Obstructive Shock
| Specialty | Critical Care |
| Causes | Tension pneumothorax; cardiac tamponade; ... |
| Diagnostic method | Thorough history and physical exam; EKG; |
| Differential diagnosis | Cardiogenic shock; hypovolemic shock; di ... |
What are the signs and symptoms of obstructive shock?
Obstructive shock: Signs and Symptoms. Dependent on cause: Dyspnea Rapid, weak pulse Rapid, shallow breaths Decreased lung compliance Unilateral, decreased or absent breath sounds Decreased blood pressure Jugular vein distention Subcutaneous emphysema Cyanosis Tracheal deviation to unaffected side
What is the initial treatment for shock?
Then immediately take the following steps:
- Lay the person down and elevate the legs and feet slightly, unless you think this may cause pain or further injury.
- Keep the person still and don't move him or her unless necessary.
- Begin CPR if the person shows no signs of life, such as not breathing, coughing or moving.
How to treat obstructive shock?
- Obviously, if this is a new spinal cord injury you’ll work with your team to stabilize the spine. ...
- IV fluids to help restore preload
- Vasopressors to support the blood pressure
- Treat bradycardia as needed
What are the treatment options for shock?
- Examine the person visually but do not touch them. ...
- Call 911 or have someone else call 911
- Check for a source of electricity and turn it off if possible. ...
- When you are sure you will be safe from electrical shock, check the victim's breathing and pulse. ...
Do you give fluids for obstructive shock?
In this case, giving fluids can improve right heart filling. However, in other causes of obstructive shock, too much fluid can worsen cardiac output. Thus, fluid therapy should be monitored closely. After these stabilizing measures, further treatment depends on the cause.
What is a common treatment for shock?
Seek emergency medical care Lay the person down and elevate the legs and feet slightly, unless you think this may cause pain or further injury. Keep the person still and don't move him or her unless necessary. Begin CPR if the person shows no signs of life, such as not breathing, coughing or moving.
What are signs of obstructive shock?
Obstructive ShockLow blood pressure can happen quickly, but the body will be trying to compensate (unlike neurogenic shock)Rapid pulse.Unequal breath sounds (if caused by a pneumothorax)Trouble breathing.
How do you treat a tension pneumothorax shock?
Treatment of a tension pneumothorax requires emergent needle decompression, usually performed by placing a sterile needle in the second intercostal space along the midclavicular line. Definitive treatment requires thoracostomy tube placement [3, 5].
What causes obstructive shock?
Obstructive shock is caused by the inability to produce adequate cardiac output despite normal intravascular volume and myocardial function. Causative factors may be located within the pulmonary or systemic circulation or associated with the heart itself.
What are 3 treatments for shock?
Shock TreatmentCall 911.Lay the Person Down, if Possible.Begin CPR, if Necessary.Treat Obvious Injuries.Keep Person Warm and Comfortable.Follow Up.
What's the difference between cardiogenic and obstructive shock?
In cardiogenic shock, the contractility is impaired; but in obstructive shock, the heart is prevented from contracting appropriately. Common causes of obstructive shock are cardiac tamponade, tension pneumothorax, congenital heart malformations, and pulmonary embolism.
What is obstructive shock EMT?
Obstructive shock occurs when there is a physical obstruction in the heart or blood flow that causes a decrease in cardiac output. A common cause of obstructive shock is cardiac tamponade.
What is the immediate treatment for pneumothorax?
Treatment of tension pneumothorax is immediate needle decompression by inserting a large-bore (eg, 14- or 16-gauge) needle into the 2nd intercostal space in the midclavicular line. Air will usually gush out.
How is emergency pneumothorax treated?
Emergency treatment of pneumothorax is bed rest, oxygen therapy, observation, simple aspiration, closed intercostal tube drainage and tube thoracostomy.
How is a closed pneumothorax treated?
Treatment options may include observation, needle aspiration, chest tube insertion, nonsurgical repair or surgery. You may receive supplemental oxygen therapy to speed air reabsorption and lung expansion.
What is obstructive shock?
Obstructive shock refers to the anatomical obstruction of the great vessels of the heart (e.g., superior vena cava, inferior vena cava, and pulmona...
What causes obstructive shock?
There are two major causes of obstructive shock: a blockage of the pulmonary vascular system, thereby affecting the blood flow from the right-sided...
What are the signs and symptoms of obstructive shock?
Individuals with obstructive shock typically experience respiratory distress and may present with tachycardia, hypotension, tachypnea, air hunger (...
How is obstructive shock diagnosed and treated?
Obstructive shock can be diagnosed based on a thorough review of the individual’s medical history and physical examination. A detailed respiratory...
What are the most important facts to know about obstructive shock?
