Читать книгу Emergency Medical Services - Группа авторов - Страница 178

All treatment approaches to shock must include the following basic principles:

1 Perform the initial assessment.

2 Deal with issues identified during the initial assessment such as airway, breathing, and circulation issues, including active external bleeding.

3 Determine the need for early definitive care:hemorrhage control and volume resuscitationneedle thoracostomyelectrical therapy for dysrhythmiainvasive airway management.

4 Maintain adequate oxygen saturation (SaO2 greater than 94%).

5 Ensure adequate ventilation without hyperventilating.

6 Monitor vital signs, ECG, oxygen saturation, capnography, and lactate (if available).

7 Prevent additional injury or exacerbation of existing medical conditions.

8 Protect the patient from the environment.

9 Determine the etiology of the shock state and treat accordingly.

10 Notify and transport to an appropriate facility.

Often the etiology of the patient’s shock state and the initial management options are clear from the history. For example, the out‐of‐hospital treatment of a young, previously healthy college student with hypotension secondary to severe vomiting and diarrhea includes intravenous (IV) fluids. The treatment of cardiogenic shock in an unresponsive elderly patient with ventricular tachycardia requires prompt cardioversion. Occasionally, the primary problem may be strongly suspected but not readily diagnosable or treatable in the field (e.g., pulmonary embolism). Less frequent, but most difficult to manage, is the patient in shock without an obvious cause. With the understanding of the limited treatment options in the prehospital setting (primarily fluids, inotropic agents, and vasopressors), field treatment may be individualized for the four categories of shock: hypovolemic, distributive, obstructive, and cardiogenic.