B4 Shock

Shock may occur with any injury and will certainly be present to some extent with serious injuries. Shock is caused by a loss of blood flow, resulting in a drop of blood pressure and decreased circulation. If not treated, this drop in the quantity of blood flowing to the tissues can have serious permanent effects, including death.

5B-4.1 Signs and Symptoms of Shock. Shock can be recognized from the following signs and symptoms.

Respiration shallow, irregular, labored

■ Eyes vacant (staring), lackluster, tired-looking

■ Pupils dilated

■ Cyanosis (blue lips/fingernails)

■ Skin pale or ashen gray; wet, clammy, cold Pulse weak and rapid, or may be normal

■ Blood pressure drop

Possible retching, vomiting, nausea, hiccups

5B-4.2 Treatment. Shock must be treated before any other injuries or conditions except breathing and circulation obstructions and profuse bleeding. Proper treatment involves caring for the whole patient, not limiting attention to only a few of the disorders. The following steps must be taken to treat a patient in shock.

1. Ensure adequate breathing. If the patient is breathing, maintain an adequate airway by tilting the head back properly. If the patient is not breathing, establish an airway and restore breathing through some method of pulmonary resuscitation. If both respiration and circulation have stopped, institute car-diopulmonary resuscitation measures (refer to paragraph 5B-2).

2. Control bleeding. If the patient has bleeding injuries, use direct pressure points or a tourniquet, as required (refer to paragraph 5B-3).

3. Administer oxygen. Remember that an oxygen deficiency will be caused by the reduced circulation. Administer 100 percent oxygen.

4. Elevate the lower extremities. Since blood flow to the heart and brain may have been diminished, circulation can be improved by raising the legs slightly. It is not recommended that the entire body be tilted, since the abdominal organs pressing against the diaphragm may interfere with respiration. Exceptions to the rule of raising the feet are cases of head and chest injuries, when it is desirable to lower the pressure in the injured parts; in these cases, the upper part of the body should be elevated slightly. Whenever there is any doubt as to the best position, lay the patient flat.

5. Avoid rough handling. Handle the patient as little and as gently as possible. Body motion has a tendency to aggravate shock conditions.

6. Prevent loss of body heat. Keep the patient warm but guard against overheating, which can aggravate shock. Remember to place a blanket under as well as on top of the patient, to prevent loss of heat into the ground, boat or ship deck.

7. Keep the patient lying down. A prone position avoids taxing the circulatory system. However, some patients, such as those with heart disorders, will have to be transported in a semi-sitting position.

8. Give nothing by mouth.

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