Shock

Shock is actually an insidiously dangerous condition. The simple description of it is lack of blood flow (and the nutrients and oxygen carried by it) to the tissues and organs.

Untreated, or unsuccessfully treated, it then progresses through several stages, including death.

An excellent, but very technical, rundown on shock, its phases and types, is available on Wikipedia, graphically represented by this flow chart of shock and its way of working.

I have to admit: I’ve known about shock for decades, and that it is very dangerous. However, on reading up on it in depth, I have to say I’m in shock about shock! Scary stuff!

Especially for anyone who is “out there” on his or her own, or in a small group far away from medical care, treat for shock upon any serious injury, condition, or trauma. The necessity is that, since shock is so insidious (symptoms may not appear until the condition has progressed significantly), and since early treatment is such a lifesaver, treat for it even in the absence of symptoms.

In particular, there is a high probability of shock with:

• Severe (internal or external) bleeding
• Major bone fractures
• Major burns
• Dehydration
• Heart failure
• Severe allergic reactions
• Spinal cord injuries involving paralysis

Prevention

Prevention of shock can be summed up as being fit, taking care to avoid accidents, taking care of yourself in terms of eating and drinking, and knowing what allergies and conditions you have (to avoid exposure to allergens and whatever else might bring on a flare-up of the condition).

It could also be said that acting quickly, even treating in the absence of symptoms, is prevention, in that it helps avoid slipping from one phase of shock into the next.

Symptoms

• The fundamental symptoms of shock are:
• Pale (perhaps mottled), cool, or clammy skin, especially in the extremities
• Altered mental state: anxious, confused, restless or combative, stages of unconsciousness
• Rapid, deep breaths
• A rapid, weak, perhaps unreliable pulse
• Fatigue
• Low blood pressure
• Hypothermia (from lack of blood to tissues and from evaporation of sweat)
• Thirst and dry mouth
• Additional symptoms may include:
• Distended jugular veins and lack of pulse (in cardiac arrest)
• Distended jugular veins and shifting pulse strength (from vascular blockage)
• Fever (from advanced infections)
• Symptoms of Anaphylactic shock
• Skin eruptions and welts
• Localized swelling, especially around the face
• Weak, rapid pulse
• Breathlessness and coughing because of constricted airways

Treatment

It’s important to recognize the symptoms of shock. When they’re present, it is best to get medical care. With or without symtoms, however, treat for it if any significant injury has been sustained, especially in the high probability conditions listed above.

Quoting directly from the Wikipedia article cited above: The treatment of shock is sometimes taught to lifesavers as an acronym: WARTS. W: Warmth A: ABC's (Airway, Breathing, Circulation or CPR) R: Rest and reassurance T: Treatment (treat the cause of shock) S: Semi-prone position, which is the same thing as recovery position.

From what I’ve seen and know about shock, while WARTS may be a good way to remember the parts of treatment, it appears to suggest a somewhat backwards order. In fact, it seems that STRAW may be closer to accurate.

• The main treatment:
• Victim should receive comforting words and actions
• Get the victim into a position that is semi-prone or flat. This helps keep the blood more in the torsoe and upper body. Raising the legs is suggested only in cases where the victim has simply fainted or is in shock because of external bleeding that has been controlled; and it is no longer thought to be particularly effective
• Stop any serious external bleeding
• Loosen restrictive clothing
• Splint broken bones. If the femur is broken, and you know how to apply and maintain traction, it is recommended
• Cover for warmth, insulate from the ground. Not too much warmth, but enough to compensate for reduced internal temperature due to lack of blood flow
• Be prepared to perform cardiopulmonary resuscitation
• Be prepared to help victim if nauseated
• Collect as much medical and incident information as possible; victim may lose consciousness, but if you have that information, it can be useful to emergency care providers
• Heart failure victims may benefit from lying with head and shoulders elevated
• For anaphylactic shock:
• Epinephrine (adrenaline) is the primary treatment. People who know they have severe allergies (bee stings, etc.) may be equipped with self-injecting epinephrine. Otherwise, it may be hard to come by “in the field”
• Diphenhydramine can be useful in reducing reaction to allergens, but shouldn’t be substituted for epinephrine if ephinephrine is available
• Treat for non-allergic shock—comfort, lying down, loosen restrictive clothing, keep warm

My favorite reference book for first aid matters is A Comprehensive Guide to Wilderness & Travel Medicine, by Eric A. Weiss. Handy, small, easy to pack around, but solid in its coverage.

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