国际创伤生命支持ITLS-05-休克的评估及处理Chapter8_Shock_SC.pptVIP

NOTE: This slide is setup slide for next with progression. TALK ABOUT REFILL HERE—demo next slide. Prolonged capillary refill time was previously thought to be very useful for detecting early shock. The test is suspicious for shock if blanched area remains pale for longer than 2 seconds. Scientific evaluation of this test has shown it to have a high correlation with late shock but to be of little value for detecting early shock. Test was associated with both frequent false-positive and false-negative results. Low blood volume, cold temperatures, and catecholamine-induced vasoconstriction can all cause decreased perfusion of capillary bed in skin, and thus cause abnormal results. Measurement of capillary refill is useful for small children in whom it is difficult to get an accurate blood pressure, but it is of little use for detecting early shock in adults. * NOTE: Progression * When confronted with patient with an elevated pulse rate, try to determine underlying cause. * NOTE: “~” (tilde) means approximately. Heart delivers oxygen and nutrients to cells of body by way of blood vessels. Cells “burn” nutrients in presence of oxygen to produce energy, water, and carbon dioxide (CO2). Water and CO2 move into bloodstream, CO2 being carried to lungs by red blood cells for excretion during exhalation. CO2 then is exhaled by-product of metabolism. When measured moment to moment at airway, level of CO2 being excreted may be graphed as a waveform. Falling measured CO2 indicates either that patient is hyperventilating (from anxiety or acidosis) or that amount of oxygen being supplied to cells is falling. Patients in shock have decreased oxygen being supplied to their cells. Thus, if you are monitoring a patient who appears to be in shock or at risk of going into shock, monitor level of exhaled CO2. A level of exhaled CO2 that falls much under 40—especially if it falls into 20s or below—may be an indication of circulatory collapse and thus can be an additional warning sign of