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15.

1 Key Terms
15.2 Explain the pathophysiology of shock (hypoperfusion), including the
consequences of cellular hypoxia and death.
15.3 Describe the physiology of maintaining adequate perfusion.
15.4 Describe how inadequate vascular volume, inadequate heart function, and
decreased peripheral vascular heart function, and decreased peripheral vascular
resistance can lead to shock.
15.5 Give examples of conditions that can lead to:
a) Loss of vascular volume
b) Inadequate heart function
c) Decreased peripheral vascular resistance
15.6 Explain the mechanisms and pathophysiology of each of the following
categories and types of shock:
a) Hypovolemic (hemorrhagic and nonhemorrhagic)
b) Distributive (anaphylactic, septic, neurogenic)
c) Cardiogenic
d) Obstructive
e) Metabolic or respiratory
15.7 Explain how compensatory mechanisms to shock are maintained through:
a) Direct nerve stimulation
b) Release of hormones
15.8 Explain the bodys compensatory responses to hypoperfusion and how they
manifest in the early signs and symptoms of shock.
15.9 Differentiate between early (compensatory) and late
(decompensatory/irreversible) signs of shock.
15.10 Describe the progression of shock through the compensatory,
decompensatory (progressive), and irreversible stages.
15.11 Explain how to identify the patient who is in a shock state and demonstrate
the assessment of patients to identify shock.
15.12 Explain the influence of age on the assessment and management of patients
with shock.
15.13 Discuss the goals of prehospital management of patients with shock.
15.14 Describe the pathophysiology of cardiac arrest.
15.15 Differentiate between the electrical, circulatory, and metabolic phases of
cardiac arrest.
15.16 Identify situations in which resuscitative attempts should be withheld.
15. 17 Explain each of the links in the Chain of Survival of cardiac arrest for the
adult and pediatric patient.
15.18 Explain the importance of early defibrillation in cardiac arrest.
15.19 Explain the rationale for the push hard and push fast approach to
cardiopulmonary resuscitation (CPR).
15.20 Describe the features, functions, advantages, disadvantages, use, and
precautions in the use of automated external defibrillators (AEDs).
15.21 Compare and contrast ventricular fibrillation, ventricular tachycardia,
asystole, and pulseless electrical activity.
15.22 Given a series of cardiac arrest scenarios involving infants, children, and
adults, demonstrate appropriate assessment and resuscitative techniques, including

the integrated us of AEDs (automated and semi automated), ventilation, and CPR,
and explain the purpose and procedure for reassessment of the cardiac arrest
patient.
15.23 Demonstrate assessment and management of a post-cardiac arrest patient
with return of spontaneous circulation.
15.24 Given a cardiac arrest scenario, make decision regarding obtaining advanced
cardiac life support (ACLS).
15.25 Describe the safety precautions to be taken to protect yourself, other EMS
providers, the patient, and bystanders in resuscitation situations.
15.26 Explain the importance of AED maintenance, EMT training and skills
maintenance, and medical direction in the Chain of Survival of cardiac arrest.
15.27 Discuss special considerations in the use of an AED in patients with cardiac
pacemakers and automatic implanted cardioverter-defibrillators.
15.28 List the advantages and disadvantages of automated chest compression
devices, impedance threshold devices, and other circulation-enhancing devices
Anaphylactic shock: a shock (hypoperfusion) state that results from dilated and
leaking blood vessels related to sever allergic reactions, also called anaphylaxis or
anaphylactic reaction.
Asystole: a heart rhythm indicating absence of any electrical activity in the heart,
also know flat line.
Automated external defibrillator: a device that can analyze the electrical activity or
rhythm of a patients heart and deliver an electrical shock (defibrillation) if
appropriate.
Burn shock: a form of nonhemorrhagic hypovolemic shock resulting from a burn
injury.
Cardiac arrest: the cessation of cardiac function with the patient displaying no
pulse, no breathing, and unresponsiveness.
Cardiogenic shock: poor perfusion resulting from an ineffective pump function of the
heart, typically the left ventricle.
Chain of survival: a series of five interventions, or links, identified by the American
Heart Association as those that provide the best chance for successful resuscitation
of a cardiac arrest patient. The five links of the adult chain are immediate
recognition and activation, early CPR, rapid defibrillation, effective advanced life
support, and integrated post-cardiac-arrest, early high-quality CPR performed by
bystanders, rapid activation of EMS or other emergency medical responders,
effective advanced life support and rapid transport to an appropriate medical
facility, and integrated post-cardiac-arrest care.
Compensatory shock: the stage of shock in which a cascade of organ and gland
stimulation and hormones occurs to increase the blood pressure, restore arterial
wall tension, and maintain a near normal blood pressure and perfusion of the vital
organs. Also called compensative shock.
Decompensatory shock: an advanced stage of shock in which the bodys
compensatory mechanisms are no longer able to maintain a blood pressure and
perfusion of the vital organs. Also called decompensated shock or progressive
shock.

