Shock First Aid

Shock is a word used with many meanings. Of most value to first aider’s is traumatic shock, which is a down condition of many of the body functions due to failure of enough blood to circulate through the body following serious injury. Decidedly different conditions are electric shock, insulin shock, caused by an overdose of Insulin; the temporary shock of simple fainting, and the psychiatric condition formerly called shell shock.

Causes and Dangers of Shock 

Traumatic shock is related with injury to body tissue from burns, wounds, or fractures. In most instances it is caused by loss of largo quantities of blood either externally or into the tissues or body cavities. In general, the greater the damage to flesh and bone and the larger the blood loss, the greater the danger that shock will occur. Shock may be produced or made worse by any manipulation that increases hemorrhage or causes it to recur.

Rough handling of the patient should be particularly avoided. The aged and the debilitated do not withstand shock as well as others. If a person develops shock and remains in it, death may result even though the injury causing the shock would not be fatal otherwise. Therefore, proper first aid to help prevent or to deal with shock is essential when caring for any seriously injured person.

Signs and Symptoms of Shock 

The most important indication is the victim's weakness, coupled with a skin that is pale and moist and cooler than it should be.

• Eyes: (Vacant, Lackluster)
• Pupils: (Dilated)
• Breathing: (Shallow, Irregular)
• Pulse: (Weak or Absent)
• Skin: (Pale, Cold, Moist)

Beads of perspiration may be noted about the lips, forehead, palms, and armpits. The patient may vomit or complain of nausea. His mental reactions may appear normal at first. Later, he may be restless or lose alertness and interest in his surroundings. Thirst is commonly present. The pulse is fast but may be weak or impossible to feel. The patient may breathe faster than usual and occasionally take deep breaths. These signs may not appear at once. Especially in cases of severe hemorrhage, they may develop only after an hour or more. Shock should not be confused with simple fainting. Individuals with minor injuries may faint. Even persons who have not been injured may faint at the sight of a serious accident, particularly if blood is visible. One who has fainted will he pale and often covered with perspiration. He may he nauseated. The pulse will usually be slow. If he is allowed to lie flat, recovery will occur promptly.

Since the evidence of shock may not be present, even when the injuries are severe, the first aider may fail to apply proper measures. The victim may seem alert and react optimistically, but suddenly he may collapse. Sometimes only a few signs of shock are noted, and the first aider may think there is little need for concern. He may even permit transportation of the victim in the sitting up position. The proper course is simple: give first aid for shock to all seriously injured people.

First Aid for Shock

The same first aid measures apply to both prevention and care of shock.

Position

Position Keep the patient lying down. The lying-down position favors the flow of a greater amount of blood to the head and chest, where it is needed most. It places less demand upon the body than the sitting or standing positions. It is the most favorable position if there is injury to internal organs and the head, or in case of a fracture. There is one exception to the horizontal position: if there is difficulty in breathing, the patient's head and chest should be elevated.

Position of shock victim when head and chest injuries are absent.

Except as noted below, elevate the lower part of the body if the blood loss is great, or the injury severe. Raise the foot of the bed or stretcher eight to twelve inches. If the victim is on the floor or ground, place pillows or substitutes beneath the lower extremities. 

This elevation should not be done:

1. If there is a head injury.
2. If breathing difficulty is thereby increased.
3. If the patient complains of pain when it is attempted, such as pain at a fracture site in the lower extremity or abdominal pain. 

For lesser injuries, such as a fracture of the wrist, elevation is unnecessary, though not harmful.

Heat

If the victim is lying on the ground or floor, place a blanket beneath him. Cover him only sparingly, according to the temperature of the environment. Do not cause sweating. It is better if he is slightly cool than toasting warm. On warm days little or no surface covering is needed. 

Application of external heat by hot water bottles and heating pads is usually harmful in shock. They may be used in cold weather, if sufficient blankets are not available to prevent freezing. If so, use utmost care not to burn the patient. Remember that you test the warm object for only a second or so, whereas it may be in contact with his skin for a long time.

Normally his skin will not withstand heat; further, he usually does not recognize that a burn is developing, whether he is unconscious or not. The warm object should have a temperature only slightly above body temperature. The overall principle relating to heat in shock is this does not add heat; simply prevent a large loss of body heat.

Fluids

If the patient will be under medical care within a half hour or less, the first aider need not concern himself with fluids except to allay thirst. Fluids have value in shock. Nevertheless, they should not be given if the patient is unconscious or only partly conscious, if he is nauseated has a penetrating abdominal wound, or probably faces early operation.

Plain water, neither hot nor cold, is the best fluid. Other drinks may cause nausea, a feeling of fullness, and hiccups. Do not give alcoholic drinks. A set rule concerning the amount of fluid to give cannot be stated, because individual cases vary so much. If there will be delay until medical care is available, administer a few sips at first. Observing the patient’s tolerance and thirst, increase the amount to a half glass at a time. In case of large blood loss, the patient is usually thirsty and will take drinks at short intervals.

Your concern should be to see that he does have fluids, but at such doses and intervals that he does not vomit. If he vomits or is nauseated do not give fluids. If medical care will be unavailable or considerably delayed, give half glass doses of water, to which has been added one half level teaspoon table salt and one half level teaspoon of baking soda per quart, at about 15 minute intervals. Within an hour medical advice should be obtained. The problem of fluid administration is not great in first aid usually, because the patient will have medical attention fairly soon.

Other measures against Shock

The underlying injuries should receive attention; for example, hemorrhage should be controlled and fractures splinted. The victim should not be disturbed by unnecessary questioning, manipulation, and noise. Tactful encouragement should be given. Stimulants such as ammonia or coffee have no value in traumatic shock.

References:
www.redcross.org.uk/
www.prcs.org.pk/