minimizes carbon dioxide concentration in thedelivered breaths. Perform chest compressions byusing two fingers to depress the middle of the sternumapproximately ½ to 1 inch. See figures 4-16 and 4-18for proper finger positioning for chest compressions.For both infants and children, the compression rateshould be at least 100 compressions per minute.Compressions must be coordinated with ventilations ata 5-to-1 ratio. The victim should be reassessed after 20c y c l e s o f c o m p r e s s i o n s a n d v e n t i l a t i o n s(approximately 1 minute) and every few minutesthereafter for any sign of resumption of spontaneousbreathing and pulse. If the child or infant resumeseffective breathing, place the victim in the recoveryposition.SHOCKLEARNING OBJECTIVE:Recognize thesigns and symptoms of shock, and determinetreatment by the type of shock presented.Shock is the collapse of the cardiovascular system,characterized by circulatory deficiency and thedepression of vital functions. There are several typesof shock:Hypovolemic shock–caused by the loss ofblood and other body fluids.Neurogenic shock–caused by the failure of thenervous system to control the diameter of bloodvessels.Cardiogenic shock–caused by the heart failingto pump blood adequately to all vital parts of thebody.Septic shock–caused by the presence of severeinfection.Anaphylactic shock–caused by alife-threatening reaction of the body to asubstance to which a patient is extremelyallergic.Multiple types of shock may be present in varyingdegrees in the same patient at the same time. The mostfrequently encountered and most important type forthe Hospital Corpsman to understand is hemorrhagicshock, a type of hypovolemic shock which will bediscussed later in this chapter.Shock should be expected in all cases of majorinjury, including gross hemorrhage, abdominal orchest wounds, crash or blast injuries, extensivelarge-muscle damage (particularly of the extremities),major fractures, traumatic amputations, or headinjuries, or in burns involving more than 10 percent ofthe body surface area.SYMPTOMS OF SHOCKThe symptoms of shock vary from patient topatient and even within an individual during the courseof illness. Evaluation of the whole situation is moreimportant than one particular sign or symptom.Degrees of ShockTable 4-2 provides a generalized overview of thedegrees of shock and their symptoms correlated to theapproximate volume deficit.4-21Figure 4-17.—Palpating brachial artery pulse in an infant.Figure 4-18.—Locating proper finger position to performchest compressions in infants.
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