Shocks

 Definition: The reaction of the body to the

failure of the circulatory system to provide
enough blood to all-the vital origins of the
body.
 It is a condition resulting from a depressed
state of many vital body functions due to
decreased tissue perfusion that could threaten
life as a result of severe pain (Neurogenic
shock), electric burn (electric shock), massive
bleeding (hemorrhagic shock), massive fluid
loss (hypovolmic shock), hypersensitivity
reaction (anaphylactic shock) , etc.
 Sign and symptom of shock:
 Pale or bluish skin /Mucus membrane
 Cold extremities to touch
 Moist and clammy skin
 Rapid and weak pulse
 Rapid and shallow breathing /especially in
abdomen & chest injuries)
 Low B/P and may be unresponsive
 Shocks…
 Cause
Trauma
Heart failures
Sever bleeding
Loss of plasma – in burns or crushing injures
Allergy
Loss of body fluid - recurrent vomiting from any
cause
First aid management of shock
 Body positioning /lying down to improve
circulation
 Keep the head lower and turned on the side
 Body positing depends on the site & type of
injury
 E.g. If the injury is on the neck & spine, do not
move the victim until he is Prepared for
transport
 Keep the causality warm
 Loosen any tight clothing /assists breathing/
 Don't give fluid by mouth /moisten the lips
 Shocks…
 Symptoms of shock
 General body weakness – the most significant symptoms
 Nausea with possible vomiting
 Thirst
 Dizziness
 Restlessness, and fear
 Fast breathing and shallow
 pulse – rapid and weak
 Pupils - dilated • Face – pale
 Lips-blue
 Restlessness, become unresponsive
 Skin- cool and clammy- eyes- lack luster
 Breathing – rapid and shallow
 First aid management of shock
 Have the patient lie down and stay at rest
 Keep the air way open and preventing the forward tilting of the head
 Control external bleeding
 Keep the patient warm by covering with blanket or sheet
 Properly position the patient
 Open air way and alert for vomiting If there is no spinal injuries use one of the
following positions
 Elevate the lower extremities, place patient place patient
 flat, face up, and elevate the legs 8 to 12 inches
 Do not tilt the patient's body
 Don not elevate any fractured limb unless they have been properly splinted
 Do not elevate the leg if there are fractures to the pelvic
 Nothing by mouth (NPO)
 Monitor the patient vital signs
 Refer the patient to Hospital
Approach to shock
 Introduction
 Poor perfusion is when the body is not able to
get enough oxygen-carrying blood to vital
organs. When organ function is affected, this is
called shock and can lead rapidly to death.
Infants, children and older adults are more
likely to be affected by shock.
 Introduction…
o Causes of poor perfusion which may lead to shock include:
o loss of blood (haemorrhage);
o loss of fluid due to diarrhoea, vomiting, extensive burns or excess
urination (such as caused by high blood sugar);
o poor fluid intake. Small children, the elderly and the very ill may be
unable to drink enough fluids without assistance and are at risk of
dehydration;
o abnormal relaxation and enlargement (dilation) of the blood vessels
(with the same amount of blood inside the vessel) can lower blood
pressure. This can occur in severe infection, spinal cord injury and
severe allergic reaction;
o poor filling of the heart can result from blood or other fluid in the sac
around the heart (pericardial tamponade), or increased pressure in the
chest that can shift and block the vessels returning blood to the heart
(tension pneumothorax);
o failure of the heart muscle to pump effectively can be due to a heart
attack (vessel blockage that causes acute heart muscle damage);
inflammation or other disease of the heart muscle itself; an abnormal
rhythm or valve problems. (Shock due to failure of the heart to pump
effectively is sometimes called cardiogenic shock.)
 ABCDE: KEY ELEMENTS IN
SHOCK
• AIRWAY
– Face/mouth swelling or voice changes
can indicate an allergic reaction. A
severe allergic reaction can cause
shock.
• BREATHING
– Wheezing can indicate a severe allergic reaction
which can cause shock. Shock, difficulty in breathing
and absent breath sounds on one side can indicate a
tension pneumothorax. Poor perfusion itself can
sometimes cause rapid breathing when vital organs
do not receive enough oxygen. Severe heart
failure can cause poor perfusion with difficulty in
breathing when fluid backs up into the lungs. Any
infection severe enough to cause shock may be
associated with lung inflammation that causes
difficulty in breathing.
• CIRCULATION
– Shock can be caused by many types of
bleeding (from the stomach or
intestines, pregnancy-related, and
internal and external haemorrhage
from trauma). Shock can also result
from the fluid loss associated with
diarrhoea, vomiting, extensive burns, or
excess urination (such as caused by
high blood sugar).
• DISABILITY
• Confusion in a person with poor
perfusion suggests severe shock.
Paralysis may indicate a spinal cord
injury causing shock.
• EXPOSURE
– Look for signs of bleeding, trauma, and
excessive sweating (diaphoresis). Hives
can indicate allergic reaction, and other
rashes can indicate systemic infection.
 S: SIGNS AND SYMPTOMS
o Has there been vomiting and/or diarrhoea? For
how long?
o Has the person had blood in stool or vomit?
o Has there been any vaginal bleeding?
o Has the person had any chest pain?
o Has there been fever?
o Has there been any exposure to toxins,
medications, insect stings or other substances?
o Has there been altered mental status or
unusual sleepiness?
 A: ALLERGIES
• Does the person have any known
allergies?
 M: MEDICATIONS
• Currently taking any medications?
 P: PAST MEDICAL HISTORY
o History of pregnancy or recent
miscarriage or delivery?
o History of recent surgery or induced
abortion?
o History of heart disease (heart attack
or heart valve problems)?
o Is there a history of HIV?
 L: LAST ORAL INTAKE
• When did the person last eat or
drink?
E: EVENTS SURROUNDING ILLNESS

