisandanaphylaxiswillcause:Weak,rapidpulseDry,flushedskinCanyouexplainthedifferencesinthesignsandsymptoms?49Shock:

SignsandSymptomsHypo

Shock:SignsandSymptomsPatientswithanaphylaxiswill:Develophives(urticaria)ItchDevelopwheezinganddifficultybreathing(bronchospasm)Whatchemicalreleasedfromthebodyduringanallergicreactionaccountsfortheseeffects?50Shock:Shock:

SignsandSymptomsShockisNOTthesamethingasalowbloodpressure!AfallingbloodpressureisaLATEsignofshock!51Shock:

SignsandSymptomsShocTreatmentSecure,maintainairwayApplyhighconcentrationoxygenAssistventilationsasneededKeeppatientsupineControlobviousbleedingPreventlossofbodyheat52TreatmentSecure,maintainairwTreatmentElevatelowerextremities8to12inchesinhypovolemicshockDoNOTelevatethelowerextremitiesincardiogenicshockWhythedifferenceinmanagement?53TreatmentElevatelowerextremiTreatmentAdministernothingbymouth,evenifthepatientcomplainsofthirst54TreatmentAdministernothingbyBleedingSignificanceIfuncontrolled,cancauseshockanddeath55BleedingSignificanceIfuncontIdentificationofExternalBleedingArterialBleed

BrightredSpurtingVenousBleedDarkredSteadyflowCapillaryBleedDarkredOozing

Whatisthephysiologythatexplainsthedifferences?56IdentificationofExternalBleControlofExternalBleedingDirectPressureglovedhanddressing/bandage