GEMC - Medical Student - Trauma - Shock

Project: Ghana Emergency Medicine Collaborative
Document Title: Shock
Author(s): Patrick Carter (University of Michigan), MD 2012
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CLASS

I

II

III

IV

BVL

< 15%

15 - 30%

30 - 40%

> 40%

AMOUNT

750 cc

750 - 1500 cc

1500 - 2000 cc

> 2000 cc

PULSE

<100

> 100

>120

>140

BP

No change

Narrowed pulse
pressure

Consistent decrease
in SBP

Decreased SBP and
narrowed pulse pressure or
no DBP

RESP

No change

20-30

30-40

>35

CNS

No change

Anxiety

Anxious, confused

Confused. lethargic

Urine

>30cc per hr

20-30cc per hr

5-15cc per hr

negligible

TX

Replace fluid
loss

2L NS IV

2 L NS IV, usually requires
blood transfusion

Rapid transfusion of blood
and NS, requires immediate
intervention to stop
hemorrhage

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Rapid Response

Transient
Response

No Response

Vitals

Return to normal

Transient
Remain Abnormal
improvement with
return to previous

Estimated Blood
loss

10-20%

20-40% with
ongoing likely

Severe >40%

Need for more
Fluid

Low

High

High

Need for Blood

Type and cross

Type specific

O neg

Need for surgery

Possible

Likely

Highly likely

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B  9'5+3+<'2<"Q:=.<'2+3.2"?5'7<6'2<"
B  C@"2."5'+=.2+'"7n'5"#YA"i"CNdR"(.2+3D'5"+<75)2;"7"
*7+.=5'++.5"W4.5'=32'=-532'R"0.=7632'R"'<(X"72D"
)<57<'"<."^e9"
B  [.78b""^e9"o"SP"
B  >.2+3D'5"7D5'278"32+F`(3'2(:b""Q:D5.(.5)+.2'"!cc"
6;"CN"

AJ"

V758:"[.78"035'(<'D"?-'57=:"
B  ,'=)(",-.(/"?5'7<6'2<"e8;.53<-6R"H3*'5+"'<"78l"
4Vh^R"#cc!"

B  ,<FD:"<-7<"'G7632'D"F+'".@"72"'758:";.78"D35'(<'D"
<-'57=:"78;.53<-6"<."<5'7<"=7)'2<+"I3<-"+'=)("+-.(/"W7+"
D'12'D"%:"5'@57(<.5:"-:=.<'2+3.2".5"87(<7<'"o"JX"
B  #SA"=7)'2<+"572D.68:"7++3;2'D"<."'3<-'5"<5'7<6'2<"756"
.5"<."+<72D75D"5'+F+(3<7).2"756+"W!Ac"*+l"!AAX"
B  >.2<5.8"756"<5'7<'D"I3<-"+<72D75D"(75'"72D"7D63_'D"<."
C>j"
B  ?5'7<6'2<"756"@.88.I'D"=5.<.(.8"32"V0"@.5"S"-.F5+"72D"
<-'2"7D63_'D"<."C>j"

B  d32D32;+f$F<(.6'"

B  ?5'7<6'2<";5.F="5'('3*'D"6.5'"F3D+"(.6=75'D"<."
(.2<5.8";5.F="WP"i"*+l"AlP"iX"
B  AlU"D7:+"8'++"32"-.+=3<78"@.5"<5'7<6'2<";5.F="
B  #"@.8D"8'++"(75D3.=F86.275:"(.6=83(7).2+"@.5"<5'7<6'2<"
;5.F="
B  D&).2?&'#&8*12$0',0'+$#".),"7'$/'EFGFH'
AP"

V758:"[.78"035'(<'D"?-'57=:"

H3*'5+"V"'<"78l"V758:";.78YD35'(<'D"<-'57=:"32"<-'"<5'7<6'2<".@"+'*'5'"+'=+3+"72D"
+'=)("+-.(/"4"V2;8"h"^'Dl"#cc!bAJPb!ASUY!ATTl"
"

AS"

e27=-:87()(",-.(/"
B  e27=-:87G3+"

