Shock
Recognizing and treating shock, a life-threatening condition.
What Shock Is
Shock is the body running out of oxygenated blood at the tissue level. Cells starve. Organs fail. Death follows if it isn't reversed.
The patient may look fine for minutes, then crash. Treat early signs as the real signs.
Shock is a medical emergency. Call 911 immediately.
Types of Shock
| Type | Cause | Common In |
|---|---|---|
| Hypovolemic | Blood/fluid loss | Trauma, bleeding, dehydration |
| Cardiogenic | Heart failure | Heart attack, heart disease |
| Anaphylactic | Severe allergic reaction | Allergies to food, stings, medications |
| Septic | Severe infection | Infections that spread to bloodstream |
| Neurogenic | Spinal cord injury | Trauma to spine |
Recognizing Shock
Early Signs
| Sign | What You See |
|---|---|
| Pale, ashen skin | Color drains from face, lips |
| Cool, clammy skin | Moist, cold to touch |
| Rapid pulse | Fast, may be weak |
| Rapid breathing | Shallow, fast |
| Anxiety | Restless, agitated |
| Thirst | Asking for water |
Progressive Signs
| Sign | What You See |
|---|---|
| Confusion | Disoriented, difficulty thinking |
| Weakness | Can't stand, losing strength |
| Nausea/vomiting | May vomit |
| Blue lips/fingertips | Cyanosis - lack of oxygen |
| Fading consciousness | Becomes less responsive |
Late Signs
- Unresponsive
- Very weak or absent pulse
- Extremely low blood pressure
- Not breathing
Don't wait for late signs. Act on early signs.
Treating Shock
Basic Care
1. Call 911 immediately
2. Control obvious bleeding
- Direct pressure
- Tourniquet if needed
3. Position the victim
Standard position:
- Lay flat on back
- Elevate legs 8-12 inches (if no suspected spinal injury)
- This helps blood flow to vital organs
Exceptions:
| Condition | Position |
|---|---|
| Head injury | Elevate head slightly |
| Suspected spinal injury | Don't move, stabilize |
| Difficulty breathing | Semi-sitting may help |
| Unconscious but breathing | Recovery position |
| Chest injury | Injured side down |
4. Prevent heat loss
- Cover with blanket or coat
- Insulate from cold ground
- Don't overheat
5. Loosen restrictive clothing
- Belt
- Tie
- Tight collar
6. Do NOT give food or drink
- May need surgery
- May vomit and aspirate
- Moisten lips only if needed
7. Reassure and calm
- Talk to them
- Explain what you're doing
- Keep them still
8. Monitor continuously
- Level of consciousness
- Breathing
- Pulse
- Be ready for CPR
Anaphylactic Shock
Causes
Severe allergic reaction to:
- Foods (nuts, shellfish, eggs)
- Insect stings (bees, wasps)
- Medications (penicillin, aspirin)
- Latex
- Other allergens
Signs (Rapid Onset)
- Swelling of face, tongue, throat
- Difficulty breathing
- Widespread hives
- Rapid pulse
- Dizziness
- Nausea/vomiting
- Sense of doom
Treatment
1. Call 911 immediately
2. Ask about epinephrine
- "Do you have an EpiPen?"
- "Are you allergic to something?"
3. Help them use epinephrine auto-injector
Using an EpiPen:
- Remove safety cap
- Hold orange tip against outer thigh
- Push firmly (through clothing is OK)
- Hold for 10 seconds
- Remove and massage area
- Note time given
4. Position based on symptoms
- Breathing difficulty: Sitting up
- Feeling faint: Lying down with legs elevated
- Unconscious: Recovery position
5. Be prepared for second dose
- Effects may wear off
- Another dose may be needed in 5-15 minutes
6. Monitor airway
- Swelling can close airway
- Be ready for CPR
7. Keep them calm
- Anxiety worsens symptoms
- Reassure help is coming
If No Epinephrine Available
- Call 911 (critical)
- Monitor airway
- CPR if needed
- Antihistamine (Benadryl) may help minor reactions but won't stop anaphylaxis
Insulin Shock (Diabetic Emergency)
Two Types
| Low Blood Sugar (Hypoglycemia) | High Blood Sugar (Hyperglycemia) |
|---|---|
| Sudden onset | Gradual onset |
| Shaky, sweaty | Fruity breath |
| Confused, irritable | Very thirsty |
| May be combative | Frequent urination |
| Needs sugar NOW | Needs insulin |
For Low Blood Sugar
Signs:
- Shaking
- Sweating
- Pale
- Hungry
- Irritable/confused
- Rapid heartbeat
Treatment:
- If conscious, give sugar:
- Juice or regular soda
- Glucose tablets
- Candy
- Have them sit
- Monitor for improvement (10-15 minutes)
- If no improvement or consciousness declines, call 911
If Unsure Which Type
When in doubt, give sugar.
- If low sugar: Sugar will help
- If high sugar: Small amount won't hurt much
Call 911 for:
- Unconsciousness
- No improvement after sugar
- Uncertainty about what's happening
Prevention of Shock
After Injury
- Control bleeding immediately
- Don't let injured person "walk it off"
- Keep warm
- Elevate injured limb if appropriate
- Monitor for shock signs
For Those at Risk
Diabetics:
- Carry glucose
- Wear medical ID
- Know warning signs
Those with severe allergies:
- Carry epinephrine
- Wear medical ID
- Avoid known triggers
- Have action plan
Key Points
- Shock is life-threatening - Don't underestimate
- Call 911 immediately - This is an emergency
- Lay flat, elevate legs - Helps blood flow to organs
- Control bleeding - Blood loss causes shock
- Prevent heat loss - Keep them warm
- No food or drink - May need surgery
- Monitor continuously - Condition can worsen rapidly
- Epinephrine for anaphylaxis - Time-critical intervention
- Sugar for diabetic emergency - When in doubt, give sugar
Next Steps
Continue to 06-fractures-sprains.md to assess and stabilize bone and joint injuries without making them worse.