As a first responder in the backcountry, one of our main goals is keep our patient from going into shock.Shock is a life-threatening medical condition and a major medical emergency! It is vitally important to recognize the signs and symptoms of shock and to treat as quickly as possible to prevent your patient from going deeper into shock. Shock is easiest alleviated when it is treated early - when not treated properly or in the early stages, shock can rapidly to lead to unconsciousness and death. Shock is a serious medical condition that needs immediate treatment.
What is the definition of shock? The inadequate perfusion of oxygenated blood to the the body's cells, tissues and organs under adequate pressure.
The term perfusion is derived from the French verb "perfused" meaning "to pour over or through." What this means in medical terms, is the process of oxygenated blood being delivered to the body's cells: oxygenated blood being poured over and through all of the body's cells and then to the organs systems. Adequate pressure is achieved through proper blood pressure within the veins and arteries.
In wilderness situations shock should be suspected after traumatic injuries, significant loss of blood due to internal or external bleeding, extreme loss of fluid, heart attacks, and spinal cord injuries. A first responder should always anticipate that your patient may go into shock after any traumatic injury.
There are several types of shock to consider. The three most common type of shock would be:
- Hypovolemic Shock: this is caused by loss of fluid volume from bleeding injuries, burns, vomiting and from excessive sweating without proper fluid replacement.
- Cardiogenic Shock is caused by the failure of the heart to adequately pump blood - this would most commonly be caused by cardiac arrest or heart attack.
- Vasogenic Shock is the most complex of the types of shock. Vasogenic shock is cause by loss of vascular tone resulting in an increase in vascular space (inadequate pressure) - mainly caused by spinal cord injuries, septic infections and anaphylaxis.)
As you can see, shock can be brought upon by several traumatic medical injuries or sudden illnesses.
There are three stages of shock that a first responder must pay attention to and each of the stages, if not attended to properly, can progressively lesson the chances of survival for your patient.
The three stages are:
- Compensatory: heart rate increases, respiratory rates increase, their is vasoconstriction - blood pressure rates are still within normal range to keep adequate perfusion and pressure. This stage of shock, if treated properly can be kept under control and all systems within the body can return to normal.
- Decompensatory: the body's efforts to compensate begins to fail, blood pressure starts to drop, inadequate perfusion begins and the brain is no longer receiving the oxygen rich blood it needs.
- Irreversible: the name says it - irreversible shock means that your body's systems and organs have failed due to inadequate oxygen rich blood. With organ failure comes systemic toxicity and the patient dies.
Signs and symptoms of shock.
In Compensatory Shock, the patient will be anxious, restless and disoriented. Heart rate will be rapid. Respiratory rate will be quite rapid and shallow. The skin will be pale, cool and clammy. The patient may have symptoms of nausea, vomiting, dizziness and excessive thirst.
In Decompensatory Shock, the patient's mental status deteriorates rapidly, eventually becoming unresponsive. Heart rate is rapid but quite weak and shallow. Respiratory rate continues to increase and becomes even more shallow. The skin has become alarmingly pale, cool and clammy, even ashen or cyanotic (bluish.) Pupils become much slower to respond and may become fixed and dilated.
With Irreversible Shock, the patient has succumbed to organ and total body system failure.
As you can see, shock is a serious situation and must be treated rapidly.
Treatment principles for shock are:
- Treat before serious signs develop.
- Treat the cause of the shock.
- Keep the patient calm!
- Keep the patient temperature controlled within normal temperature range.
- Keep the patient flat and if you are to elevate the legs, only elevate to approximetley 8 inches.
- If the patient can swallow water on their own, consider oral fluids - but only if they can drink on their own.
- Monitor the patient closely and often for changing and/or deteriorating vital signs!
Please evacuate any patient whose vital signs do not stabilize or improve over time.
Learning how to check vital signs is one of the most important skills a first responder can acquire. Vital signs - heart rate, respiratory rate, skin color and temperature and level of responsiveness - are the brain's way of communicating what is going on with the body. Learn these skills!
Be prepared out there in recognizing, preventing and treating for shock. Preventing your patient from going into deeper shock, can save their lives!