Shock
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed
-----------------------------------------------------------------------Shock, is the failure of the heart and blood vessels (circulatory system) to
maintain enough oxygen-rich blood flowing (perfusion) to the vital organs of the
body. There is shock to some degree with every illness or injury; shock can be
life threatening. The principles of prevention and control are to recognize the
signs and symptoms and to begin treating the casualty before shock completely
develops. It is unlikely that you will see all the signs and symptoms of shock in a
single casualty. Sometimes the signs and symptoms may be disguised by the
illness or injury or they may not appear immediately. In fact many times, they
appear hours later.
The usual signs and symptoms (Fig. 4-1) of the development of shock are:
1. Anxiety, restlessness and fainting.
2. Nausea and vomiting.
3. Excessive thirst (polydipsia).
4. Eyes are vacant, dull (lackluster), large (dilated) pupils.
5. Shallow, rapid (tachypnea), and irregular breathing.
6. Pale, cold, moist (clammy) skin.
7. Weak, rapid (tachycardia), or absent pulse.
Hypovolemic Shock
Hypovolemic shock is caused by a decreased amount of blood or fluids in
the body. This decrease results from injuries that produce internal and external
bleeding, fluid loss due to burns, and dehydration due to severe vomiting and
diarrhea.
Neurogenic Shock
Neurogenic shock is caused by an abnormal enlargement of the
(vasodilation) blood vessels and pooling of the blood to a degree that adequate
blood flow cannot be maintained. Simple fainting (syncope) is a variation, it is the
result of a temporary pooling of the blood as a person stands. As the person falls,
blood rushes back to the head and the problem is solved.
Psychogenic Shock
Psychogenic shock is a "shock like condition" produced by excessive fear,
joy, anger, or grief. Shell shock is a psychological adjustment reaction to stressful
wartime experiences. Care for shell shock is limited to emotional support and
transportation of the casualty to a medical facility.
Anaphylactic Shock
Anaphylactic (allergic) shock occurs when an individual is exposed to a
substance to which his or her body is sensitive. The individual may experience a
burning sensation, loss of voice, itching (pruritus), hives, severe swelling, and
difficulty breathing. The causative agents are injection of medicines, venoms by
stinging insects and animals, inhalation of dust and pollens, and ingestion of
certain foods and medications. Individuals with known sensitivities carry
medication in commercially prepared kits.
Prevention and Treatment of Shock
While administering first aid to prevent or treat shock, you must remain
calm. If shock has not completely developed, the first aid you provide may
actually prevent its occurrence. If it has developed, you may be able to keep it
from becoming fatal. It is extremely important that you render first aid
immediately.
To provide first aid for shock, do the following:
1. Maintain open airway - Head-tilt/chin-lift or jaw-thrust.
2. Control bleeding - Direct pressure, elevation, indirect pressure, or tourniquet
if indicated.
3. Position casualty - Place the casualty on his or her back, with legs elevated 6
to 12 inches (Fig. 4-2). If it is possible, take advantage of a natural slope of
ground and place the casualty so that the head is lower than the feet. If they are
vomiting or bleeding around the mouth, place them on their side, or back with
head turned to the side. If you suspect head or neck injuries, or are unsure of
the casualty's condition, keep them lying flat.
4. Splint - Suspected broken and dislocated bones in the position in which they
are found. Do not attempt to straighten broken or dislocated bones, because
of the high risk of causing further injury. Splinting not only relieves the pain
without the use of drugs but prevents further tissue damage and shock. Pain and
discomfort are often eliminated by unlacing or cutting a shoe or loosening tight
clothing at the site of the injury. A simple adjustment of a bandage or splint will
be of benefit, especially when accompanied by encouraging words.
Figure 4-2 Position for Treatment of Shock
5. Keep the casualty comfortable, and warm enough to maintain normal body
temperature. If possible, remove wet clothing and place blankets underneath the
casualty. Never use an artificial means of warming.
6. Keep the casualty as calm as possible. Excitement and excessive handling will
aggravate their condition. Prevent the casualty from seeing his or her injuries,
reassure them that their injuries are understood and that professional medical
assistance will arrive as soon as possible.
7. Give nothing by mouth - Do not give the casualty anything to eat or drink
because it may cause vomiting. If the casualty complains of thirst, wet his or her
lips with a wet towel.
8. Request medical assistance - Ask bystanders to call the local emergency
number or medical personnel.