Tuesday, January 2, 2024

Shock: Identification and Treatment

Shock is a potentially dangerous condition characterized by extreme weakness or unconsciousness, cold sweat, and a rapid, weak pulse.  It may arise due to dehydration, bleeding, injury, burns, severe illness, or any number of other conditions that result in inadequate perfusion of the body’s tissues and insufficient oxygen reaching the cells. 

Signs of shock (what a caregiver can see) include:

  • Low blood pressure
  • Rapid, weak pulse
  • Moist, clammy skin
  • Rapid, shallow breathing
  • Cyanosis—blue lips and fingernails
  • Fainting
  • Unconsciousness

Other symptoms of shock (what the patient reports) include:

  • Dizziness or lightheadedness
  • Nausea
  • Feelings of anxiety, aggression, or confusion
  • Chest pain

General treatment for all forms of shock:

  • Elevate the feet by 8-10 inches above the heart, unless there is a severe head injury, in which case the patient should be placed in a half-sitting position
  • Stop any bleeding
  • Keep the patient warm
  • Monitor the vital signs carefully
  • Keep the patient calm
  • Administer oxygen if available (acetylene torch oxygen is acceptable) 
  • Administer pain reliever such as aspirin if needed, but nothing with a sedative

There are several different forms of shock.  Each form of shock has additional treatment measures to implement.  The various forms can be remembered using the mnemonic RANCH PMS. 

Respiratory shock occurs when the patient cannot get enough oxygen in situations such as asthma, COPD, infection, trauma, or choking.  The airway needs to be cleared or oxygen needs to be administered immediately. 

Anaphylactic shock arises due to any number of life-threatening allergies like bee stings, foods (especially nuts), latex, and drugs (for example, penicillin).  A tracheotomy is the only solution for a severe episode in an austere situation.  Those with known allergies must take all possible measures to avoid triggering an anaphylactic response.

Neurogenic shock may occur due to spinal cord damage or drugs.  In either case, the result is the lungs are paralyzed.  An injury high enough in the neck can paralyze the lungs.  The blood vessels may dilate and the skin may become warm and flushed.  The blood pressure drops.  As a result, oxygen will not be carried to the rest of the body. 

Cardiogenic shock occurs with heart conditions such as a heart attack, congestive heart failure, or high blood pressure.  As a result, the blood supply to the rest of the body is insufficient.

Hypovolemic shock occurs due to severe blood loss, again threatening the blood supply to the rest of the body.  Direct pressure must be applied immediately to stop the bleeding.  If possible, the wound should be elevated above the heart.  Hypovolemic shock also occurs as a result of severe dehydration or extensive burns and may also be fatal if the patient is not rehydrated immediately.  Replacing fluids alone will not suffice for a patient with extensive blood loss, as blood is needed to carry oxygen to the cells. 

Psychogenic shock is the shock one experiences following the receipt of bad news, or fainting at the sight of blood (or whatever else troubles the patient), or a traumatic injury.  The blood vessels dilate, blood pressure drops, and there is less oxygen going to the brain, resulting in lightheadedness, dizziness, and fainting. 

Metabolic shock arises due to excessive vomiting and diarrhea, where electrolytes in the body become unbalanced.  Dysentery is still a leading killer in third world countries.  If the electrolyte balance is not restored, such as with oral rehydration solution, the patient will die.

Septic shock occurs as a result of infection from bacteria multiplying in the blood and releasing toxins.  Pneumonia, urinary tract infections, cellulitis, meningitis, and ruptured appendix are common causes of septic shock. 

Links to related posts:

Oral Rehydration Solution

3rd Degree Burns

Dehydration

Insect Stings

Penicillin 

Pneumonia

Meningitis

Appendicitis

1.27.21

1 comment:

  1. Probably the single most important therapy for treating schock is intravenous therapy. Shock is often cause by volumetric loss which
    can only be treated quickly with IV fluid replacement. Without experience and skills identifying shock is difficult. Blood pressure is the key indicator. Learn to take it an learn what is normal for you and your family so you can recognize dangerous changes.

    ReplyDelete