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.
The Four Main Types of Shock
Hypovolemic Shock
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
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.
Distributive Shock
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
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.
How to Provide Care
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:
- Nervousness
- Rapid heart rate or breathing
- Anxiousness
- Sweaty
- Fearful
- Clammy skin
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.
How to Deal with a Shock Victim
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.
- Call 911 or EMS. Depending on the cause of the shock, time is critical to get them to advance care.
- Always ensure scene safety for you and other bystanders.
- Maintain the victim's airway and help them breathe if they're not able to on their own. Begin CPR if unresponsive and not breathing.
- Help improve their circulation by controlling any bleeding. Start with the worst bleed, first, but all bleeding should be as controlled as possible.
- Place the victim flat on their back if possible. Do not elevate the legs if injury is suspected or if it causes discomfort. If a victim is breathing normally, but is unconscious with no concerns of spinal injury, another option is the recovery position. This is a great way to protect their airway.
- Cover the victim with a blanket or coat. Insulate them as best you can and keep them warm. This will help their bodies combat the effects of shock.
- Do not give shock victims anything to eat or drink as this could cause nausea and vomiting, which in turn can make the shock worse, not to mention this risk of blocking the airway.
- Stay with the patient and keep them calm.
- If you have oxygen available, it may be appropriate to provide supplemental oxygen. Always follow local protocols when administering oxygen.