Shock Symptoms and Medical Treatment

Shock Symptoms

Shock is defined as abnormal metabolism at the cellular level. Since it is not easy to directly measure cellular problems, the symptoms of shock are indirect measurements of cellular function. Shock is the end stage of all diseases, and symptoms will often be dependant on the underlying cause.

Vital signs

As the patient goes through the various stages of shock, vital signs change. In the early stages, the body tries to compensate by moving fluids around from within cells to the blood stream with an attempt to maintain blood pressure in a normal range. However, there may be a slight rise in the heart rate (tachycardia = tachy or fast + cardia or heart). Think of donating blood. A unit of blood (or about 10% of your blood volume) is removed, yet the body compensates well, except for a little lightheadedness, which is often resolved by drinking fluids. Another example is exercising and forgetting to drink enough fluids and feeling a little tired at the end of the day.

As the body loses the ability to compensate, the breathing rate gets faster and the tachycardia increases as the body tries to pack as much oxygen onto the remaining red blood cells as possible and deliver them to the cells. Unfortunately, blood pressure starts to fall (hypotension=hypo or low + tension= pressure) as compensation mechanisms fail.

Body function

Cells don't get enough oxygen and the organs that they comprise start to fail. All organs may be affected.

• As the brain is affected, the patient may become confused or lose consciousness (coma).
• There may be chest pain as the heart itself doesn't get an adequate oxygen supply.
• Diarrhea often occurs as the large intestine becomes irritated due to hypotension.
• Kidneys may fail and the body may stop making urine.
• The skin becomes clammy and pale.

Shock Medical Treatment

• EMS personnel are well trained in the initial assessment of the patient in shock. The first course of action is to make certain that the ABCs have been assessed. The so-called ABCs are:
  • Airway: assessment of whether the patient is awake enough to try to take their own breaths and/or if there is there anything blocking the mouth or nose.
  • Breathing: assessment of the adequacy of breathing and whether it may need to be assisted with mouth-to-mouth resuscitation or more aggressive interventions like a bag and mask or intubation with an endotracheal tube.
  • Circulation: assessment of the adequacy of the blood pressure adequate and determination of whether intravenous lines are needed for delivery of fluid or medications to support the blood pressure.
• If there is bleeding that is obvious, attempts to control it with direct pressure will be attempted.
• A fingerstick blood sugar will be checked to make certain that hypoglycemia (low blood sugar) does not exist. Many people can appear to be on death's door, but wake up and remain normal when given sugar.
• In the Emergency Department, diagnosis and treatment will happen at the same time.
• Patients will be treated with oxygen supplementation through nasal cannulae, a face mask, or endotracheal intubation. The method and amount of oxygen will be titrated to make certain enough oxygen is available for the body to use. Again, the goal will be to pack each hemoglobin molecule with oxygen.
• Blood may be transfused if bleeding (hemorrhage) is the cause of the shock state. If bleeding is not the case, intravenous fluids will be given to bolster the volume of fluids within the blood vessels.
• Intravenous drugs can be used to try to bolster blood pressure (vasopressors). They work by stimulating the heart to beat stronger and by squeezing blood vessels to increase the flow within them.

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