B  ,'*'5'"+:+<'63("
-:='5+'2+3)*3<:"5'7().2"
B  >-757(<'53g'D"%:"
6F8)+:+<'6"32*.8*'6'2<""
B  C;V"6'D37<'D"

B  e27=-:87(<.3D"5'7().2"

B  >8323(788:"32D3+)2;F3+-7%8'"
@5.6"727=-:87G3+"
B  0.'+"2.<"5'EF35'"7"
+'2+3)g32;"'G=.+F5'"

Justin Beck, Flickr

B  4.<"C;V"6'D37<'D"

AT"

e27=-:87()(",-.(/"O">8323(78"
^723@'+<7).2+"
•  >8323(78",='(<5F6"
–  d35+<",:6=<.6+b""

•  H3+/"@7(<.5+"@.5"@7<78"
727=-:87G3+""

–  95.;5'++3.2b""

•  H'.((F55'2('"57<'+"

–  ,'*'5'",:6=<.6+b"""

•  ^.+<"(.66.2"(7F+'+"

•  95F53<F+"
•  d8F+-32;"
•  j5)(7537"
• 
• 
• 
• 
• 

?-5.7<"@F882'++"
e2G3'<:"
>-'+<");-<2'++"
,-.5<2'++".@"%5'7<-"
i3;-<-'7D'D2'++"

•  e8<'5'D"6'2<78"+<7<F+"
•  H'+=357<.5:"D3+<5'++"
•  >35(F87<.5:"(.887=+'"

–  9..58:"(.2<5.88'D"7+<-67"""
–  95'*3.F+"727=-:87G3+""
"
–  JcYScp"@.5"32+'(<"+)2;+"
–  #cYJcp"@.5"57D3.(.2<57+<"
7;'2<+"
–  !cY#cp"@.5"='23(38832"
"
–  e2)%3.)(+"
–  C2+'(<+"
–  d..D""

AU"

e27=-:87()(",-.(/"Y"037;2.+3+"
•  >8323(78"D37;2.+3+"
–  0'12'D"%:"735I7:"(.6=5.63+'R"-:=.<'2+3.2R".5"
32*.8*'6'2<".@"(F<72'.F+R"5'+=357<.5:R".5"[C"+:+<'6+"
B  ^38DR"8.(783g'D"F5)(7537"(72"=5.;5'++"<."@F88"727=-:87G3+"
B  ,:6=<.6+"F+F788:"%';32"I3<-32"Sc"632F<'+".@"'G=.+F5'"
B  d7+<'5".2+'<".@"+:6=<.6+"L"6.5'"+'*'5'"5'7().2"
B  K3=-7+3("=5'+'2<7).2".((F5+"32"F="<."#cp".@"=7)'2<+"
B  ,:6=<.6+"I388"5'<F52"AYJ"-.F5+"7n'5"323)78"5'7().2"-7+"(8'75'D"

•  i../"@.5"'G=.+F5'"<."D5F;R"@..DR".5"32+'(<"
•  i7%+"-7*'"2."5.8'"

A]"

e27=-:87()(",-.(/"Y"?5'7<6'2<"
•  eK>q+"
–  H'+=357<.5:"(.6=5.63+'"5'EF35'"366'D37<'"
32<F%7).2"

• 
• 
• 
• 

CNR">75D37("^.23<.5R"9F8+'"$G36'<5:"
CNdq+R"$G:;'2"
V=32'=-532'"@.5"e27=-:87G3+f,-.(/"
,'(.2D"832'"?-'57=3'+"
–  >.5)(.+<'5.3D+"
–  Q!"72D"Q#"%8.(/'5+"
Jc"

e27=-:87()(",-.(/"Y"?5'7<6'2<"
•  V=32'=-532'"
–  clA"6;"C^".5",>".@"!b!ccc"D38F).2"@.5"727=-:87G3+""
–  H'='7<"'*'5:"PY!c"632"7+"2''D'D"
–  >7F).2"3@"=7)'2<".2"%'<7"%8.(/'5+"DF'"<."
F2.==.+'D"78=-7"+)6F87).2"72D"5'+F8<72<"+'*'5'"
-:='5<'2+3.2"
–  d.5">N"(.887=+'"W3l'l"(75D37("755'+<XR"!"6;"CN".@"
!b!cRccc"W+76'"7+"e>i,"0.+'X"
–  C@"5'@57(<.5:"-:=.<'2+3.2"72D"+-.(/R"+<75<"CN"D53="
J!"

