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Now, we're going to cover the topic of shock. In my opinion as a paramedic, shock is one of the most lethal syndromes that a person can go into, in that it is multi-symptom. It is complex, and in the end, everybody dies from the same thing. Shock from one form or another. Now why is that? Well, it's because shock is basically the failure of the body to circulate oxygenated blood to the level of which it needs to keep cells alive. For whatever reason, and that reason could be that it's anaphylactic in nature. It could be that they have hypovolemia, which is low blood pressure, due to low volume of blood. It could also be a form of that, because they didn't lose any blood, but the heart isn't beating strong enough; we call that cardiogenic shock. And, another one that we see in multi-trauma or severe trauma systems is when they go into spinal shock or a neurogenic shock, which is when we have a spinal cord injury or severance and there is no communication from the brain to the rest of the body to fight or flight, which is what keeps people, um, basically stable, it keeps their blood pressure up, it makes their heart beat faster, it keeps their vessels constrict, and so on and so forth. So, what do we do to save these individuals' lives or to at least buy them time until we can get them to definitive care and fix the reason that they're actually in shock in the first place? There are several things we can do and they're very helpful. First thing is to recognize it. What are the signs and symptoms of shock? They kind of have a progression. They'll start at very minimum: nervousness. Um, there might be a little bit of a rapid heart beat. They're a little sweaty, anxious, they're fearful that they might be in trouble. If I notice that I'm going to keep an eye on them. They then begin to become more pale, more rapid breathing, rapid pulse, maybe clammy, and they're very cold. That coldness comes primarily because the body is shunting blood away from its extremities to keep it in the vital organ area. But because of that, the blood is not flowing out to the extremities and the individual may feel cold. They may also begin to show signs of blue colored nail beds. If we pinch the nail bed and it takes more than 3 to 4 seconds to refill or the timing which it takes to say, capillary refill, we call that delayed capillary response. And this response is what shows us that they may actually be showing the next stage and sign of shock. Now when we get into that situation, our treatment plan has got to be pretty confident and it has to be pretty quick. We're going to maintain their airway, make sure it's open, help them breathe if they're not breathing normally. We're going to lay them down as long as they're not having trouble breathing and we're going to elevate the legs above their heart, So we elevate the legs and then if you don't have a stretcher that elevates, you could always use a box, or pillow, or something to put their feet on. And then we're going to cover the patient with a sheet, coat, or blanket. If all you have is newspaper or something to help the person stay warm, it's still going to help insulate them better than if you didn't do anything at all. Remember, they're cool and clammy, they're starting to expire because of the adrenal dump and all the fight or flight mechanism, but this warming of the patient helps them with their own internal abilities to fight the shock symptoms. It’s at this time that we need to make sure that if we've not already activated EMS or 911. We've done so now to get them to definitive care and get them back on track.
Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body. When organs don't receive enough blood, the body begins to compensate by conserving and limiting blood flow to the legs, arms, and the skin. As shock progresses, more systems shut down until the effects become irreversible and death occurs.
Hypovolemic shock is caused by a severe lack of blood and bodily fluids. The most common types of hypovolemic shock is dehydration and hemorrhagic shock, which occurs as a result of significant water or blood loss.
Obstructive shock is caused by an obstruction to blood flow usually within the blood vessels, like a pulmonary embolism – a blood clot in a lung artery.
When there is an inadequate distribution of blood that results in low levels of blood returning to the heart, this can cause distributive shock. Examples include septic shock (due to toxins), anaphylactic shock (due to food allergies), and neurogenic shock (due to spinal cord or brain trauma).
Pro Tip #1: One item to keep in mind is when you think of shock, it is the pale, cool, clammy skin. Which is true, unless we have distributive shock. Since distributive shock causes blood vessels to dilate (expand), this causes increased blood flow to the skin often making it warm and flushed (red).
Cardiogenic shock is the result of the heart being unable to pump correctly to supply enough blood to vital organs. This can be caused by an injury to the heart, disease, or trauma.
Shock is a serious and potentially life-threatening condition that requires immediate medical care. It is a multi-symptom and complex condition, which is also progressive.
Pro Tip #2: The goal of care when the victim is in shock is to find and fix the problem that's sending them into shock. In the case of bleeding injuries, controlling blood loss is the first priority to help allow enough oxygenated blood to circulate, thereby keeping cells and vital organs working properly.
The first step is to recognize the signs and symptoms of shock and realize that these can all progress and therefore should be monitored periodically.
Look for these early signs of shock:
As shock progresses, the victim's skin could become more pale, clammier, and the other symptoms could get worse. Clammy skin, incidentally, is due to a restriction in blood flow to the skin and extremities.
Pro Tip #3: If you suspect shock, pinch a toenail or fingernail and measure the capillary response – the length of time it takes for blood to refill that nail. If it's more than a few seconds, your victim is likely in shock.
Your quick and competent response may be the difference between life and death. If you suspect the victim is in shock, proceed with the following steps.