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Medical Education Division |
Operational Medicine 2001
Standard First Aid Course
NAVEDTRA 13119
ShockShock, 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.
Figure 4-1 Symptoms of Shock 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. References 1. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2
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