Shock
(Hypovolemic Shock; Traumatic Hemorrhagic Shock)
Shock is a life-threatening emergency in which insufficient oxygenated blood reaches vital body organs and tissues because of extremely low blood pressure. One type, traumatic hemorrhagic, or hypovolemic shock, results from a severe loss of blood. Typical causes range from a major accident to a ruptured tubal pregnancy, a perforated intestinal ulcer, or ruptured aneurysm. Other types of shock may be due to serious illnesses (see Other Causes). For example, septic shock occurs when bacteria multiply in the bloodstream and then release toxins. Whatever the type of shock, emergency first aid calls for similar procedures.
When blood pressure falls, the body compensates by rerouting blood away from the skin and muscles to the more vital organs, such as the heart, lungs, and brain. The skin then becomes pale, cool, and clammy and the individual feels weak. As the heart and lungs struggle to function, the pulse becomes very rapid although weak, and the rate of breathing increases but the person feels short of breath, and perhaps also extremely anxious and restless.
As shock progresses, other symptoms may include unusual thirst, vomiting, blotched or streaked skin, dilated pupils, and disorientation and confusion. A delay in treatment can lead to permanent damage of the intestines, kidneys, and other vital organs; failure to treat shock may result in death.
Diagnostic Studies and Procedures
Shock should be suspected in any situation in which a person has suffered severe internal or external bleeding. Blood pressure may be so low that it cannot be measured. A physical examination and certain blood tests can confirm the presence of shock. After the emergency medical needs of the victim have been met, further tests may be necessary to help determine the cause.
Medical Treatments
When a shock victim is brought to the hospital, emergency treatments may include the following:
- Blood transfusions to restore blood lost from severe injuries.
- Intravenous fluids to help restore the body's fluid volume.
- Medications to help raise and maintain the blood pressure.
In addition, steps will be taken to treat the underlying cause of the shock. For example, surgery may be necessary to halt internal bleeding due to tearing of blood vessels in an accident, a ruptured aneurysm, or a tubal pregnancy.
Alternative Therapies
No alternative therapy can replace medical treatment for shock. However, if medical attention cannot be obtained immediately and is not likely to be available for several hours, steps may be taken to help the patient retain body fluid, but only if she is conscious and has not suffered convulsions, a stomach wound, or bleeding from the mouth or rectum. If these conditions apply, the patient may be given a weak saline solution made with 1/2 teaspoon of salt added to four ounces (1/2 cup) of water. Children under 12 should be given only 2 ounces of such a solution and infants 1 ounce. The liquid should be sipped very slowly over a period of 15 minutes or more.
Self-Treatment
If you have any medical condition that increases your risk of shock, follow your doctor's recommended self-care regimen scrupulously. Keep the phone numbers of your nearest hospital emergency room posted near your telephone and wear a medical ID bracelet.
Other Causes of Shock
A heart attack, cardiac arrhythmias, pericarditis, or a pulmonary embolism can cause cardiogenic shock. Severe blood poisoning or infections such as toxic shock syndrome can lead to septic shock. Extensive burns, prolonged diarrhea or vomiting, or other conditions that upset the body's fluid and electrolyte balance can cause shock. Still other possible causes of shock include uncontrolled diabetes or an overdose of insulin, poisons, and a severe allergic reaction that results in anaphylactic shock.