Treating someone in shock

The term ‘shock’ has many meanings to people outside the medical field. The term may be applied to people recently suffering from a dramatic event (such as a car collision). It can also be used to describe an altered level of concentration that results from receiving emotionally disturbing news (such as the news of a loved one’s death).

The medical application of the term shock however is different. Shock occurs when the bloodstream is unable to provide enough nutrients to feed the cells of the body, effectively starving the cells.

We will briefly look at the different stages and types of shock but it is very important to remember that shock itself can be a life threatening emergency and anyone being treated for a severe illness or injury should also be treated for shock, regardless of whether they show any signs or symptoms.

There are three main stages of shock. Stage one occurs when the body first detects low blood flow (perfusion). A number of systems are activated in the body to restore or maintain normal blood flow. As a result the heart beats faster, the blood vessels constrict, and the kidneys work to retain fluid in the circulatory system.

All this serves to maximize blood flow to the most important organs and systems in the body. A patient in this stage of shock has very few symptoms and treatment can completely halt any progression.

In stage two of shock these methods of ‘compensation’ begin to fail. The body’s own systems are unable to improve or maintain blood flow and the patient quickly begins to experience symptoms.

Oxygen deprivation in the brain causes confusion and disorientation, and oxygen deprivation in the heart may cause chest pain. With quick and appropriate treatment this stage can also be reversed.

In stage three (irreversible) shock, the length of time that poor blood flow has existed begins to take a permanent toll on the body’s organs and tissues.

The heart and kidneys begin to shut down and cells in the body begin to die. This stage of shock occurs when treatment is not given in the earlier stages.

Shock can occur from three main categories of problems: cardiogenic (meaning problems with the heart’s functioning); hypovolemic (meaning that the actual volume of blood in the body is low); and septic shock (caused by massive infection, usually bacterial).

Initial signs and symptoms of shock may include cold clammy skin, pale or bluish skin tone, weak, fast pulse, chest pain, fast breathing, low blood pressure, fainting, restlessness or nervousness, nausea/vomiting, thirst, and confusion or loss of awareness.

To treat for shock, first perform a primary assessment by following the ABCD’S of the patient’s lifeline. Don your barriers (gloves) and have a ventilation barrier at hand. Assess the scene, activate EMS, ensure the airway is open, check for breathing (provide rescue breathing if necessary), check for circulation (provide CPR if necessary), and control serious bleeding.

Position the patient on their back (if head, neck, or spinal injury is suspected stabilize the patient in the position you found them).

If the patient is vomiting place them on their left side in the ‘recovery position’. Maintain normal body temperature (this may include covering the patient with a blanket). Elevate the feet higher than the heart to improve blood flow to the brain (unless other injuries prevent this).

Continue to monitor the patient’s lifeline until EMS arrives.

This weekly column is only an introduction to emergency care skills and is designed to increase interest in First-Aid/CPR training. For information on courses please contact the Red Cross, a medical professional, or a local dive shop.