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Shock (optional)

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Now, let's cover shock emergencies. In this scenario, we had an individual who was bleeding from an arterial wound, and lost quite a bit of blood. Now they didn't pass out, but they were starting to feel dizzy and lightheaded, so we helped weigh them to the ground, and now we're going to be suspect that they either are going to kind of a psychogenic psychosomatic shock, which is more psychological, because they've seen all the blood and they're concerned, or they might have lost enough that they're having some hypovolemic shock which means low blood volume. Either way, the symptoms are the same, and we're not gonna take a chance. We're going to treat them. Gloves are on, our shield is available with a one way valve, and we've checked for scene safety. The scene is safe, they are responding to me, they are breathing normally, and they do have a pulse. So, its still something where we're trying to decide do we call 911 or not, but as soon as I see that they're pale, that they're starting to lose a level of consciousness or going to pass out, in my opinion that's time to call 911. You in the plaid shirt, go call 911 and come back, bring in an AED with you, if you can find one, and so now we're ready to begin treatment. I wanna re-assess like I just did for normal breathing and for pulse, but now I see that they're a little pale, I squeeze the nail bed, and turn it right and then I let go. It takes longer than it takes me to say capillary refill for it to refill. This is an early sign of potential shock. To treat this, I am now going to explain my patient what's going on, and elevate their legs, its important that you just find something that six twelve inches high, doesn't have to be super high, but you could use a stool, a chair, a box whatever you have available. I have a blanket here, but you would't have to necessarily use a blanket, you could use coats, you could use newspaper, anything that helps maintain the body temperature of the person that is going into shock, because this is going to help maintain their core body temperature. When they start going into shock, their body shunts the blood from the extremities,and brings it back to their vital organs. This makes them very cold to the peripheral. When this happens, the body will only take so long before it needs to read the rest of the body. When it does that, it will read basal dilate, and the blood pressure that they do have could drop again. So, we wanna help combat that by keeping them warm, covering them, and watching for regular breathing, making sure they're awake, and if they ever change lose their breathing, lose their pulse, they're going to respond with CPR, and wait for EMS to arrive.

Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body.

When organs don't receive enough blood, the body begins to conserve blood flow by limiting it to legs, arms, and the skin. This insufficient blood volume is one thing that can lead to shock, as can low levels of plasma and fluids in the blood and airway obstruction.

There are several types of shock, including psychosomatic shock – a psychological condition in which worry and concern send a person into shock, rather than a physiological condition. While this shock lesson is in the bleeding control section, it's important to understand that any first aid emergency could send a person into shock.

Pro Tip #1: The important thing to remember with shock is that the symptoms are the same regardless of what contributes to it. It's a serious condition that warrants rapid treatment and an immediate 911 call.

Besides psychosomatic shock, there are four main types.

The Four Main Types of Shock

Hypovolemic Shock

Hypovolemic shock is caused by a severe lack of blood and bodily fluids. The most common type of hypovolemic shock is hemorrhagic shock, which occurs as a result of significant blood loss.

Obstructive Shock

Obstructive shock is caused by an obstruction to blood flow usually within the blood vessels, like a pulmonary embolism – a blood clot in a lung artery.

Distributive Shock

When there is an inadequate distribution of blood that results in low levels of blood returning to the heart, this can cause distributive shock. Examples include septic shock (due to toxins), anaphylactic shock (due to food allergies), and neurogenic shock (due to spinal cord or brain trauma).

Cardiogenic Shock

Cardiogenic shock is the result of the heart being unable to supply enough blood to vital organs. This can be caused by an injury to the heart, disease, or trauma.

How to Provide Care

Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue mask with a one-way valve available if necessary.

Pro Tip #2: You may be wondering why you need a rescue mask when helping a shock victim. After all, victims of shock are likely responsive and breathing normally. However, if at any time the victim loses his or her pulse and stops breathing normally, you'll have to go right into CPR, in which case you'll be glad the rescue mask is nearby.

  1. Call 911 immediately.
  2. Continually reassess for signs of normal breathing and consciousness.
  3. Explain to the victim what's happening and that you're there to help.
  4. Elevate the victim's legs at least 6-12 inches off the ground using whatever is available – chair, box, stool, etc.
  5. Keep the victim warm by covering them with a blanket, coat, newspapers, or whatever you have access to.

Pro Tip #3: It's important to help maintain the victim's core body temperature when they're in shock. When a person goes into shock, the body reduces blood flow to the extremities, so more is available to vital organs, which is why people in shock feel cold.

Warning: If at any point the victim stops breathing normally or becomes unresponsive, begin CPR (or rescue breathing) immediately and continue until medical professionals arrive.

A Few Common Shock Questions

How can I tell if someone is in shock?

The first step is to recognize the signs and symptoms of shock and realize that these can all progress and therefore should be monitored periodically.

Look for these early signs of shock:

  • Nervousness
  • Rapid heart rate or breathing
  • Anxiousness
  • Sweaty
  • Fearful
  • Clammy skin

As shock progresses, the victim's skin could become paler, clammier, and the other symptoms could also get worse. Clammy skin, incidentally, is due to the restriction in blood flow to the skin and extremities.

Are there any tests I can perform on the victim to better help identify shock?

If you suspect shock, pinch a toenail or fingernail and measure the capillary response – the length of time it takes for blood to refill that nail bed. If it's more than a few seconds – or the time it takes to say capillary refill – your victim is likely in shock.

How do I know when to call 911?

It's always better to be safe than sorry, so call 911 any time it's an actual emergency or if you're unsure what to do or overwhelmed, and how exactly that's defined will vary rescuer to rescuer. However, as it pertains to this lesson, always call 911 immediately as soon as you suspect shock or as soon as the victim loses consciousness or begins having breathing issues.

In other words, err on the side of victim safety.