“bystanders were taken to hospital and treated for shock” - quite a common phrase in the daily news, but what does ‘treatment for shock’ actually mean?
Tea and sympathy?
Tell you what, Mangetout, I reckon there’s more than one definition of “shock”. All the stuff I can find on google says it’s a failure of the blood system, or loss of blood volume. However, people who witnessed something ghastly aren’t suffering from this, are they?
I had a car wreck, and went into some form of shock - I was white and totally dazed for about ten minutes. I didn’t know what I was doing or where I was - but I wasn’t injured. Was that purely a mental state, or did it have a physiological cause?
Must say I haven’t heard of “bystanders” being treated for shock. Normally you hear it as an accident victim suffering from no major injuries but being treated for shock. People can die from shock so it is a serious thing.
I am replying armed only with my Boy Scout and Army training…
Keep them warm (or cool as the conditions may require) quiet on the back with the legs elevated above the heart.
It is an imperfect answer but will have to do until the doctor arrives.
Well, we must differentiate between two definitions of shock:
1 : a sudden or violent disturbance in the mental or emotional faculties
2 : a state of profound depression of the vital processes of the body that is characterized by pallor, rapid but weak pulse, rapid and shallow respiration, reduced total blood volume, and low blood pressure and that is caused usually by severe especially crushing injuries, hemorrhage, burns, or major surgery <the patient was admitted to the hospital in shock>
From: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9276/9276.html
Newspaper accounts usually refer to the 1st definition. But its the 2nd one which is a medical emergency.
QtM, MD
I’m definitely talking about people who have not sustained any physical injury whatever, but have been exposed to extremes of stress or emotional trauma (witnesses of a particulalry gruesome accident, released hostages etc.)
Then I would say treatment would consist of taking a history, checking vital signs to make sure they’re ok, doing an appropriate exam (with tests if needed) then giving tea and sympathy, unless other medical needs require addressing.
I never liked dealing with this type of shock too much. I was always in the trauma room, dealing with the life-threatening variety.
[Former first-aid instructor hat on]
The medical term “shock” refers to a failure to adequately circulate oxygenated blood to the body tissues.
In hypovolemic shock, there is not enough blood to go around, usually caused by blood loss due to trauma.
In respiratory shock, there is enough blood, but it isn’t adequately oxygenated.
In cardiac shock, there is enough oxygenated blood, but the heart is not able to pump it well enough.
In neurologic shock the blood vessels loose their muscle tone due to an interruption in signals from the brain, and dialate to their widest diameter. There often is not enough blood to fully fill the resulting volume.
Psychogenic shock has a similar effect. This is often what is experienced by people who have been through a horrible experience. Because the peripheral blood vessels dialate, blood is drawn away from the brain, and fainting can result.
(There are other types of shock, but these are the main ones.)
In all types of shock, the body attempts to maintain circulation of oxygenated blood to the brain. When shock occurs, the body will attempt to compensate by increasing the amount of oxygen in the blood (by increasing the respiratory rate), increasing the cardiac output (by increasing the heart rate), and decreasing the amount of blood required (by shutting down systems that are less critical, starting with the skin, and the digestive organs).
If you understand the mechanism of shock, it is quite clear why you observe the symptoms that you see: Pale, sweaty skin (due to the shutdown of circulation to the skin), nausea (due to shutdown of the gut), rapid heartbeat and respirations (due to the attempts to compensate), dizzyness and loss of concentration (due to inadequate oxygen flow to the brain).
If you understand the mechanism of shock, the treatment is also pretty straightforward: If the patient is losing blood, control the bleeding. Stabilize injuries so no futher bleeding or other damage will occur. Maximize blood flow to the brain by lying the patient down. Keep the patient warm (because much of the body’s musculature is not generating heat). Don’t give him anything to eat or drink (because the gut is shut down). Be gentle and reassuring to the patient (because of the confusion and anxiety).
These steps can be taken by pretty much anyone. Trained personnel can do quite a bit more, including partially replacing blood volume by interveneous administration of appropriate fluids, administration of medications, etc. There are also specific steps to be taken for different types of shock, etc.
Finally, get the patient to the emergency room for definitive treatment.
[Former first aid instructor hat off]
You know, that makes a lot of sense. I experienced the last one on the list- Psychogenic shock. I got in a car accident last week. While physically unhurt, the experience was so traumatic that I pretty much froze up. Left half of my body felt numb, right half felt ice cold, was hyperventalating, etc.
In the ambulance, the paramedic was actually able to help me calm down quite a bit by making casual small talk with me- asking me typical everyday questions. This was actually able to get me to re-evaluate what had just happened.
psychogenic shock is generally self-correcting. It’s usually induced by a vaso-vagal reflexive slowing of the heart rate and drop in blood pressure. Fainting results, lowering the head, and allowing the brain to be perfused better as a result. Other than the dangers from falling, or becoming unconscious in public, this type of shock is is generally not the extreme threat to life that Cardiac, hypovolemic, and septic shock are.
Psychogenic shock should also be recognized as being different from my first definition of shock: a sudden or violent disturbance in the mental or emotional faculties. This latter type of shock may have some features of psychogenic shock also, but can occur without it.
Victims of psychogenic shock often win a trip to the ER just to make sure that a) it is psychogenic shock, and not some unrelated medical problem b) no injuries occurring during the fainting spell and c) that it does reverse itself with no relapses.
Besides, if you happen to be around a bunch of paramedics when you get all woozy and your bp drops to 80/60, you’re going for a ride no matter what. It can be back to normal before they get you in the rig, but you’ll still be disoriented, and they’re still taking you in.
Just a note on neurogenic shock. You have enough blood for adequate circulation as long as not more than about 5% of your capillaries are open. In neurogenic shock many more than that open and you don’t have enough blood volume to circulate.
That’s not really how it goes. The vast majority of our capillaries are open all the time, else our tissues would become hypoxic, and would die.
What needs to be avoided is simultaneous dilation of all our arteries, arterioles, and capillaries. when this happens, the effective vascular capacity more than doubles, with the same fluid volume circulating. Down goes the pressure. One sees this reaction in hot tubs occasionally. And its also why rapid warming of a hypothermic patient is contra-indicated. Immerse them in hot water, their shrunk vascular system opens wide, and they can’t perfuse vital organs.
QtM, MD
[/Former first aid student hat on]
The way they taught me to remember all the kinds of shock was to remember CRAMPS, NH (as in New Hampshire), which stands for Cardiac/Cardiogenic, Respiratory, Anaphylactic, Metabolic, Psychogenic, Septic, Neurogenic, and everybody’s favorite, Hypovolemic shock(s). I needed this info for a couple tests about ten years ago. Little else from the class in question is still in my brain, but I still know what ole Cramps, NH means. I wonder if this really is the complete list of shock “forms.” Well, anyway, I saw shock, remembered that old mnemonic device, and thought I’d share. Nothing else to add, really. Yes, I realize about half this post is probably misspelled.
[Former first aid student hat off]
Have a great day.
During first-aid instructor training were were given about a bazillion mnemnonic aids (like CRAMPS, above) to give the students. I dunno, some people find them helpful. I never liked them, myself…