e27=-:87()(",-.(/"Y"?5'7<6'2<"
•  >.5)(.+<'5.3D+"

–  ^'<-:8=5'D23+.8.2'"!#P"6;"CN""
–  95'D23+.2'"Sc"6;"9$"

•  e2)-3+<7632'+"

–  Q!"%8.(/'5Y"03=-'2-:D57632'"#PYPc"6;"CN"
–  Q#"%8.(/'5Y"H723)D32'"Pc"6;"CN"

•  K5.2(-.D387<.5+"

–  e8%F<'5.8"2'%F83g'5"
–  e<5.*'2<"2'%F83g'5"
–  ^7;2'+3F6"+F8@7<'"#";"CN".*'5"#c"632F<'+""

"
J#"

B  0'12'D"7+b"

>75D3.;'23(",-.(/"

B  ,K9"m"]c"66Q;"
B  >75D37("C2D'G"m"#l#"if6f6#"
B  9F86.275:">7=38875:"Z'D;'"
95'++F5'"W9>Z9X"o"!U"
66Q;"

Patrick J. Lynch, Wikimedia Commons

B  ^.5<783<:"=53.5"<."5'='5@F+3.2"
<-'57=:"L"PcYUcp"
B  ,3;2+b"
B 
B 
B 
B 
B 
B 
B 

>..8R"6._8'D"+/32"
?7(-:=2'7"
9F86.275:"*7+(F875"(.2;'+).2""
Q:=.<'2+3.2"
e8<'5'D"6'2<78"+<7<F+"
4755.I'D"=F8+'"=5'++F5'"
H78'+R"6F56F5"

JA"

>75D3.;'23(",-.(/""
•  >75D3.;'23(",-.(/"V).8.;:"
–  e(F<'"^:.(75D378"C2@75().2"We^CX"
–  ,'=+3+"
–  ^:.(75D3)+"
–  ^:.(75D378">.2<F+3.2"
–  e(F<'"e.5)("C2+F`(3'2(:"
–  e.5)(".@"^3<578",<'2.+3+"
–  Q:='5<5.=-3(">75D3.6:.=7<-:"
JJ"

>75D3.;'23(",-.(/"
•  $n'2"5'+F8<+"@5.6"6:.(75D378"3+(-'637"
I3<-"8.++".@"8'n"*'2<53(F875"WiNX"@F2().2"
–  >8323(78"+-.(/"'2+F'+"7n'5"8.++".@"Jcp"iN"

•  H'+F8)2;"(75D37(".F<=F<"5'DF().2"8'7D+"
<."87()("7(3D.+3+"72D"-:=.G37"
•  ,<5./'"*.8F6'"3+"5'DF('D""
–  ?7(-:(75D37"D'*'8.=+"7+"(.6='2+7).2"@.5"
D'(5'7+'D",N"<."6732<732"(75D37(".F<=F<""
–  C+(-'637"72D"32@75().2"I.5+'2+"(5'7)2;"
D.I2I75D"+=3578"
JP"

>75D3.;'23(",-.(/"Y"037;2.+3+"
•  Vt["
•  >MH"
•  i7%.57<.5:b""
–  >.6=8'<'"K8..D">.F2<"
–  >-'63+<5:"972'8"WV8'(<5.8:<'+R"Kj4f>HX"
–  >75D37("'2g:6'+"W^:.;8.%32R">tR">tY^KR"?5.=.232X"
–  >.7;F87).2"+<FD3'+"

•  V(-.(75D3.;576"
JS"

>75D3.;'23(",-.(/"Y"?5'7<6'2<"
•  ?5'7<6'2<"[.78+"

