By Coach Nick
Happy Wednesday everyone, I hope you all had a great Labor Day Weekend! It’s time for another Wilderness Medicine Wednesday post. Today’s topic is going to be shock, which is a very serious condition that can occur from a variety of different injuries or illnesses. The goal of this post is to give you guys a functional understanding of shock and especially how to see it and begin to treat it. There are different kinds of shock and ways to understand it but I want to keep this post short and useful.
The main types of shock that we will encounter are hypovolemic shock, and neurogenic shock. Hypovolemic shock occurs when there is decreased blood volume in the body. This can be caused obviously, by excessive bleeding, but also by a dramatic decrease in the volume of water in the body. Dehydration, vomiting, diarrhea, and thermal burns are what can cause that. Neurogenic shock is caused by injuries to the brain or spine, or allergic reactions.
What’s happening in your body when you go into shock? Well, simply put when you go into shock it’s because your body thinks you are dying. If the brain detects a major compromise to your circulatory system it goes into survival mode and pulls your blood from “non-essential” areas to your major organs. This process is called vasoconstriction. While this process keeps blood and oxygen in your brain longer it does not keep you alive and the condition itself can kill you.
It is important to be able to recognize shock in patients and act quickly. Patients going into shock will give off some pretty obvious signs and symptoms. First, they will be awake but they will probably appear dazed or “out of it”, they will experience anxiety (the brain thinks you’re dying), and they will have what we call decreasing level of consciousness. They will not be able to answer simple questions, probably not feel the pain that they are in, or ignore really obvious injuries. All of this is the brain’s instinct to protect itself. As a result of this protection instinct the patient’s heart rate will be extremely elevated but feel weak. This is because the heart is working as hard as it can to pump blood to the brain and they are scared/anxious. The most obvious way to spot shock is the patient’s skin which appear pale, cool, and clammy. This is important, if you take nothing else from this post remember pale, cool, and clammy. The reason this sign manifests itself is because the blood is being pulled from extremities to the core of the body which is basically “draining” the skin of color and temperature. If you know how to take blood pressure the patients blood pressure will begin to fall as shock starts to fail. In summary, think shock when you see a patient becoming confused and anxious, their heart rate goes through the roof, and their skin becomes pale, cool, and clammy.
If you see someone exhibit these signs and symptoms, it’s important to realize that you are in a life-threatening situation. Your mind should immediately turn to evacuating the patient, keep in mind that at this state they will need to be carried out of the woods they will not be what we call “ambulatory” or mobile. In the meantime, you can do a few things to help them and increase their chances of survival. First, ensure that their airway is clear and open (remember DRGXABCDE). Next, we need to find and treat the underlying causes of the shock. If it’s bleeding, dehydration, allergic reaction, or vomiting/diarrhea we should have some basic ideas how to treat that. Most of the other causes may be outside of our scope to treat such as spinal injuries, if this is the case do your best to stabilize them and get help ASAP. When the patient is not being moved we need to protect them from the environment and keep them in a comfortable position place them in a recovery position. Ideally we would place them on their side (risk of choking on vomit) with their knees close to their chest and one arm under their head to support their neck. Unfortunately at our level of medicine there isn’t much more we can do to treat patients at this stage. However, having a simple understanding of shock, knowing the severity of the situation, and doing some basic treatment can be the difference between life and death. As always, especially in this case, I hope none of you every have to use this information. I’m confident with the information I have provided here that you are all a little more prepared to deal with this and potentially help save the life of someone in your group.
I hope you all have a great week and are enjoying some of the nicer weather!
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