Obstructive shock refers to the anatomical blockage of the great vessels of the heart, leading to decreased venous return, increased afterload, and...
How to treat shock from aortic dissection?
Treatment for an aortic dissection and vena cava syndrome in an emergency situation is to perform surgery by removing the portion of torn aorta or vena cava and replacing it with a graft.
What causes obstructive shock?
As previously stated, obstructive shock occurs when there is an obstruction, which causes a decreased amount of blood to get to the heart. Several diseases or disorders can cause obstructive shock, such as: 1 Aortic dissection: the large blood vessel attached to the heart tears and cannot transport blood to and from the heart effectively 2 Tension pneumothorax: air leaks out of the lungs due to trauma 3 Vena cava syndrome: a major vein in the body becomes blocked and cannot carry blood from the body to the heart 4 High blood pressure: pulmonary or systemic hypertension 5 Pulmonary embolism: blood clot in the lungs 6 Heart lesions: obstruct the flow of blood from the heart 7 Cardiac tamponade: a pressure on the heart that keeps it from filling, which decreases blood pressure
What is the term for a large blood vessel attached to the heart that cannot transport blood to and from the heart?
Aortic dissection: the large blood vessel attached to the heart tears and cannot transport blood to and from the heart effectively. Tension pneumothorax: air leaks out of the lungs due to trauma. Vena cava syndrome: a major vein in the body becomes blocked and cannot carry blood from the body to the heart.
Why are obstructive shocks considered emergencies?
The symptoms of obstructive shock are considered emergencies because they can lead to organ failure, tissue death, and death. Symptoms that are associated with neurological function include confusion, loss of consciousness, and inability to concentrate.
How old is Dave from the aortic aneurysm?
Dave is a sixty-five-year old man who has a history of an aortic aneurysm. He has been followed closely by his doctor to monitor the condition. He's taking medications and has been trying to alter his lifestyle to make healthier choices. However, Dave recently went on vacation and forgot his medications, ate a bad diet, and was not paying attention to his health. Dave is now having severe chest pain and shortness of breath. He's at home with his wife and suddenly loses consciousness. Dave's wife immediately calls for an ambulance.
What is the best treatment for obstructive shock?
Heart lesions. Cardiac tamponade. The best way to treat obstructive shock is to treat the cause. However, initial treatment of shock includes medication and high volumes of intravenous fluid to increase the blood pressure.
What is the treatment for tamponade?
The preferred treatment for cardiac tamponade is a procedure called a pericardiocentesis.
What causes a blockage in the heart muscle?
Vena cava syndrome. In the case of vena cava syndrome, blood is actually blocked from entering into the heart muscle to be oxygenated and pumped into other parts of the body. This blockage is typically caused by a cancerous tumor that must be removed immediately. Talk to your doctor to learn more about obstructive shock causes.
Why is obstructive shock a two way street?
Obstructive shock is a two-way street in the sense that the heart might either not be receiving a sufficient supply of blood due to an external blockage in the body, or it might not be pumping a sufficient supply of blood to the other organs due to a blockage within its own vessels. There are a few different potential causes ...
What to do if you are in obstructive shock?
The first thing you should do if you or someone in your vicinity is enduring obstructive shock is to get yourself or the person to the hospital as soon as possible. Never drive yourself to the hospital, especially if you’re feeling faint or lightheaded. Always ask someone else to take you. Administer basic CPR to the person who’s experiencing obstructive shock until medical help arrives to try to get their heart to pump blood again.
Why is the heart unable to pump blood to other parts of the body?
The heart’s ventricles are kept constricted rather than expanding as they’re supposed to, and therefore the heart is unable to pump blood to other parts of the body. This lack of blood supply can cause the other organs to go into potentially fatal obstructive shock and eventually fail.
How to help someone with obstructive shock?
Administer basic CPR to the person who’s experiencing obstructive shock until medical help arrives to try to get their heart to pump blood again. Employ your absolute best efforts to keep the person conscious and keep checking their pulse and circulation.
What to do if you notice someone exhibiting the abovementioned symptoms while out in public?
If you notice anyone exhibiting the abovementioned symptoms while out in public, make sure to call 9-1-1 immediately and stay by their side. Your assistance could help save a life. Related: Cardiogenic shock: Causes, symptoms, diagnosis, treatment, and prevention. 19 foods that increase blood flow. Advertisement.
What happens when the heart is not filled with blood?
Without regular diastolic filling, the heart can’t adequately perform its cardiac functions, which means that fresh supplies of blood won’t be pumped to the other organs in the body.
What is tamponade shock?