Defibrillation: electrical shock or current delivered to the heart through the patients
chest wall or internally from an implanted device to help the heart restore a normal
rhythm.
Distributive shock: shock associated with a decrease in intravascular volume caused
by massive systemic vasodilation and an increase in the capillary permeability.
Downtime: the time from when the patient goes into cardiac arrest until CPR is
effectively being performed.
Hemorrhagic hypovolemic shock: shock from the loss of whole blood from the
intravascular space, often called just hemorrhagic shock.
Hypoperfusion: shock.
Hypovolemic shock: shock caused by the loss of blood or fluid from the
intravascular space resulting in a low blood volume.
Irreversible shock: the stage of shock in which interventions are unable to prevent
the advance of shock to death.
Neurogenic shock: a type of distributive shock that result from massive vasodilation.
Also called vasogenic shock.
Nonhemorrhagic hypovolemic shock: shock caused by loss of fluid form the
intravascular space with red blood cells and hemoglobin remaining within the
vessels.
Obstructive shock: a poor perfusion state resulting from a condition that obstructs
forward blood flow.
Pulseless electrical activity (PEA): a condition in which the heart generates relatively
normal electrical rhythms but fails to perfused the body adequately because of
decreased or absent cardiac output from cardiac muscle or blood loss.
Resuscitation: bring a patient back from a potential or apparent death; an attempt
to restore normal or adequate physiological function.
Return of spontaneous circulation (ROSC): return of spontaneous pulse during the
cardiac resuscitation.
Septic shock: a type of distributive shock caused by an infection that releases
bacteria or toxins into the blood.
Shock: the insufficient delivery of oxygen and other nutrients to some of the body
cells and inadequate elimination of carbon dioxide and other wastes that results
from inadequate circulation of blood. Also called hypoperfusion.
Sudden death: the death of a patient within one hour of the onset of signs and
symptoms.
Survival: term applied to a patient who survives cardiac arrest to be discharged
from the hospital
Total downtime: the total time from when a patient goes into cardiac arrest until he
is delivered to the emergency department.
Unwitnessed cardiac arrest: for the purposes of emergency medical services and
provision of resuscitation and defibrillation, a cardiac arrest, with a patient already
unresponsive, apneic, and pulseless, when EMS arrives on the scene.
Ventricular fibrillation (VF or V-Fib): a continuous, uncoordinated, chaotic rhythm
that does not produce pulses.
Ventricular tachycardia (VT or V-Tach): a very rapid heart rhythm that may or may
not produce a pulse and is generally to fast to adequately perfuse the bodies
organs.

Witnessed cardiac arrest: for the purposes of emergency medical services and
provision of resuscitation and defibulation, a cardiac arrest in which an EMT and
other emergency responder witnesses the patient become unresponsive, apneic,
and pulseless (does not refer to a layperson witnessing the patient collaple).

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