1. 14 - September - 2012 Prepared By Dr Gamal Soliman 1 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A ER POLICYER POLICY DEAD ON ARRIVAL MANAGEMENT OF SHOCK

2. 14 - September - 2012 Prepared By Dr Gamal Soliman 2 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A DEFINITION A person brought to a hospital lifeless and confirmed dead after the physician legally pronounced it. 3. 14 - September - 2012 Prepared By Dr Gamal Soliman 3 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A OBJECTIVE 1. To examine and confirm death. 2. To give immediate resuscitative measures before confirming death. 3. To inform police department. 4. 14 - September - 2012 Prepared By Dr Gamal Soliman 4 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A POLICY 1. "Dead- on- Arrival" patients must be examined and resuscitative measures must be given before confirming death. 2. Police department must be informed by information personnel. 5. 14 - September - 2012 Prepared By Dr Gamal Soliman 5 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 3. All emergency resuscitative measures will be carried out to save the patient's life. 4. Vital signs are obtained and monitored continuously. 6. 14 - September - 2012 Prepared By Dr Gamal Soliman 6 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 5. When all resuscitation efforts have been exhausted, the physician will examine and confirm the death. 7. 14 - September - 2012 Prepared By Dr Gamal Soliman 7 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A MANAGEMENT OF SHOCK 8. 14 - September - 2012 Prepared By Dr Gamal Soliman 8 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A DEFINITION Shock is a complex life-threatening condition (or syndrome) characterized by inadequate blood flow to the tissues and cells of the body. OBJECTIVE 1. To ensure rapid recognition and prompt intervention to increase the chance of survival. 2. To initiate priorities in the assessment for all types of shock. 9. 14 - September - 2012 Prepared By Dr Gamal Soliman 9 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 3. To restore and maintain tissue perfusion 4. To correct physiological abnormalities 5. To restore the patient to a stable physical condition. 10. 14 - September - 2012 Prepared By Dr Gamal Soliman 10 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A POLICY 1. The nurse must have the knowledge of the classification of shock and comparisons. Hypovolemic results in reduced circulating vascular volume, water, plasma or whole blood. Cardiogenic when the heart muscles lose its contractive power or when cardiac output is insufficient to meet the metabolic demands of the body, resulting in inadequate tissue perfusion. Septic results of bacteria and their products circulating in the blood. 11. 14 - September - 2012 Prepared By Dr Gamal Soliman 11 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A Spinal Shock Neurogenic shock Anaphylactic shock Hypoglycemic shock 12. 14 - September - 2012 Prepared By Dr Gamal Soliman 12 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A The initial priorities in the assessment are the same for all types of shock. Is the airway open Is the patient breathing Is there a circulation problem 13. 14 - September - 2012 Prepared By Dr Gamal Soliman 13 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A MATERIALS & EQUIPMENT 1. Crash cart Emergency drugs Emergency equipments Suction machine Oxygen Cardiac monitor BP cuff and stethoscope 3. Intravenous equipment plus fluid 4. Urinary catheter equipment 5. Emergency room flow sheet 14. 14 - September - 2012 Prepared By Dr Gamal Soliman 14 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A INITIAL MANAGEMENT OF SHOCK 15. 14 - September - 2012 Prepared By Dr Gamal Soliman 15 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 1. Assess level or consciousness: 1.1Confusion 1.2 Irritability 1.3 Anxiety 1.4 Agitation 1. Important indicator of shock because it reflects cerebral perfusion. 1.5 Inability to concentrate 1.6 Increased lethargy, progressing to coma, indicating progression of shock. 16. 14 - September - 2012 Prepared By Dr Gamal Soliman 16 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 2. Draw blood samples for investigations. 2. As data baseline. 3. Monitor arterial blood pressure. 3. The blood pressure may initially rise approximately 20%. If the patient is compensating for shock. 17. 14 - September - 2012 Prepared By Dr Gamal Soliman 17 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 4. Assess urinary output. 4. Urine output should be 50 ml/hour. An output less than 25 ml./hour may indicate shock 18. 14 - September - 2012 Prepared By Dr Gamal Soliman 18 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 5. Administer 02 to maintain the Pa02 at 80-100 Torr. 5. This will augment oxygen- carrying capacity of arterial blood. 5.1 100% oxygen by non- breather face mask. 19. 14 - September - 2012 Prepared By Dr Gamal Soliman 19 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 5.2 Intubation if the patient is unable to manage or is ventilating poorly. 5.3 If intubated, the patient may be hyperventilated to help control acidosis. 20. 14 - September - 2012 Prepared By Dr Gamal Soliman 20 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 6. Initiate I.V. fluid therapy 6.1 Two large-bore I.V. lines should be established.6. To restore intravascular volume. To improve cardiac and tissue oxygenation. 21. 14 - September - 2012 Prepared By Dr Gamal Soliman 21 S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 6.3 Fresh whole blood is infused when there is massive blood loss. 6.3 Rate of flow depends on severity of loss and clinical evidence of hypovolemia.