Sunday, July 26, 2009
'Shock' is defined as 'inadequate perfusion to sustain life'. On many, many responses I've arrived at scene to have people tell me "He's going into shock!!" Which, to them means, he's starting to shake. EVERYBODY goes into shock at least once in their lives, usually the first and last time preceeding a lengthy temperature change. Actual shock that gets reversed is not very common.
Obstructive, hypovolemic, neurogenic...there are quite a few things that can hinder perfusion (bloodflow). A block in the lungs. All your blood fell out a hole. Your spinal cord got unplugged so all your vessels dilated, making you die early.
Today's hoist rescue might have been simple dehydration and hyponatremia. It also might have been cardiogenic shock. This guy was 1/4 mile from the top of Iron Mountain hiking through the heat, alone. (thank God for Verizon) Hx hypertension. He's 9 years younger than me; his dad died at 40 of heart disease....
Before I was even on the ground I could see how pale he looked. He also had that pre-death panic. (Some of you know what I'm talking about) Fast beating heart, low blood pressure, would get dizzy sitting up. Decision time----figure this out here and get some medicine in him, or put him through the stress of a hoist and fly him down the mountain to the ambulance below? I spoke to him briefly and told him to turn it all over to me, everything would be fine, we'd be in the ambulance in 5 minutes. He didn't protest. I have a trick where I start telling them some boring story while on the ground,and continue it all the way up to the helicopter (this guy was in town for Comic con so I talked about Groo. He was into that.)
Didn't take long for the IV, fluids, 12 lead, O2, etc. once in the copter- then handed him off to the Poway folks for a quick trip to the hospital. (In this case no time would be saved by flying him there) BP came up good with the fluids, so I'm still thinking dehydration, but that's what the ER doc is for, and as long as his pressure's good the prehospital treatment's the same.
Decision to extract instead of treat---my thinking was, if it's dehydration, staying in the sun won't help and he'll do OK during the hoist. Cardiogenic shock, once he turns the corner I'd really have my hands full with no help, then I'm struggling to get him stable enough for the pick-off. 5 minute gamble and I'll have lots of help. #1 most effective treatment option available to paramedics is rapid transport