The word "shock" is used in a special sense
in surgery and first aid, and should not be confused with ordinary,
temporary reactions to sudden stimuli. Bad news and terrifying events
can cause momentary confusion and frustration, as in emotional upsets or
they can have more lasting effects, as in the neuro-psychiatric condition
called shell-shock. Injections of drugs can have abrupt effects, like
those of insulin shock. Sudden, brief electric current applied to skin,
muscles or nerve are called electric shock, and can elect more or less
vigorous physiological responses.
But when used in surgery and
first aid, shock means a peculiar,
dangerous state in which the blood pressure is so low, the circulation
so inadequate and all the protective reflexes of the body so depressed
that the patient very survival is in doubt.
If the cause of shock is known in a given case it may
be specified in this manner:
Traumatic Shock
is that caused by severe accidental injury.
Hemorrhagic shock
is associated with great loss of blood.
Anaphylactic Shock
is an intense allergic reaction.
Bacterial Shock
follows a sudden spread of a severe infection.
Cardiogenic shock: This refers to a state of decreased tissue perfusion that occurs secondary to inadequate pumping function of the heart. This can occur secondary to a heart attack, heart valve disorder (aortic
stenosis), cardiac arrhythmia, or from cardiac de-compensation.
Cardiopulmonary Obstructive shock: This can occur as the result of an "obstruction" of the cardiopulmonary circuit. Examples include massive pulmonary embolism, pericardial
tamponade, pneumothorax, and severe constrictive pericarditis.
Signs & Symptoms of Shock
The first step in properly aiding an accident victim
is to recognize the signs and symptoms of shock. Look for evidence of
weakness due to inadequate circulation: pale skin color,
moist, cool
skin temperature. Take note of victim's face. If he is suffering from
shock, his eyes will be vacant and lackluster, with dilated pupils and
his breathing will be shallow and irregular. Perspiration may appear
above his lips and on his forehead, palms and armpits. Nausea may
accompany signs of restlessness.
The extremities, like the face, will be cold, pale
and moist. His pulse will be wither weak or absent, but if noticeable
will be fast. These signs may not appear at once, especially the irregular
breathing, but may become evident an hour or more after the injury.
Shock is often confused with fainting since simple
or minor injuries may cause a victim to faint. (See Fainting for
more details.)
Sometimes an accident victim, even when severely
injured, will appear alert at first and display no shock symptoms. But
first aid measures should be followed anyway, for in many cases he
will collapse later. Whether or not the victim shows signs or symptoms
of shock, always keep him lying flat and do not allow him to move.
First Aid
First aid measures apply to both the prevention and
care of shock. The primary objective is to keep
the victim lying down, warm and comfortable, so as to
facilitate blood circulation to the head and chest area. There are however,
two important exceptions to this procedure:
If the victim has
difficulty in breathing, elevate the upper part of his body.
If he has lost a great
deal of blood or if his injury is severe, elevate the lower part
of his body from 8-12 inches above the ground.
WARNING
Should he have trouble
breathing when you attempt to elevate him, or if pain occurs,
or if he has a head injury, keep the victim in a prone
position. (See Bleeding)
DO NOT elevate legs if the
casualty has an un-splinted broken leg, head injury, or
abdominal injury. (See Fractures)
It is important that the shock patient
be warm and free from drafts. A blanket should be used to keep him
warm and prevent sweating. If the outside temperature is warm, little
covering will be necessary. During winter months, more covering will
be needed. Be careful if you use an electric
blanket, hot water bottle or heating pad. The victims skin will
not be able to withstand high heat and he himself will not feel the
burn, so keep the warming object at a temperature just above body
temperature. Test it on yourself for several seconds before placing it
on the victim. The main reason for covering him is to prevent the loss
of body heat, not to increase it.
Do not give the victim fluids if you
expect the doctor or ambulance within half an hour. Never give them if
the victim is unconscious or partly conscious, if he is nauseated, or
has penetrating abdominal injury or so is seriously injured as to
require immediate surgery. If you offer him water, be sure it is
neither cold nor hot but at room temperature. Avoid other fluids,
especially alcohol. Begin by giving him few sips at a time, an
increase the amount to half a glass at a time if he complains thrust
and can tolerate water without discomfort. If he vomits, discontinue
the water. If possible, add one-half level teaspoon of table salt and
one-half level teaspoon of baking soda to a quart of room temperature
water and administer at approximate 15 minutes interval.
Along with these first aid measures for
shock, treat the victim's injuries. Fractures should be splinted,
bleeding controlled, and above all he should be kept quite.
Stimulants such as ammonia or coffee
should never be given. Make certain that he gets medical assistance
within an hour after the accident.
Homoeopathic Remedies
Electrical
Shock:
The first rule of treatment in electrical injuries is to SAFELY remove the victim from continued
exposure. Give artificial respiration until natural breathing resumes.
Morphia acetate 30C in frequent doses is said to be very useful.
However, the patient will immediately need ambulance transportation to the hospital.
Labeled with ICRA