Tamponade physiology is classified under obstructive shock. It is most common after penetrating trauma. Pericardial fluid (blood) compresses the myocardium and inhibits diastolic filling. Patients may develop cardiogenic shock as the myocardium is stressed against the obstruction. Clinical signs of tamponade physiology include distended neck veins, muffled heart tones, and hypotension. This constellation of findings is called Beck’s triad. One may also identify an abnormal peripheral pulse called pulsus paradoxus. This is when the systolic blood pressure decreases >10 mm Hg during inspiration. As a result, the radial, brachial, or femoral pulse is weakened or disappears momentarily. Distended jugular veins from a rise in venous pressure with inspiration is called Kussmaul’s sign. An exaggerated drop in diastolic central venous pressure is known as Friedreich’s sign. Definitive treatment is evacuation of the pericardial blood and repair of the myocardium via a sternotomy or anterolateral thoracotomy. Temporizing measures include pericardiocentesis with aspiration of blood. Leaving a flexible catheter with a three-way stopcock can be useful to frequently aspirate blood based on physiologic demands while transferring to definitive care.
What is the importance of echocardiography?
Echocardiography is of particular value in detecting the presence of pericardial effusion and can provide clues about the presence of tamponade. In rapid tamponade caused by hemorrhage, as in trauma, shock dominates the picture. Left untreated, it leads to electromechanical dissociation.
What causes obstructive shock?
Obstructive shock is caused by the inability to produce adequate cardiac output despite normal intravascular volume and myocardial function. Causative factors may be located within the pulmonary or systemic circulation or associated with the heart itself.
When should pericardiocentesis be performed?
Pericardiocentesis should be performed as soon as possible if the patient is considered to be in a life-threatening condition. Pericardiocentesis is a blind procedure; introduction of the needle should be monitored by echocardiography whenever possible. The subxiphoid approach is generally preferable (see Chapter 15 ).
What is the effect of auto-peep on the heart?
Auto-PEEP impairs venous return to the heart, increases risk of barotrauma to the lungs, and can increase the patient’s work of breathing while impeding their ability to trigger the ventilator.48 Short respiratory cycles, high minute volumes, and obstructive lung disease predispose a patient to auto-PEEP.
What is shock physiology?
Shock is a dynamic physiologic state that is the final end point for various disease processes. Hypovolemic, cardiogenic, distributive, and obstructive shock are the major physiologic mechanisms by which we define shock. However, a combination of these mechanisms may play a role in individual patients with shock.
What causes shock in trauma?
Circulation. Shock in trauma is due to hypovolemia until proved otherwise. Other causes, such as obstructive shock (due to tension pneumothorax) or neurogenic shock (due to spinal cord transection or spinal vasoparesis), must be excluded.
What is obstructive shock?
Obstructive shock is a form of shock associated with physical obstruction of the great vessels or the heart itself. Pulmonary embolism and cardiac tamponade are considered forms of obstructive shock.
Is CO decreased in obstructive shock?
In obstructive shock, CO is decreased, CVP is elevated, SVR is increased, and PAOP is increased which is similar to cardiogenic shock. Obstructive shock can most easily be differentiated from cardiogenic shock by considering the greater clinical picture in the context of the PA catheter data (or echocardiography)
Why does pneumothorax cause pleural pressure?
Causes of tension pneumothorax in children include trauma, asthma, cystic fibrosis, pneumonia and excessive positive pressure during manual or mechanical ventilation. Once a tension pneumothorax occurs air can continue to accumulate within the pleural space but cannot escape.
Why does obstructive shock occur in children?
The most common causes of obstructive shock in children are tension pneumothorax, pulmonary embolism, and cardiac tamponade. There are also several congenital abnormalities that can cause obstructive shock.
What is the best treatment for pulmonary embolism?
The primary treatment for pulmonary embolism is anticoagulant therapy , but since anticoagulant therapy does not act immediately, fibrinolytic therapy should be considered for severe cases of pulmonary embolism.
What is a tamponade in the heart?
Cardiac Tamponade is the accumulation of fluid or blood within the pericardial sac. As fluid accumulates, the increased pressure decreases venous return to the heart and causes right ventricular compression which results in a progressive decline in right ventricular end-diastolic volume.
What is the treatment for tamponade?
The primary treatment for cardiac tamponade is pericardiocentesis. If cardiac tamponade is suspected and the patient is not in cardiac arrest, expert consultation should take place. If cardiac arrest is ongoing or impending and cardiac tamponade is suspected, emergency pericardiocentesis can be performed.
What causes a pulmonary embolism?
Common causes of pulmonary embolism include blood clots (most prevalent), air, and fat. Children who have existing risk factors are at higher risk for pulmonary embolism.
What are the components of obstructive shock?
The following should be considered: positioning, airway and breathing, vascular access, fluid resuscitation, monitoring, frequent reassessment, lab studies, medication therapy, and expert consultation.
