Shock is one of the features most commonly present after accident, injury or sudden illness, especially if the sudden illness is characterized by pain. The essential factors in shock is a lowered blood pressure. Shock may be 1. Primary – This occurs actually at the of the accident or sudden illness. 2. Secondary – This may not develop until several hours after the accident or sudden illness and is usually very serious. There are several terms used to classify shock; probably the two most commonly used are 1. Oligamic shock . Neurogenic shock Oligamic shock – This occurs when the tissues have been damaged and there is loss of blood or fluid from the circulation. It is very commonly present in the following circumstances. -Fractures -Haemorrhage -Burns and scalds -After surgical operations -In any sudden illness associated with extreme pain, such as perforated gastric ulcer or coronary thrombosis. -In severe vomiting and diarrhea Neurogenic Shock – this may happen when no specific injury has taken place but when the emotional upset has occurred.
It can occur in the following circumstances. -In states of fear -In states of high emotion due to bad news. -Being involved in an accident although not physically injured. -Due to exposure Shock may be defined as a depression of the vital centers in the medulla oblongata due to it’s being depleted or sufficient blood supply” In Oligemic Shock, the main factors that is involved is loss of fluid from the body or a reduction in the circulating blood. Because of this, the presence of a lowered blood pressure can easily be understood.
The circumstances under which blood or fluid is lost from the body varies. in haemorrhage, large amounts of blood may be lost. In burns and scalds, substancial amount of fluid can be lost. In fracture, a substancial haemorrhage may occur and this can be over looked as the haemorrhage will be internal. IN NEUROGENIC SHOCK; The lowered blood pressure is not always so easy to explain. It is thought that in cases of fear or high emotion, there is increased permeability of the capillary walls particularly in the deep abdominal organs.
Thus fluid is lost from the blood stream and the volume is decreased. There is also dilatation of the capillaries in the deep organs causing “stasis of blood” and slowing down of the blood circulation. These two factors are important to remember and explain the presence of a lowered blood pressure even without the presence of obvious wounds or injury. SIGNS AND SYMPTOMS OF SHOCK 1. To begin with the pulse may be slow, but gradually it becomes rapid and feeble. This is due to the heart trying to pump more rapidly the small amount of circulation blood.
If the heart contracts more rapidly than usual it does to less strongly. 2. Breathing is rapid, sighing and shallow. The patient, in trying to take in as much oxygen as possible, breathes more rapidly. 3. The skin becomes cold and clammy to touch and is either very pale or grey in colour. This is due to constriction of the peripheral blood vessels and limitation of the blood supply to the skin. 4. The temperature if taken will be found to be sub-normal, that is, below 350C, (970F). 5. If the blood pressure can be taken, it will be lower than normal.
This signs and symptoms will vary markedly depending upon the circumstances. Fainting , with its well known signs and symptoms, constitutes a mild shock form of shock, and thus may extend to extreme cases of accident, injury, sudden illness, fear, or states of emotional upset, shock may be present to a greater or lesser degree and the first aid worker must be prepared to treat this condition as well as the obvious injury. The first-aid worker should also appreciate that shock may not initiaaly be present but could develop later.
Early treatment of any of the conditions known to be associated with shock may prevent it from occurring or lessen its severity. TREATMENT OF SHOCK The only satisfactory treatment of shock is to replace the fluid lost from the body by blood transfusion, and as this can only be done in the hospital, the first step is to arrange immediate transport either by air or by ambulance. The steps that can be taken prior to admission of the patient to hospital are: 1. Lay the patient down, either in bed, on the floor or where the accident occurred.
If possible, place the patient in the prone position with the head turned to the side. If this position is not possible, then place the patient on his or her side or in the recumbent position with the head turned to one side. 2. If it is possible, raise the lower part of the body, this may help the flow of the blood to the brain. 3. If the patient is indoors, merely cover him with a light blanket. It is of the greatest important that the patient is not overheated or made to sweat as this causes further loss of fluid from the body.
If the patient is outdoors, a blanket or rug may be placed between the patient and the ground and a light blanket or rug used to cover him. 4. Do not give the patient any stimulants. If the first-aid worker is quite sure that the haemorrhage is present and that fluid is not being lost a would be in the case in burns, then sips of sweet tea may be given. It is important to look ahead and if an operation may be necessary than nothing should be given by mouth. 5. Undo any tight clothing around the neck, chest, waist and make sure the patient is not being crowded by spectators or bystanders. . Keep the patient absolutely still and quite. 7. If the patient is conscious, reassure him by appearing calm and have self confidence. 8. Any obvious bleeding must be stopped as soon as possible. 9. Pain should be relieved as far as possible by, for example, supporting an injured limb, or placing the patient in the most comfortable position. 10. Medical aid should be sent for, particularly if there is going to be delay in getting the patient to the hospital and if the patient is in serious pain. A medical doctor is the only person who can administer drugs which will relieve pain.