o Has there been any recent trauma?

o Has there been any recent illness?
 CHECK: SECONDARY EXAMINATION FINDINGS IN
SHOCK

o Check breath sounds and respiratory rate:

o Abnormal or noisy breathing can indicate pneumonia
as a source for system-wide infection causing shock.
o High sugar levels can result in chemical imbalance
(diabetic ketoacidosis) that the body tries to address
by faster or deeper breathing. This condition may
also result in sweet or ‘fruity’ smelling breath. Since
elevated blood glucose levels cause increased
urination, severe dehydration and shock can result.
o Vaginal bleeding may be an important source of
blood loss from pregnancy-related bleeding (even in
those who think they are not pregnant) or from
masses in the cervix or uterus.
o Check for bleeding:
o All external bleeding should be
controlled with direct pressure. Arterial
bleeding may appear as pulsing or high
pressure bleeding, and significant blood
volume can be lost in minutes.
o Check fluid status:
o In dehydration states, the patient may
feel thirsty or may have dry lips and
mouth, abnormal skin pinch, lethargy,
and delayed capillary refill. Patients with
heart failure can be in shock with fluid
overload, and may have lower body
swelling (usually in both legs), crackles
on lung examination, and distended
neck veins.
o Check for pale conjunctiva (the
inside of the lower eyelid):
o No matter the person’s skin color, the
inside of the eyelid should appear pink
and moist. If the inner portion of the
eyelid (conjunctiva) is pale, it may
indicate significant blood loss. You can
compare the patient’s conjunctiva to
another healthy person or look at your
own in a mirror.
o Check mental status:
o Confusion in a patient with other signs
of poor perfusion suggests severe shock.
o Check for fever:
o Fever in a patient with shock suggests
severe infection.
o Check blood sugar:
o Low blood glucose can sometimes look
like shock. If you cannot check blood
glucose, but the person has altered
mental status, a history of diabetes or
another reason to have low sugar (for
example, is taking quinine for malaria, is
very ill, or is very malnourished),
giveglucose.
o Check for severe abdominal pain
or a very firm abdomen:
o If the person has severe abdominal pain,
this can be a sign of bleeding or
infection in the abdomen. In a patient
who might be pregnant, this can be a
sign of an ectopic pregnancy.
o Check urine:
o Check the urine colour and volume.
Small amounts of darker urine may
indicate substantial dehydration.
o Check stool:
o Any significant diarrhoea can cause
dehydration. A large amount of watery,
“rice-water” stool suggests cholera,
which can rapidly cause severe
dehydration and shock. Black, dark, or
reddish colored stool can suggest
stomach or intestinal bleeding.
o Check for malnourishment:
o If the person appears malnourished,
fluid must be adjusted. Be sure to ask
about recent changes in weight.
o Check for swelling, rash or
excessive sweating:
o Swelling of mouth or body can indicate
an allergic reaction. Rashes can indicate
allergic reaction (hives) or systemic
infection. Swelling of both legs can
indicate heart failure. Sweating may
occur with moderate to severe shock.
POSSIBLE CAUSES OF SHOCK
POSSIBLE CAUSES OF SHOCK
POSSIBLE CAUSES OF SHOCK
POSSIBLE CAUSES OF SHOCK
POSSIBLE CAUSES OF SHOCK
POSSIBLE CAUSES OF SHOCK