Paramedic Field Guide

Shock Review

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Chapter 1

Objectives

Definition, goals & key concepts

Learning Objectives

Ontario Base Hospital Group — 2014 Curriculum

Upon completion you should be able to:

Define shock and distinguish it from hypotension

Classify the types of shock (S.H.O.C.K. mnemonic)

Describe the pathophysiology and clinical features of each type

Identify prehospital situations where shock should be anticipated

Definition of Shock

A clinical state of widespread reduction of tissue perfusion resulting in:

Inadequate oxygenation at a cellular level

Inadequate removal of toxic metabolic by-products → cellular death if prolonged

Key words: perfusion and oxygenation

⚕ Clinical Vignette

Hypotension and shock are NOT synonymous. A BP of 90/50 may be normal for one patient while a BP of 120/70 may represent shock in a normally hypertensive patient who is now vasoconstricted and cyanotic. Assess the entire clinical picture.

CPR Refresher

Compression : Ventilation

30:2

Regardless of officer numbers

Rate100–120 /min

Depth≥ 5 cm

Hand placement2 hands — lower sternum

CPR if pulse< 40 BPM

Advanced airway6–10 breaths/min (continuous compressions)

ALS Medications

Epinephrine1 mg IV/IO q3–5 min

Amiodarone300 mg IV/IO (refractory VF/VT)

Lidocaine1–1.5 mg/kg IV/IO (alt)

Magnesium1–2 g IV (torsades)

Sodium Bicarb1 mEq/kg IV (hyperK/TCA)

Peds GuideALS PCS v5.4

Enter patient weight (0.5 – 149 kg)

Enter patient weight to calculate doses