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    Module 10: Shock Recognition: TCCC Tier 4 TCCC Tier 1 TCCC Tier 3

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    Luis-alfredo Perez Bolde Hernandez
    1) Shock is inadequate blood flow to tissues that occurs when blood volume is too low, leading to organ failure and death if not treated. 2) Signs of shock include confusion, weak pulse, pale skin, excessive thirst, and rapid breathing. 3) The best indicators of shock for tactical care are decreased consciousness and weak or absent radial pulse. 4) Controlling bleeding is critical to preventing shock; reassess that all hemostatic measures remain effective. Monitor the casualty for worsening shock signs.

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    Module 10: Shock Recognition: TCCC Tier 4 TCCC Tier 1 TCCC Tier 3

    Uploaded by

    Luis-alfredo Perez Bolde Hernandez
    41 views18 pages
    1) Shock is inadequate blood flow to tissues that occurs when blood volume is too low, leading to organ failure and death if not treated. 2) Signs of shock include confusion, weak pulse, pale skin, excessive thirst, and rapid breathing. 3) The best indicators of shock for tactical care are decreased consciousness and weak or absent radial pulse. 4) Controlling bleeding is critical to preventing shock; reassess that all hemostatic measures remain effective. Monitor the casualty for worsening shock signs.

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    1) Shock is inadequate blood flow to tissues that occurs when blood volume is too low, leading to organ failure and death if not treated. 2) Signs of shock include confusion, weak pulse, pale skin, excessive thirst, and rapid breathing. 3) The best indicators of shock for tactical care are decreased consciousness and weak or absent radial pulse. 4) Controlling bleeding is critical to preventing shock; reassess that all hemostatic measures remain effective. Monitor the casualty for worsening shock signs.

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    41 views18 pages

    Module 10: Shock Recognition: TCCC Tier 4 TCCC Tier 1 TCCC Tier 3

    Uploaded by

    Luis-alfredo Perez Bolde Hernandez
    1) Shock is inadequate blood flow to tissues that occurs when blood volume is too low, leading to organ failure and death if not treated. 2) Signs of shock include confusion, weak pulse, pale skin, excessive thirst, and rapid breathing. 3) The best indicators of shock for tactical care are decreased consciousness and weak or absent radial pulse. 4) Controlling bleeding is critical to preventing shock; reassess that all hemostatic measures remain effective. Monitor the casualty for worsening shock signs.

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    of 18

    MODULE 10: SHOCK RECOGNITION

    TCCC TIER 1 TCCC TIER 2 TCCC TIER 3 TCCC TIER 4


    All Service Members Combat Lifesaver Combat Medic/Corpsman Combat Paramedic/Provider
    TACTICAL COMBAT CASUALTY CARE (TCCC)
    ROLE-BASED TRAINING SPECTRUM

    ROLE 1 CARE
    NONMEDICAL MEDICAL
    PERSONNEL PERSONNEL

    ASM CMC CPP

    CLS YOU ARE HERE

    STANDARDIZED JOINT CURRICULUM

    #TCCC-CLS-PPT-10 30 JUN 20 2
    STUDENT LEARNING OBJECTIVES

    TERMINAL LEARNING OBJECTIVE


    11 Describe shock assessment in Tactical Field Care in accordance with CoTCCC Guidelines

    63 Identify the signs, symptoms, and management steps of shock in a trauma casualty with
    life-threatening bleeding
    64 Identify the importance of level of consciousness and radial pulse as indicators of shock in Tactical Field Care

    2 ENABLING LEARNING = Cognitive ELOs = Performance ELOs

    OBJECTIVES (ELOs)
    #TCCC-CLS-PPT-10 30 JUN 20 3
    TACTICAL FIELD CARE
    MARCH PAWS
    DURING LIFE-THREATENING AFTER LIFE-THREATENING

    M MASSIVE BLEEDING #1 Priority

    P PAIN
    A AIRWAY
    A ANTIBIOTICS

    R RESPIRATION (breathing)
    W WOUNDS
    C CIRCULATION
    S SPLINTING

    H HYPOTHERMIA/
    HEAD INJURIES
    #TCCC-CLS-PPT-10 30 JUN 20 4
    SHOCK RECOGNITION

    Video can be found on DeployedMedicine.com

    #TCCC-CLS-PPT-10 30 JUN 20 5
    CIRCULATION/SHOCK

    SHOCK
    § Shock is inadequate blood flow to body tissues.
    Inadequate blood volume inside the circulatory system
    results in inadequate oxygen delivery to the body’s cells
    § As cells cease to function, tissues cease to function,
    then organs cease to function, and eventually the whole
    body will fail and DEATH follows

    IMPORTANT
    CONSIDERATIONS:
    § Shock will lead to the casualty's death if
    not quickly recognized and treated

    #TCCC-CLS-PPT-10 30 JUN 20 6
    CIRCULATION/SHOCK
    SHOCK
    § Caused by a decrease in the amount of blood volume circulating in the
    casualty's blood circulatory system
    § Shock can have many causes – low blood volume or hypovolemia
    (dehydration or blood loss), low blood pressure (massive infection),
    heart failure, or neurologic damage
    § Usually caused by severe bleeding, but it can also be caused by severe
    burns (second- and third-degree burns on 20 percent or more of the
    body surface)
    § On the battlefield, assume shock is from severe blood loss (also called
    hemorrhagic shock)

    Hemorrhagic shock can


    result in the casualty's death MA R C H
    #TCCC-CLS-PPT-10 30 JUN 20 7
    CIRCULATION/SHOCK

