1. Shock
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2. Objectives Describe shock List the causes of shock
Describe the compensatory & decompensatory stages of shock
Recognize the signs & symptoms of shock

3. Scope Shock Causes of Shock Stages of Shock How to Recognise Shock
Management of Shock
Conclusion

4. Shock Shock is a condition in which:- Blood flow Oxygen
Nutrients to the tissues
are inadequate for normal cell function
Explain to the cadets that this condition is life-threatening and occurs when the circulatory system (which distributes oxygen to the body tissues and removes waste products) fails and, as a result, vital organs such as the heart and brain are deprived of oxygen.
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5. Causes of Shock Shock can be due to: Pump (heart) failure
Severe blood loss
Loss of vascular tone
Other causes:
e.g. low blood sugar, hypothermia, allergic reaction, drug overdose etc
Pump Failure (Heart failure):- cardiogenic shock
Heart attack
Acute heart failure
Severe heart disease
Severe blood loss: hypovolemic shock
-sets in when blood loss is >1.2L (2 pints, i.e. approx 1/5th of normal blood volume in humans) -may arise from
wounds;
hidden bleeding from internal organs;
blood escaping into a body cavity;
bleeding from damaged blood vessels due to a closed fracture *effects of blood loss -up to 2L adrenaline released -> pulse quickens and sweating is induced
Small blood vessels in non-vital areas e.g. skin shut down to divert blood and oxygen to vital organs
Shock becomes evident
>2L
Pulse at wrist may become undetectable
Casualty usually loses consciousness
Breathing may cease, heart may stop
Loss of vascular tone (other bodily fluids): metabolic shock
-may arise from
diarrhoea;
vomiting;
blockage in the intestine;
severe burns
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6. Stages of Shock 1st stage of Shock 2nd stage of Shock
Compensatory Shock
2nd stage of Shock
Decompensatory Shock

7. Compensatory Shock
To protect the vital organs, the body does the following:
Increases the rate & force of the heartbeat
Constricts the blood vessels of the skin
Selectively constricts some of the blood vessels in organs (vasoconstriction)
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8. Compensatory Stage Initial Signs Lethargy or weakness Confusion Fear
Irritability, Agitation
Disorientation

9. Decompensatory Shock
If the causes of compensatory shock are not corrected, decompensatory shock takes place
Blood pressure falls further
Blood pools in the extremities & cardiac output is reduced
Usually results in death
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10. Decompensatory Stage Late Signs
Drowsiness, deteriorating to loss of consciousness
Lower level of consciousness
Patient may be uncooperative, abusive, or combative
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11. How to Recognise Shock Initially, the adrenaline causes:
A rapid pulse
Pale, cold, clammy skin; sweating
As shock develops:
Grey-blue skin (cyanosis), especially inside the lips.
Weakness and dizziness
... Cont’d
Cyanosis – when a fingernail or earlobe, if pressed, will not regain its colour immediately
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12. How to Recognise Shock As the brain’s oxygen supply weakens:
Nausea, and possibly vomiting
Thirst
Rapid, shallow breathing
A weak, “thready” pulse.
As the brain’s oxygen supply weakens:
Restlessness and aggressiveness
Yawning and gasping for air
Unconciousness
Finally, the heart will stop.
*Note that when the pulse at the wrist disappears, about half of the blood volume would have been lost (~3L)
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13. Management of Shock Your Goals:- To recognise shock
To treat any obvious cause of shock
To improve the blood supply to the brain, heart, and lungs
To arrange urgent removal to hospital

14. Management of Shock
Treat any possibly cause of shock that you can detect e.g. severe bleeding
Lay the casualty down on a blanket to insulate her from the cold ground. Constantly reassure her
Raise and support her legs to improve the blood supply to the vital organs. Take care if you suspect a fracture
*2. Shock can be made worse by fear and pain. Whenever there is a risk of shock developing, reassuring the casualty and making him comfortable may be sufficient to prevent him from deteriorating
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15. Management of Shock
Loosen tight clothing at the neck, chest, and waist to reduce constriction in these areas
Keep the casualty warm by covering her body and legs with coats or blankets. Dial 995 for an ambulance
Monitor and record vital signs – level of response, pulse and breathing. Be prepared to resuscitate if necessary
*Note:
Never let the casualty eat, drink, smoke or move unnecessarily. If he/she complains of thirst, moisten their lips with a little water.
Do not leave the casualty unattended, except to call an ambulance.
Do not try to warm the casualty with a hot-water bottle or any other direct source of heat.
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16. Management of Shock
Raise casualty’s legs so that they are higher than his heart
Take pulse at wrist
Keeping head low may prevent casualty from losing consciousness
Protect casualty from cold with coats or blankets

17. Conclusion
A casualty in shock requires immediate emergency treatment to prevent permanent organ damage and death.
Hence, it is important that the shock patient be rapidly transported to a medical facility.