–  e35I7:"(.2<5.8"W3@"2'('++75:X"
–  C6=5.*32;"6:.(75D378"=F6="@F2().2"
–  H'='5@F+3.2"W3@"7*7387%8'X"
–  95'*'2)2;"@F5<-'5"6:.(75D378"D767;'"

•  ^.23<.532;""

–  >75D37("6.23<.5"
–  9F8+'"$G36'<5:"

•  ,F==8'6'2<78".G:;'2R"CN"7(('++"
•  C2<F%7).2"D'(5'7+'+"=5'8.7D"72D"(7F+'+"
-:=.<'2+3.2"""

–  ^7:"2''D"<.";3*'"F3D"%.8F+"<."(.6='2+7<'"3@"32<F%7)2;"
JT"

>75D3.;'23(",-.(/"Y"?5'7<6'2<"
•  e^C"

–  e+=3532R"K'<7Y%8.(/'5R"^.5=-32'R"Q'=7532"
–  43<5.;8:('532"@.5"=732"(.2<5.8"W7*.3D"32"32@'53.5"^CX"
–  C@"2."=F86.275:"'D'67R"67:"<5:"CN"F3D"@.5"K9"+F==.5<"
–  C@"=F86.275:"'D'67"
•  0.=7632'"O"I388"x"QH"72D"<-F+"(75D37("I.5/"
•  0.%F<7632'"O"^7:"D5.="%8..D"=5'++F5'"DF'"<."='53=-'578"
*7+.D387<7).2"
•  >.6%327).2"<-'57=:"67:"%'"6.5'"'a'()*'"

–  H'='5@F+3.2"?-'57=:"W3@",?V^C"72D"7*7387%8'"32"<-'"(8323(78"
+'y2;X"
•  >75D37("(7<-'<'53g7).2"I3<-"32<'5*'2).2""
•  ?-5.6%.8:)(+"

"

JU"

4'F5.;'23(",-.(/"
•  H'+F8<+"@5.6"+=3278"(.5D"32&F5:"I3<-"+-.(/"
87+)2;"@5.6"!YA"I''/+"
•  i.++".@"+:6=7<-')("<.2'"72D"5'+F8<72<"
F2.==.+'D"*7;78"<.2'"
•  0'(5'7+'D"*7+.6.<.5"<.2'""
•  H'+F8<+"32"-:=.<'2+3.2"72D"%57D:(75D37"
•  97)'2<+"67:"5'6732"78'5<R"I756R"72D"D5:"
D'+=3<'"<-'"-:=.<'2+3.2"
•  ,=3278"+-.(/"
–  ?'6=.575:"8.++".@"+=3278"5''G"7()*3<:"
%'8.I"7"<.<78".5"2'75"<.<78"+=3278"(.5D"
32&F5:"
–  4.<"<-'"+76'"7+"2'F5.;'23("+-.(/R"<-'"
<'56+"75'"2.<"32<'5(-72;'7%8'"

gunkyboy, Wikimedia Commons

J]"

4'F5.;'23(",-.(/Y"?5'7<6'2<"
•  eRKR>+"

–  H'6'6%'5">Y+=32'"=5'(7F).2+"
–  Q3;-">Y+=32'"32&F53'+"5'EF35'"6'(-723(78"*'2)87).2""
•  >AY>JY>P"O"9-5'23("4'5*'"322'5*7).2"

•  d8F3D"5'+F+(3<7).2"

–  t''="^e9"7<"UPY]c"66"Q;"@.5"15+<"T"D7:+"
–  ^32363g'"+'(.2D75:"(.5D"32&F5:"
–  C@"(5:+<788.3D"3+"32+F`(3'2<"F+'"*7+.=5'++.5+"

•  ,'75(-"@.5".<-'5"(7F+'+".@"-:=.<'2+3.2"

–  $n'2R",>C"5'+F8<+"@5.6"<57F67"L"5f."Q'6.55-7;3(",-.(/"

•  d.5"%57D:(75D37"
–  e<5.=32'"
–  97('67/'5""

Pc"

$%+<5F()*'",-.(/"
• 
• 
• 
• 

?'2+3.2"92'F6.<-.57G"
>75D37("?76=.27D'"
9F86.275:"V6%.83+6"
,'*'5'"e.5)(",<'2.+3+"

P!"

