Shock Treatment

Early Signs

• Pale skin (may appear grayish)
• Cold, clammy skin (sweaty but cool)
• Rapid, shallow breathing
• Rapid, weak pulse
• Anxiety, agitation, restlessness
• Thirst
• Nausea, vomiting

Progressing Shock

• Confusion, disorientation
• Lethargy, drowsiness
• Bluish lips, nail beds (cyanosis) - late sign
• Decreased urine output
• Dilated pupils
• Chest pain
• Loss of consciousness

Person may seem calm or even "fine" initially. Don't be fooled - shock can develop over time, especially with internal bleeding.

Hypovolemic (Most Common)

Cause: Blood or fluid loss - bleeding, burns, dehydration, vomiting/diarrhea

Treatment: Stop bleeding, replace fluids (IV in hospital), keep warm

Losing 20% of blood volume (1 liter in average adult) causes shock. 40% loss often fatal.

Cardiogenic

Cause: Heart can't pump effectively - heart attack, arrhythmia, heart failure

Treatment: Treat heart condition, hospital care. Keep head elevated slightly if breathing easier.

Distributive (Septic, Anaphylactic, Neurogenic)

Sepsis: Infection causes blood vessels to dilate. Needs antibiotics, hospital.

Anaphylaxis: Allergic reaction causes vessel dilation. EpiPen, hospital.

Neurogenic: Spinal cord injury causes loss of vessel tone. Immobilize spine, hospital.

Obstructive

Cause: Blockage prevents blood flow - tension pneumothorax, cardiac tamponade, pulmonary embolism

Treatment: Remove obstruction (needle decompression for tension pneumo, pericardiocentesis for tamponade - advanced procedures)

Immediate Actions

1. Call 911 immediately for suspected shock
2. Lay person flat on back on firm surface
3. Elevate legs 8-12 inches IF no suspected:
   • Head, neck, or spinal injury
   • Chest injury
   • Abdominal injury
   • Pelvic fracture

   If any of above, keep flat. Don't elevate legs.

4. Keep warm: Cover with blankets, coats, clothing. Blood loss = hypothermia risk.
5. Control obvious bleeding: Direct pressure, tourniquet
6. Don't give food or water: May need surgery. Small sips okay only if help is hours away and conscious.
7. Monitor breathing: Be ready to start CPR
8. If vomiting: Turn on side (recovery position) to prevent choking
9. Treat cause if known: EpiPen for anaphylaxis, immobilize for spinal
10. Stay calm, reassure: Anxiety worsens shock

Positioning

Standard shock position: Flat on back, legs elevated 8-12 inches

Head/neck/chest injury: Flat, head in neutral position, don't elevate legs

Breathing difficulty: Semi-sitting (45°) may help breathing but worsens shock. Balance priorities.

Unconscious but breathing: Recovery position (on side)

Pregnant (3rd trimester): Left side lying, or tilt left with pillow under right hip (reduces pressure on vena cava)

What NOT To Do

Monitor Vital Signs

Breathing: Count breaths per minute (normal 12-20). Watch for changes.

Pulse: Count beats per minute at wrist or neck. Note if getting faster/weaker.

Level of consciousness: Can they answer questions? Getting more confused?

Skin: Color, temperature, moisture. Getting paler/colder?

Capillary refill: Press nail bed or palm until white, release. Should return to pink in <2 seconds. Longer = poor circulation.

Write down vital signs and time. This information helps medical team.

Keep Person Calm

• Talk reassuringly - "Help is on the way"
• Explain what you're doing
• Hold their hand if appropriate
• Keep bystanders calm - anxiety is contagious
• Answer questions honestly but don't alarm

Oral Fluids

If help is HOURS away, person is conscious, can swallow, and shock is from dehydration (not bleeding):

• Small, frequent sips
• Oral rehydration solution: 1 liter water + 6 tsp sugar + ½ tsp salt
• Or: Gatorade, Pedialyte diluted
• Don't force if nauseous

Don't give oral fluids if: unconscious, can't swallow, abdominal injury, likely need surgery, or bleeding. Choking/aspiration risk.

IV Fluids (If Trained)

Only if trained and equipment available. Lactated Ringer's or normal saline. Large bore IV, wide open if severe. 1-2 liters rapidly, then reassess.

IV fluids in field are advanced. Don't attempt without training. Risks include fluid overload, air embolism, infection.

After Any Major Injury

• Assume shock could develop - monitor even if person seems okay
• Control bleeding immediately - every drop matters
• Keep person warm - even in warm weather
• Keep person still - activity increases oxygen demand
• Don't let them stand up suddenly - can cause drop in blood pressure
• Keep giving fluids if appropriate (not before surgery)

Burn Shock

Large burns cause massive fluid loss through damaged skin. Shock can develop hours after burn. Fluid requirements are huge. Hospital care essential. Keep giving small sips of water if conscious and help is delayed.

Crush Injury

When compressed limb is freed, toxins from damaged muscle flood bloodstream. Can cause shock, kidney failure, cardiac arrest. Be prepared for rapid deterioration when weight removed. Hospital urgently.

Internal Bleeding

May not be obvious. Signs: Abdominal pain and rigidity, bruising on flanks, blood in urine/stool/vomit, shoulder pain (blood irritating diaphragm), worsening shock with no external bleeding. Hospital immediately. Nothing by mouth.

Children compensate well initially then crash suddenly. Don't be reassured by "stable" child with significant injury.

Signs in children:

• Tachycardia (fast heart rate) out of proportion to activity
• Delayed capillary refill (>2 seconds)
• Decreased mental status
• Pale, mottled skin
• Weak or absent peripheral pulses

Normal child heart rates: Infant 100-160, Toddler 90-150, Preschool 80-140, School age 70-120

How To

1. Kneel beside person
2. Place arm nearest you at right angle to body
3. Place other arm across chest, hand against cheek
4. Pull far leg up, knee bent
5. Roll person toward you, keeping hand against cheek
6. Adjust top leg so hip and knee bent at right angles (stabilizes position)
7. Tilt head back to keep airway open
8. Check breathing regularly