    GENERAL INDICATORS OF SHOCK


    SIGNS AND SYMPTOMS
    OF SHOCK INCLUDE:

    Mental Weak or absent


    confusion radial pulse
    Rapid
    breathing Nausea

    Sweaty, cool, Excessive


    clammy skin thirst

    Pale/gray Previous severe


    skin bleeding

    MA R C H #TCCC-CLS-PPT-10 30 JUN 20 8
    CIRCULATION/SHOCK

    GENERAL INDICATORS OF SHOCK


    If BOTH indicators exist, the casualty
    IMPORTANT IMPORTANT has lost a SIGNIFICANT amount of
    Indicator: Indicator: blood
    § Weak or absent radial As previously stated, shock will lead to
    § Mental confusion
    pulse the casualty's death if not quickly
    recognized and treated

    #TCCC-CLS-PPT-10 30 JUN 20 9
    CIRCULATION/SHOCK

    GENERAL INDICATORS OF SHOCK


    Blood Volume Blood Loss Signs/Symptoms Effects/Outcome
    4 liter bottles full, 500cc Possible increased HR Usually no effects
    1 bottle ½ empty
    4 liter bottles full, 1,000cc Radial pulse >100 Unlikely to die from this
    1 empty Breathing probably normal amount of loss
    3½ bottles full, 1,500cc Change in mental status Still unlikely to die
    1½ empty Weak radial pulse >100
    Increased respirations
    3 bottles full, 2 empty 2,000cc Confusion and lethargy Very possibly fatal if not
    Very weak radial pulse >120 managed
    High respiratory rate >35
    2½ bottles full and 2,500cc Unconscious Fatal without
    2½ bottles empty No radial pulse, carotid pulse, immediate and rapid
    HR >140 interventions
    Respirations >35

    MA R C H #TCCC-CLS-PPT-10 30 JUN 20 10
    CIRCULATION/SHOCK

    PREVENT SHOCK BY CONTROLLING BLEEDING


    #1- Reassess to confirm all bleeding
    control measures are still effective § It is better to prevent shock with hemorrhage control
    than to treat it
    Ensure TQs and pressure dressings
    remain tight § If shock is present, though, the most critical first step is
    to control the bleeding
    § Check radial pulse
    § Internal bleeding from chest or abdominal trauma may
    not be controllable, and shock may develop later, so
    continuously assess the casualty
    § Medical personnel will provide other treatments,
    but you can save them time if extremal bleeding
    is controlled

    DO NOT WAIT for signs and


    symptoms of shock to occur MA R C H #TCCC-CLS-PPT-10 30 JUN 20 11
    CIRCULATION/SHOCK

    ASSESS/MONITOR FOR HEMORRHAGIC SHOCK


    § Assess for signs and symptoms of shock as soon as
    hemorrhage is controlled, the airway is open, and respirations
    have been managed
    § The best TACTICAL indicators of shock are a decreased state of
    consciousness (if casualty has not suffered a head injury) and/or
    an abnormal, weak, absent radial pulse
    § Assess for hemorrhagic shock (altered mental status in the
    absence of brain injury and/or weak or absent radial pulse)
    § Reassess/monitor for changes in the level of consciousness
    by checking for alertness or responsiveness to verbal or
    physical stimulation

    MA R C H
    #TCCC-CLS-PPT-10 30 JUN 20 12
    SHOCK RECOGNITION

    REASSESS

    Level of consciousness Breathing rate


    Check casualty every 15 minutes for AVPU Monitor respirations
    Alertness - Knows who, where they are § Thoracic trauma may indicate tension
    pneumothorax (needle decompression
    Verbal - Orally responds to verbal commands of the chest required)
    Pain – Level of pain felt when the sternum is briskly
    § If a casualty becomes unconscious or
    rubbed with the knuckle (if needed)
    their breathing rate drops below two
    Unconscious - Unresponsive respirations every 15 seconds, insert
    a nasopharyngeal airway
    Decreasing AVPU could indicate condition worsening 13
    #TCCC-CLS-PPT-10 30 JUN 20
    CIRCULATION/SHOCK

    SHOCK MANAGEMENT

    Fluids by mouth are permissible if the casualty is


    conscious and can swallow § Place casualty in recovery position
    Evacuate the casualty if medical help is not available

    Reassess the casualty frequently


    for the onset of shock
    #TCCC-CLS-PPT-10 30 JUN 20 14
    CIRCULATION/SHOCK

    HYPOTHERMIA MANAGEMENT
    REMEMBER:
    Keep the casualty warm and prevent
    hypothermia. Even in very hot environments,
    a casualty in hemorrhagic shock (blood loss)
    is at EXTREME risk for hypothermia

    § Place a poncho or blanket § Cover the casualty with a


    under the casualty to protect survival blanket or other
    from the temperature or available materials to keep
    dampness of the ground them warm and dry

    #TCCC-CLS-PPT-10 30 JUN 20 15
    CIRCULATION/SHOCK

    SUMMARY
    § We defined shock
    IMPORTANT
    Indicator: § We identified indicators of shock
    § We discussed prevention measures for shock
    § Mental confusion
    § We discussed the management of shock
    § We introduced hypothermia
    IMPORTANT
    Indicator:
    § Weak or absent
    radial pulse

    #TCCC-CLS-PPT-10 30 JUN 20 16
    CHECK ON LEARNING
    What is shock?
    What are the best TACTICAL indicators of shock?
    What is the most important action to prevent hemorrhagic shock?

    #TCCC-CLS-PPT-10 30 JUN 20 17
    ANY QUESTIONS?

    #TCCC-CLS-PPT-10 30 JUN 20 18

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