$%+<5F()*'",-.(/"
B  ?'2+3.2"=2'F6.<-.57G"
Delldot, Wikimedia Commons

Source:
www.meddean.luc.edu/lumenMedEd/medicine/
pulmonar/cxr/pneumo1.htm

B  e35"<57=='D"32"=8'F578"+=7('"I3<-"!"
I7:"*78*'R"735f=5'++F5'"%F38D+"F="
B  ^'D37+)2F6"+-3n'D"36='D32;"
*'2.F+"5'<F52"
B  >-'+<"=732R",$KR"D'(5'7+'D"%5'7<-"
+.F2D+"
B  4."<'+<+"2''D'Df(8323(78"D37;2.+3+"
B  ?5'7<6'2<b"4''D8'"D'(.6=5'++3.2"
@.88.I'D"%:"(-'+<"<F%'"
P#"

$%+<5F()*'",-.(/"
9'53(75D3F6"
K8..D"

V=3(75D3F6"
Aceofhearts1968, Wikimedia Commons

B  >75D37("<76=.27D'"
B  K8..D"32"='53(75D378"+7("=5'*'2<+"
*'2.F+"5'<F52"<."72D"(.2<57().2".@"
-'75<"
B  V).8.;:b""?57F67R"9'53(75D3)+R"^C"
B  K'(/q+"<537Db""
B  Q:=.<'2+3.2R"6Fz'D"-'75<"+.F2D+R"hN0"

B  037;2.+3+b"i75;'"-'75<">MHR"'(-."
B  ?5'7<6'2<b"9'53(75D3.('2<'+3+"

PA"

$%+<5F()*'",-.(/"
•  9F86.275:"'6%.83+6"
–  N35(-.I"<537Db""

•  Q:='5(.7;F87%8'"
•  N'2.F+"32&F5:"
•  N'2.+<7+3+"

–  ,3;2+b""

•  ?7(-:=2'7""
•  ?7(-:(75D37"
•  Q:=.G37"

–  i.I"53+/b"0YD36'5"
–  Q3;-'5"53+/b">?"(-'+<".5"Nk"
+(72"
–  ?5'7<6'2<b""Q'=7532"

Hellerhoff, Wikimedia Commons

•  >.2+3D'5"<-5.6%.8:)(+"3@"+-.(/"
@5.6"9V"
PJ"

$%+<5F()*'",-.(/"
B  e.5)("+<'2.+3+"
B  H'+3+<72('"<."+:+<.83("'&'().2"(7F+'+"D'(5'7+'D"
(75D37("@F2().2"
B  >-'+<"=732"I3<-"+:2(.='"
B  ,:+<.83("'&'().2"6F56F5"
B  0'123)*'"D37;2.+3+"I3<-"'(-."
B  N7+.D387<.5+"W4?[X"I388"D5.="=5'++F5'"
B  ?5'7<6'2<b"e.5)("*78*'"+F5;'5:"
PP"

Z-3(-"=5'++.5"+-.F8D"C"(-..+'r"
!  Q:=.*.8'63("+-.(/"
–  Fluids and Blood

!  >75D3.;'23("+-.(/"
–  Dobutamine - !1 agonist

! Increases squeeze and
heart rate

!  4'F5.;'23("+-.(/"
–  Fluids, phenylephrine, Levophed,
look for another type of shock if
it is persistent

!  e27=-:87()("+-.(/"
–  Fluids and epinephrine

!  ,'=)("+-.(/"
–  Neosynephrine - alpha agonist

! Increases SVR by
arteriolar constriction
–  Norepinephrine/Levophed - alpha
and beta agonists

!  0.=7632'"
–  Low Dose - increases renal blood
supply
–  Medium Dose - beta effects
(increases heart rate and squeeze)
–  High Dose - alpha effects
(arteriolar constriction)
PS"

kF'+).2+r"

Dkscully, Flickr
PT"

GEMC - Medical Student - Trauma - Shock

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