Shock 1.2.5

Objectives Describe shock List the causes of shock Describe the compensatory & decompensatory stages of shock Recognize the signs & symptoms of shock

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

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. 1.2.5

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 1.2.5

Stages of Shock 1st stage of Shock 2nd stage of Shock Compensatory Shock 2nd stage of Shock Decompensatory Shock

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) 1.2.5

Compensatory Stage Initial Signs Lethargy or weakness Confusion Fear Irritability, Agitation Disorientation

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 1.2.5

Decompensatory Stage Late Signs Drowsiness, deteriorating to loss of consciousness Lower level of consciousness Patient may be uncooperative, abusive, or combative 1.2.5

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 1.2.5

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) 1.2.5

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

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 1.2.5

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. 1.2.5

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

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.