You arrive at the scene of a car accident. The driver of one car is sitting at the edge of the road--pale, chilled, staring glassily ahead and not answering questions of bystanders. She slowly rocks back and forth, one hand pressed to her chest. One of the would-be helpers looks up. “I think she’s in shock,” he says. What does he mean?
What is shock?
Medically, there are different types of shock, but generally when the word is used alone it refers to circulatory shock, a potentially life-threatening condition in which the organs and tissues of the body are not receiving an adequate flow of blood. This deprives them of oxygen and allows the build-up of waste products. If not treated in time, the cells begin to die. There are three stages of circulatory shock:
Stage I (compensated or non-progressive): In this stage, the heart beats faster, blood vessels constrict a little, and the kidneys work to retain fluid levels in the body. There is little or no urine output—all this to maximize blood flow to the most important systems in the body. The patient may show few symptoms, and proper treatment can completely halt any progression of the shock.
Stage II: The body’s compensation methods (described in Stage I) begin to fail. The brain experiences oxygen deprivation, causing confusion and disorientation. Lack of sufficient oxygen to the heart causes chest pain. With quick appropriate action, Stage II can still be reversed.
Stage III: A longer period of circulatory insufficiency causes permanent damage to organs and tissues, including the heart and brain, kidneys, liver, etc. Systems begin to shut down, brain cells die—and soon, so does the individual.
Which stage of shock do you think the driver in the first paragraph was in?
What are the types of shock, and how are they treated?
In addition to circulatory shock (or often along with it) there are other types of shock:
- Cardiogenic shock—heart-related, such as from a heart attack, an infection of the heart sac, a blood clot, or fluid retention caused by heart failure.
- Hypovolemic shock—related to low blood-volume from hemorrhage, internal bleeding, pancreatitis, severe dehydration, vomiting, diarrhea, uncontrolled diabetes, large areas of severely-burned skin, or extreme heat stress.
- Septic shock—caused by an overwhelming infection, usually bacterial, that weakens the heart and affects every tissue as it circulates in the bloodstream, dropping blood pressure to dangerously low levels by widening blood vessels, causing respiratory distress, liver and kidney failure, and coma. Includes toxic shock syndrome.
- Anaphylactic shock—caused by an allergic reaction to a food, drug, or venom.
- Traumatic shock—brought on by either a traumatic physical injury such as being hit by a car or a mental/emotional blow such as seeing a loved one killed. Crushing injuries also can trigger traumatic shock.
- Insulin shock—a hypoglycemic (low blood sugar) reaction to an overdose of insulin, a skipped meal, or strenuous exercise. Symptoms include tremor, dizziness, cool, moist skin, hunger, confusion, sleepiness, tachycardia (racing heart), coma, and convulsions. Some patients can recognize when their blood sugar is getting low; others cannot. Treatment: if the person can swallow, administer a little sugar with applesauce or orange juice or a bit of candy bar and/or a little high-protein food such as cheese or peanut butter with crackers. If the person can’t swallow, rub some sugar on the gums and under the tongue. If you can’t help them, get medical attention right away.
- Neurogenic shock—from damage to the nervous system such as a severed spine or a brain injury, extreme pain, or a disease that affects the nervous system.
Treatment for most types of shock includes the following:
- Quickly diagnose the stage of shock the person is in and call 911.
- Try to halt the underlying cause if you can determine it—such as stopping obvious bleeding, removing an allergen or whatever is causing their reaction, , treating an infection, or re-starting the heart with CPR.
- Keep the patient warm, lying flat if possible with legs raised about 12 inches to encourage blood flow to the heart and brain. If the person is vomiting, turn the head slightly to one side to avoid aspirating or gagging on vomit.
- Medical personnel will treat the effects, such as transfusing blood for low blood volume or pressure, giving meds for acidic blood or for heart weakness, giving oxygen, and administering intravenous fluids and meds if the patient can’t hold anything down. .
- DO NOT move or turn a person over if you have any reason to think there may be a spinal or neck injury.
- DO NOT place a pillow under the person’s head, as that may hurt the neck or constrict breathing.
- DO NOT wait to see if his symptoms improve or get worse before calling 911. In some cases, death can occur within 15 minutes.
Shock is serious business in any of its forms, and time is of the essence in each case. Shock should be one of the first things to look for and evaluate when a person has suffered an injury, an allergic reaction, or an emotional blow.