Shock

Basically, physiological shock is circulatory failure. The body, because of sudden illness or trauma, can no longer provide an adequate supply of oxygenated blood to all of its parts. When organs (particularly the vital ones such as the heart, brain, lungs) do not receive enough oxygen, they fail to work properly.

Signs and Symptoms:

• Restlessness or irritability
• Rapid and weak pulse (greater than 100 beats/minute in an adult, greater than 120 in a child, greater than 150 in an infant)
• Rapid breathing (greater than 20 breaths per minute for an adult, greater than 24 for young children, greater than 30 for infants)
• Pale, bluish, cool, moist skin
• Excessive thirst
• Nausea and vomiting
• Drowsiness or loss of consciousness.

Keep in mind that the signs and symptoms of shock may not be immediately obvious. You must remain alert to the above signs and symptoms when there has been a sudden injury or illness.

How Shock Works

Scenario: you find an injured person who appears to be OK except for his broken arm. You provide basic first aid (knowing that medical personnel are not available, you have set the arm and have stopped the bleeding associated with that fracture). But you keep a close eye on this person because you know that:

1	an injury can cause severe bleeding (internal, external or both)
2	The heart, sensing the loss of blood, beats faster to compensate for this loss. However, as the victim continues to bleed, the pulse (which was strong and rapid) becomes weak and faint.
3	The heart is now working harder to meet a demand for more oxygen. Thus, breathing will become faster.
4	The body must now make a decision. It knows that it does not have enough blood to meet its total demands for oxygen. It has to decide what part of itself is going to get oxygen and what part isn’t. Of course, it decides to maintain circulation to the vital organs. To do this, it must constrict the blood vessels in the arms, legs and skin. Thus, the skin will appear ashen, cool, moist. The body may be perspiring heavily.
5	Cells in the arm and leg tissues begin to die. The brain then tells the body to send blood back into these area so as to balance the blood flow between them and the vital organs. As a result, the vital organs do not receive enough blood. The heart tries to further compensate by beating even faster. More blood is lost and the victim’s condition worsens.
6	Now the vital organs don’t have enough oxygen so they fail to work properly. As the brain fails, the victim will become restless, drowsy and then lose consciousness. As the heart fails, the pulse will become very irregular and weak. When the heart stops altogether, so does breathing.
7	What has happened: the body’s continuos attempts to make up for severe blood loss resulted in death.

What to Do

• Elevate the legs about 12 inches (30.5 cm) to help blood circulate to the vital organs. Do not elevate the legs if the victim is nauseated or you suspect head, neck or back injuries. Also, do not elevate the legs if you suspect hip injuries or broken leg bones. Elevation may cause more pain in the hips and legs. If you are unsure of the victim’s condition or it is painful for him/her to move, just leave him/her lying flat.

• Then, make the victim as comfortable as possible. This is very important as it decreases stress on the body. Pain and discomfort accelerates the shock process. Offer reassurance as needed.

• Keep the victim warm. Maintain normal body temp as much as possible. Don’t let the victim get overheated or chilled.

• Provide first aid care as needed (i.e., stop external bleeding)

• If victim is conscious, give him/her cool water or clear juices. Give adults 4 ounces (60 ml) of water to sip slowly over a 20 minute period of time. Give children half this amount over the same time frame. For an infant, give half that (1 ounce or 15 ml) over the same 20 minute period. This minimizes the chances of vomiting (and further fluid loss). However, do not give fluids in case of abdominal injuries, seizures of a head injury.

Offered by Lyn.