Shock

Jennifer L. Doherty, MS, LAT, ATC Management of Medical Emergencies

Overview
Shock occurs when a diminished amount of blood is available to the circulatory system The vascular system fails to hold the fluid portion of the blood Vasodilation of the blood vessels occurs and disrupts the osmotic fluid balance in the body

Overview
Plasma cells leave the blood and enter the interstitial spaces The formed elements remain in the blood
Blood viscosity increases The rate of blood flow decreases

Insufficient amounts of O2 are being transported in the blood

Predisposing Factors
Extreme fatigue Extreme exposure to heat or cold Extreme dehydration Illness Severe injury

Signs and Symptoms

Low Blood Pressure
Systolic BP is usually below 90 mmHg

Pulse is rapid and weak Respiration is rapid and shallow Skin is pale, cool, and clammy Drowsiness

Types of Shock
Hypovolemic Shock Results from trauma in which there is blood loss Decreased blood volume causes a decrease in blood pressure Insufficient amounts of O2 is being transported to body tissues and organs

Types of Shock
Respiratory Shock Results when the lungs are unable to supply enough O2 the circulating blood Trauma that may produce respiratory shock include:
Pneumothorax Injury to the respiratory control center

Types of Shock
Neurogenic Shock Results due to the overall dilation of the blood vessels within the cardiovascular system Decreased blood pressure Insufficient amounts of O2 is being transported to body tissues and organs

Types of Shock
Psychogenic Shock Commonly known as fainting (syncope) Results due to a temporary dilation of the blood vessels in the body causing a decrease in the blood flow to the brain

Types of Shock
Cardiogenic Shock Results due to the inability of the heart to pump enough blood to the body Decreased cardiac output Decreased blood pressure Insufficient amounts of O2 is being transported to body tissues and organs

Types of Shock
Septic Shock
Results due to a severe infection
Usually a bacterial infection

Toxins released by the bacteria cause dilation of the blood vessels within the cardiovascular system Decreased blood pressure Insufficient amounts of O2 is being transported to body tissues and organs

Types of Shock
Anaphylactic Shock Results due to a severe allergic reaction Allergic reaction may be caused by:
Foods Insect bites Drugs Inhaling dusts, pollens, etc

Types of Shock
Metabolic Shock
Results due to a severe illness that goes untreated
For example, untreated diabetes

Results due to an extreme loss of bodily fluid

For example, excessive urination, diarrhea, or vomiting

Psychological Impact
Shock can be compounded, or produced by the psychological reaction to an injury or a situation Fear is the common Provide reassurance and comfort

Immediate Management

Immediate Management
Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart Exceptions include:
Neck injury immobilize in the position found Head injury elevate the head and shoulders Leg fracture splint and elevate

Secondary Management

Secondary Management
Vital Signs Pulse Respiration Blood pressure Temperature Skin color Pupils Level of consciousness Movement Abnormal nerve response

Pulse
A direct extension of the functioning of the heart Normal pulse rate for adults
60 80 bpm

Normal pulse rate in children

80 100 bpm

Abnormal Pulse
Rapid and weak
Shock Bleeding Diabetic coma Heat exhaustion

Slow and strong

Skull fracture Stroke

No pulse
Cardiac arrest Death

Rapid and strong

Heatstroke Severe fright

Respiration
Normal respiration rate for adults
~ 12 breaths per minute

Normal respiration rate for children

~ 20 breaths per minute

Rapid and shallow respiration is indicative of shock

Blood Pressure
Normal systolic blood pressure in adults
Males: 115 120 mm Hg Females: 105 110 mm Hg

Normal diastolic blood pressure in adults

Males: 75 80 mm Hg Females: 65 70 mm Hg

Blood Pressure
High Blood Pressure
Systolic BP > 140 mm Hg Diastolic BP > 90 mm Hg

Low Blood Pressure

Systolic BP < 100 mm Hg Diastolic BP < 60 mm Hg

Temperature
Normal body temperature
~ 98.6F (~ 37C)

Core temperature is most accurately measured at the tympanic membrane of the ear Changes in body temperature are reflected in the skin

Skin: Temperature
Cool, clammy skin
Shock Trauma Heat exhaustion

Cool, dry skin

Overexposure to cold

Hot, dry skin

Disease Infection Overexposure to environmental heat

Skin: Color
Three skin colors are commonly identified in medical emergencies:
Red White Blue

Red skin color

Heatstroke High blood pressure Elevated body temperature

Skin: Color
White skin color
Shock Insufficient circulation Fright Hemorrhage Heat exhaustion Insulin shock

Blue skin color

Airway obstruction Respiratory insufficiency

Pupils
Pupils are extremely sensitive to changes in the nervous system If one or both pupils are dilated
Shock Head injury Heatstroke Hemorrhage CNS stimulant drug

One constricted pupil

CNS depressant drug

Pupils
If one or both pupils fail to respond to light
Brain injury Alcohol Drug poisoning

Pupil response to light is more critical than the evaluation of pupil size

Level of Consciousness
In normal conditions, the athlete is
Alert Aware of the surrounding environment Responds quickly to vocal stimulation

Abnormal levels of consciousness may result due to

Shock Head injury Heatstroke

Summary
May not be able to determine the type of shock Immediate management of shock is universal Provide reassurance and comfort Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart