Question

Case Study 2

Ms. L, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died. Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma. While en route by ambulance to the hospital, Ms. L complained of thirst and appeared restless. Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was slipping into circulatory shock as they checked her again for internal injuries.

Discussion Questions

1.      Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs. (See Shock—Neurogenic.)

2.      Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage, and as compensation mechanisms respond. (See Shock—Etiology.)

3.      Discuss emergency and follow-up treatment for shock and for complications that may arise if not treated quickly. (See Shock—Treatment.)

4.      Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.

Answer 1

1. The contributing factors to shock in this case is massive vasodilation due to stimulation of parasympathetic activity or inhibition of sympathetic activity .

Pathophysiological changes causing the changes in vital signs is primarily due to blockade of sympathetic nervous system leads to loss of arterial and venous tone with popling of blood in the dilated peripheral venous system, hence heart does not fill completely and cardiac output falls due to which there is rapid heart rate and respiration and decrease in blood pressure.

2. Sign and symptoms of shock along with rationale are :-

- cool and clammy skin = blood produces heat when there is deficiency of blood in the body ,body will become cold and clammy .

- pale skin = due to loss of blood skin becomes pale white .

- rapid pulse and breathing due to the blockade of sympathetic activity which leads to vasodilation and fall in cardiac output.

-enlarges pupils =due to activation of parasympathetic activity.

- weakness and fatigue = due to deficiency of blood oxygen supply to the organs are decreased hence metabolism is affected and patient feels tired .

- dizziness =due to decrease in blood pressure

- changes in mental status = due to deficiency of blood supply to the brain ,oxygen supply is also affected and hence leads to altered mental status and increased intracranial cranial pressure.

When patient is treated with IV fluid and multiple transfusions ,the recovery of the sign and symptoms occurs such as normal blood pressure, normal skin colour and temperature , mentally stable etc.

3. Emergency and follow up treatment are :-

- Main treatment is to correct the underlying cause like if there is bleeding from cut then appling pressure or doing surgery or suturing to stop bleeding

- Positioning the patient to Trendelenburg position assists in fluid redistribution.

- Atleast two IV lines are inserted to administer fluid , medications ,and blood .

- Ringer lactate ,0.9%normal saline are administered to restore intravascular volume .

- if fluid administration fails then vasoactive medications that prevent cardiac failure are given

- Blood products are only given if other alternatives are unavailable .

In follow up :-

- monitoring patients vital signs

- monitor for cardiovascular overload , pulmonary edema , arterial blood gas

- monitoring of fluid intake and output

- reduce fear and anxiety

Complications are:-

If proper treatment is not provided quickly then it will lead to various serious complications due to deficiency in blood supply to vital organs :-

- Irreversible brain damage

- Cardiac arrest

4. Types of shock are :-

- Hypovolemic shock = due to deficiency of blood volume

- Septic shock = circulatory shock caused by infection.

- Cardiogenic shock = caused by deceased blood supply to heart and heart problems.

- Neurogenic shock = type of shock due to sudden loss of signals from sympathetic nervous system.

- Anaphylactic shock = caused by allergic reaction.

No significant changes in the manifestations.