Special Considerations and Variations & Practice Scenarios and Self-Assessment

Different types of shock require modified approaches while maintaining basic treatment principles.

Shock in Children:

Unique Aspects:

- Compensate longer than adults - Crash suddenly when decompensating - Normal vital signs misleading - Smaller blood volume - Higher metabolic needs

Modified Approach:

- Lower threshold for concern - Don't wait for obvious signs - Monitor more frequently - Prevent hypothermia aggressively - Comfort items helpful

Pediatric Warning Signs:

- Irritability or lethargy - Poor feeding - Decreased wet diapers - Sunken fontanelle (babies) - Delayed capillary refill

Elderly Patients:

Special Challenges:

- Less physiologic reserve - Medications affect response - Multiple medical problems - Atypical presentations - Higher mortality

Considerations:

- May not mount typical response - Beta-blockers prevent increased heart rate - Blood pressure normally higher - Confusion may be baseline - Need aggressive treatment

Pregnant Women:

Unique Physiology:

- Increased blood volume - Can lose more blood before symptoms - Two patients to consider - Positioning critical - Different normal vitals

Modified Treatment:

- Position on left side - Don't lie completely flat - Wedge under right hip - Monitor fetal movement - Rapid transport essential

Environmental Shock Factors:

Heat-Related:

- Dehydration component - Vasodilation worsens shock - Cool gradually - Monitor temperature - Higher fluid losses

Cold-Related:

- Hypothermia worsens shock - Vasoconstriction masks signs - Rewarm gradually - Handle gently - Monitor for afterdrop

Multiple Casualty Situations:

Triage Priorities:

- Treat shock patients first - Quick interventions - Delegate if possible - Reassess frequently - Document on patients

Regular practice improves recognition and treatment speed. Work through these scenarios.

Scenario 1: Post-Accident Shock

You witness a bicycle accident. The rider seems okay initially but 10 minutes later is pale, sweaty, and says he feels dizzy.

Your Actions:

1. Recognize developing shock 2. Have him lie down immediately 3. Call 911 4. Elevate legs 5. Check for hidden injuries 6. Cover with jacket 7. Monitor vital signs 8. Reassure constantly

Key Recognition:

- Delayed onset common - Don't dismiss symptoms - Internal injuries possible

Scenario 2: Severe Allergic Reaction

Restaurant patron develops hives, wheezing, and says "I feel like I'm going to die" after eating.

Your Actions:

1. Call 911 for anaphylaxis 2. Ask about EpiPen 3. Help administer if available 4. Position sitting up (breathing issue) 5. Loosen tight clothing 6. Monitor airway 7. Prepare for CPR 8. Get allergen info

Critical Points:

- Anaphylactic shock is rapid - Epinephrine is life-saving - Airway can close quickly

Scenario 3: Hidden Internal Bleeding

Elderly woman falls down stairs. She insists she's fine but looks pale and complains of abdominal pain.

Your Actions:

1. Suspect internal bleeding 2. Convince her to lie down 3. Call 911 immediately 4. Elevate legs carefully 5. Cover with blankets 6. Monitor vitals q5min 7. Note any bruising 8. Keep NPO

Important Lessons:

- Elderly have less reserve - Falls can cause internal bleeding - Don't let patient refuse care

> Practice This Now: > Monthly shock drills: > - Practice vital sign checks > - Time your response > - Practice positioning > - Teach family members > - Review different types