First Aid - Shock

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:

1. If the victim has difficulty in breathing, elevate the upper part of his body.
2. 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.

Surgical Shock:

Acetic acid 30C, Arnica 200C,1M, Carbo Veg 200C,1M, Strontia Carb 30C and Veratrum Alb 200C,1M, Canadula 1M, Staphasgaria 1M, Opium 30C

Emotional Shock:

Aconite Nap 200C,1M, Ignatia 200C,1M, Gelsemium 30C, Opium 30C, and Rescue Remedy 30C to CM (Bach Flower).

Traumatic Shock:

Aconite Nap 200C,1M; Arnica Mont. 200C,1M, Hypericum 200C,1M and Nat Sulph 200C,1M, Camphor Q, Carbo Veg 30C, 1M; Lachesis 30C, Opium 30C, Verat Alb 30C,1M

Anaphylactic (allergic) Shock:

Carbolic Acid 30c, Apis Mel 200c, 1M, Carbo Veg 30C, Opium 30C, Camphor 30C

Cardiogenic Shock:***

Camphor Q, Naja T 30C, Crategus Ox Q, Arnica Q, Laurocerasus 30C & Amyle Nit Q

Cardiopulmonary Obstructive Shock:***

Lycopodium 200C,1M, Antim Tart 200C, 1M

***CAUTION

These conditions require immediate medical attention as such medicinal list provided are for professional and not for laymen.

Updated on: 01 Feb 2010