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                          Treating for Shock

   The following material may assist you in treating a victim for shock.

This information is derived from "Advanced First Aid & Emergency Care," 2nd edition, by the American Red Cross. To obtain a copy of this book and to take instruction in first aid, please contact the local office of the American Red Cross. They are listed in the white pages of your telephone book.

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Define what is "shock"

        Shock is a condition resulting from a depressed state of many
   vital body functions. It can threaten life even though the injuries or
   conditions that caused the depression may not otherwise be fatal. The
   body's vital functions are depressed when there is a loss of blood
   volume, a reduced rate of blood flow or an insufficient supply of
   oxygen. Injury-related shock, commonly referred to as traumatic shock,
   is decidedly different from electric shock, insulin shock, and other
   special forms of shock.

        The degrees of shock is increased by abnormal changes in body
   temperature, by poor resistance of the victim to stress, by pain, by
   rough handling and by delay in treatment.

What are the causes of shock?

        Shock may be caused by severe injuries of all types - hemorrhage,
   loss of blood plasma in burns, muscle swelling, loss of body fluids
   other than blood (as in prolonged vomiting and dysentery), by
   infection, by heart attack or stroke, by perforation of a stomach
   ulcer, by rupture of a tubal pregnancy, by anaphylaxis or by poisoning
   involving chemicals, gases, alcohol or drugs. Shock also results from
   lack of oxygen caused by obstruction of air passages or injury to the
   respiratory system.

What are the EARLY stages and signs of shock?

        In the early stages of shock, the body compensates for a
   decreased blood flow to the tissues by constricting the blood vessels
   in the skin, soft tissues and skeletal muscles. Their constriction
   causes an emergency redistribution of blood flow to the heart, brain
   and other vital organs and may lead to the following signs:

   a.   Pale (or bluish) skin, cold to the touch and possibly moist and
        clammy. In the case of victims with dark skin pigmentation, it
        may be necessary to rely primarily on the color of the mucous
        membranes on the inside of the mouth, on the inside of the
        eyelids or in the fingernail or toenail beds.

   b.   Weakness.

   c.   Rapid pulse (usually over 100 beats per minute or over about 17
        beats in 10 seconds), often too faint (due to decreased blood
        pressure) to be felt at the wrist but perceptible in the carotid
        artery at the side of the neck or in the femoral artery near the
        groin.

   d.   Increased rate of breathing, possibly shallow, possibly deep and
        irregular. If there has been an injury to the chest or abdomen,
        breathing will almost certainly be shallow because of the pain
        involved in breathing deeply. A person in shock from hemorrhage
        may be restless and anxious (early signs of lack of oxygen),
        thrashing about and complaining of severe thirst and he may vomit
        or retch from nausea.

What are the LATE stages and signs of shock?

        If the victim's condition deteriorates, he may become apathetic
   and relatively unresponsive because his brain is not receiving enough
   oxygen. His eyes will be sunken, with a vacant expression, and his
   pupils may be widely dilated. Some of the blood vessels in the skin
   may be congested, producing a mottled appearance; this condition is a
   sign that the victim's blood pressure has fallen to a very low level.
   If untreated, the victim eventually loses consciousness, his body
   temperature falls and he may die.

What are the objectives in the treatment for shock?

        The objectives of first aid care in shock are to improve
   circulation of the blood, to ensure an adequate supply of oxygen and
   to maintain normal body temperature.

What is the proper first aid treatment for shock?

        Give urgent first aid to eliminate causes of shock, such as
   stoppage of breathing, hemorrhaging and severe pain. Steps for
   preventing shock and for giving first aid for shock are as follows:

        a.   Keep the victim lying down.

        b.   Keep him covered only enough to prevent loss of body heat.

        c.   Summon/obtain professional medical help.

        The victim's position must be based on his injuries. Generally,
   the most satisfactory position for the injured person will be lying
   down, to improve blood circulation. If injuries of the neck or lower
   spine are suspected, do NOT move the victim until he is properly
   prepared for transportation, unless it is necessary to protect him
   from further injury or to provide urgent first aid care.

        A victim who has severe wounds on the lower part of the face and
   jaw or who is unconscious should be placed on his side to allow
   drainage of fluids and to avoid blockage of the airway by vomitus and
   blood. Extreme care must be taken to provide an open airway and to
   prevent asphyxia. Place a victim who is having difficulty in breathing
   on his back, with his head and shoulders raised. A person with a back
   injury may be kept flat or propped up, but his head must NOT be lower
   than the rest of his body. A victim with severe brain injury may be
   unconscious, but unconsciousness is not itself a cause of shock unless
   he also has associated fractures or major wounds. IF IN DOUBT
   CONCERNING THE CORRECT POSITION ON THE BASIS OF THE INJURIES, KEEP THE
   VICTIM LYING FLAT.

        A victim in shock may improve with his feet (or the foot of the
   stretcher) raised from 8 to 12 inches. This position helps to improve
   blood flow from the lower extremities. If in doubt as to whether the
   victim's feet should be raised, keep the victim flat. If he has
   increased difficulty in breathing or experiences additional pain after
   his feet are raised, lower them again.

        Keep the victim warm enough to overcome or avoid chilling. If he
   is exposed to cold or dampness, place blankets or additional clothing
   over and under him to prevent chilling.

        Do NOT add extra heat, because raising the surface temperature of
   the body is harmful to shock victims. Heat draws the diverted blood
   supply back to the skin from the more vital organs, thus robbing them
   of critically needed blood.

What are the cautions and prohibitions about giving fluids to the victim?

        Although giving fluid by mouth has value in shock, fluids should
   ONLY be given when medical help or trained ambulance personnel will
   not reach the scene for an hour or more. Other exceptions are when
   victims are unconscious, have convulsions, are vomiting or are likely
   to vomit. (They may aspirate fluids into the lungs if given fluids by
   mouth under these conditions.) Do not give fluids to victims who are
   likely to require surgery or a general anesthetic or who appear to
   have an abdominal injury. Oral fluids are harmful after injury to the
   brain, because additional fluids in the body may increase swelling of
   the brain. (A person with brain injury is likely to be unconscious or
   vomiting.) Fluids may be given by mouth ONLY if medical care is
   delayed for an hour or more and none of the above contraindications
   exist.

        Water, preferably water that contains salt and baking soda (1
   level teaspoon of salt and 1/2 level teaspoon of baking soda to each
   quart of water) and that is neither hot nor cold - is recommended.
   Adults may be given about 4 ounces (1/2 glass) every 15 minutes;
   children, ages 1 to 12, 2 ounces; infants, 1 year or less, 1 ounce.
   Discontinue if nausea or vomiting occurs.

        The preferred method of is by intravenous administration of
   fluids, a technique that provides intravascular volume restoration.
   However, this technique must only be used by individuals with
   specialized training and with authority.