❤️‍🩹First Aid Unit 6 – Shock – Recognition and Management

What is Shock?

• Life-threatening condition occurs when the body's tissues and organs do not receive adequate blood flow and oxygen
• Results from a sudden drop in blood pressure, which can be caused by various factors (severe bleeding, heart problems, dehydration, allergic reactions)
• Leads to inadequate perfusion, the delivery of blood and oxygen to the body's tissues and organs
  • Without proper perfusion, cells begin to die and organs start to fail
• Characterized by a state of hypoperfusion, where the body's tissues and organs are not receiving enough blood flow to function properly
• Can affect multiple organ systems (cardiovascular, respiratory, neurological, digestive) simultaneously
• Requires prompt recognition and immediate treatment to prevent further deterioration and potential death
• Different types of shock can have varying underlying causes and mechanisms, but all lead to inadequate perfusion and potential organ failure

Types of Shock

• Hypovolemic shock: Occurs due to a significant loss of blood or body fluids
  • Can result from external or internal bleeding, severe dehydration, or excessive fluid loss (burns, diarrhea, vomiting)
• Cardiogenic shock: Happens when the heart is unable to pump blood effectively
  • Caused by conditions that damage the heart muscle (heart attack, heart failure, cardiomyopathy, valve disorders)
• Distributive shock: Involves a sudden dilation of blood vessels, leading to a drop in blood pressure
  • Septic shock: Caused by a severe infection that triggers a systemic inflammatory response
  • Anaphylactic shock: Results from a severe allergic reaction causing widespread vasodilation
  • Neurogenic shock: Occurs due to damage to the nervous system that disrupts the body's ability to regulate blood pressure
• Obstructive shock: Happens when there is a physical obstruction preventing adequate blood flow
  • Can be caused by conditions (pulmonary embolism, tension pneumothorax, cardiac tamponade)
• Metabolic shock: Results from severe metabolic disturbances that affect cellular function and blood flow
  • Can be caused by conditions (diabetic ketoacidosis, severe hypothermia, adrenal crisis)

Signs and Symptoms

• Rapid, shallow breathing as the body tries to compensate for the lack of oxygen
• Weak, rapid pulse (>100 beats per minute) due to the heart working harder to maintain blood pressure
• Cool, clammy skin as blood is diverted away from the extremities to vital organs
• Pale or grayish skin color, especially in the face and lips, indicating poor perfusion
• Delayed capillary refill time (>2 seconds) when pressing on the nail bed or skin
• Altered mental status, ranging from anxiety and confusion to unresponsiveness, as the brain receives insufficient blood flow
• Decreased urine output (<30 mL/hour) as the kidneys attempt to conserve fluids
• Thirst and dry mouth due to dehydration and reduced perfusion to the mucous membranes

Initial Assessment

• Assess the scene for safety and potential causes of shock (bleeding, trauma, allergic reactions)
• Check the person's responsiveness using the AVPU scale (Alert, Verbal, Pain, Unresponsive)
• Simultaneously assess the person's airway, breathing, and circulation (ABC)
  • Look for signs of obstruction, listen for breath sounds, and feel for a pulse
• If the person is unresponsive and not breathing normally, begin CPR and use an AED if available
• Assess for signs and symptoms of shock (rapid breathing, weak pulse, cool and clammy skin, altered mental status)
• Take a brief history from the person or bystanders to identify potential causes and allergies
• Expose and examine the person for any visible injuries or sources of bleeding
• Monitor the person's vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) if equipment is available

First Aid Steps

• Ensure scene safety and use personal protective equipment (gloves, face mask) if available
• Call emergency medical services (911) or local emergency number for immediate assistance
• Position the person lying flat on their back with their legs elevated 8-12 inches, unless they have difficulty breathing or suspected head, neck, or back injuries
  • Elevating the legs helps improve blood return to the heart and vital organs
• Loosen any tight clothing around the neck, chest, or waist to facilitate breathing
• Keep the person warm by covering them with a blanket or coat to prevent further heat loss
• If the person is bleeding, apply direct pressure to the wound using a clean cloth or dressing
  • If the bleeding is severe or not controlled by direct pressure, apply a tourniquet proximal to the wound
• If the person is experiencing an allergic reaction and has an epinephrine auto-injector (EpiPen), assist them in administering the medication
• Provide reassurance and monitor the person's condition until emergency medical help arrives

Advanced Treatment

• Establish advanced airway management (endotracheal intubation, supraglottic devices) to secure the airway and provide oxygen
• Administer high-flow oxygen via non-rebreather mask or bag-valve-mask to improve oxygenation
• Obtain intravenous (IV) or intraosseous (IO) access for fluid resuscitation and medication administration
  • Infuse isotonic crystalloid solutions (normal saline, lactated Ringer's) to restore intravascular volume
  • Administer blood products (packed red blood cells, fresh frozen plasma, platelets) in cases of significant blood loss or coagulopathy
• Monitor and treat electrolyte imbalances, acid-base disturbances, and hypothermia
• Administer vasoactive medications (norepinephrine, epinephrine, dopamine) to support blood pressure and perfusion
• Perform diagnostic tests (blood work, imaging studies) to identify and treat the underlying cause of shock
• Provide definitive treatment based on the type and cause of shock (surgery, antibiotics, antidotes)

Prevention Strategies

• Educate individuals and communities about the signs, symptoms, and causes of shock
• Encourage the use of personal protective equipment (helmets, seatbelts) to prevent traumatic injuries
• Promote regular health check-ups and management of chronic conditions (diabetes, heart disease) that can increase the risk of shock
• Teach proper wound care and infection prevention techniques to reduce the risk of septic shock
• Raise awareness about common allergens and the importance of carrying epinephrine auto-injectors for those with known allergies
• Emphasize the importance of staying hydrated, especially during physical activity or in hot environments, to prevent hypovolemic shock
• Train individuals in basic first aid and CPR skills to enable prompt recognition and initial management of shock
• Implement public health measures (vaccination programs, sanitation improvements) to reduce the incidence of infectious diseases that can lead to septic shock

Common Mistakes to Avoid

• Failing to recognize the signs and symptoms of shock early, leading to delayed treatment
• Not calling for emergency medical help (911) immediately when shock is suspected
• Allowing the person to sit up or stand, which can worsen hypoperfusion and organ damage
• Giving the person anything to eat or drink, as this can interfere with medical treatment and increase the risk of aspiration
• Applying a tourniquet without proper training or when direct pressure is sufficient to control bleeding
• Removing an embedded object from a wound, which can cause further bleeding and damage
• Administering medications (aspirin, ibuprofen) that can worsen bleeding or interfere with medical treatment
• Failing to monitor the person's condition and vital signs while waiting for emergency medical help to arrive