Updated: Sep 22, 2020
It is practically guaranteed that when you become involved with emergency services, you will undoubtedly witness some shocking events (pun intended) throughout your career. Many of those events will involve some sort of medical element to it. In this debut article, we will be breaking down some of the most common types of shock, and some critically important first aid care that you can provide as a first responder.
The simplest definition of shock that I can come up with is that some type of event has happened to the body, and the body’s needs are not being met. Initially in most cases the body will compensate or attempt to compensate. Eventually if shock is not treated, the body will no longer be able to compensate, and the patient will die.
To understand compensation and decompensation when discussing shock, I like to use the example of a city. Imagine a large city such as Los Angeles. The city government provides multiple services such as police, fire, ems. They also provide electrical services, waste services, water services, etc. In order for the city to run efficiently, each service must pull their fair share of the weight and perform their duties well. For our example, imagine that the waste service workers go on strike and refuse to perform trash pick-up. The first couple of weeks may not be too terrible, and the city would be able to compensate. However, if the strike were to go on for months on end imagine the impact on the city that would have. Fire departments would be running more fire calls, police would be running more calls, hospitals would be overcome with sick patients due to disease from the buildup of the trash. The economy of the city would be negatively impacted. If this crisis continued, the city would for all intents and purposes die off if no aid was given.
The human body has a vast array of different systems, organs, and cells that need to work together toward the goal of living and being healthy. If one system is affected significantly, all other systems become affected as well. If not corrected, the body will eventually go into shock.
There are four main categories of shock. Each category breaks down into subcategories. For our purposes today, we will focus on the four main types. They are as follows:
· Hypovolemic Shock – This is the type of shock that most officers will be the most familiar with. This type of shock most commonly is the result from significant blood loss due to trauma to the body. As many of us have learned, it is critically important to treat this type of shock by stopping the bleeding and covering the patient with a blanket. We will discuss this point further into the article.
· Distributive Shock – This is the most common type of shock. This is the type of shock that a person who is severely allergic to bee stings or other allergens that produce a life-threatening reaction will experience. A massive fluid shift occurs in response to the invading substance (such as a bee sting) that causes significant swelling to the airway. Because the airway is being closed off, it obviously makes it a critical medical event.
The treatment for this type of emergency is administration of an EpiPen. For this type of shock, it is important to remove the substance causing the reaction. In the case of the patient that has a stinger, it is important to remove the stinger using a scraping motion with a credit card or ID card. Do NOT use tweezers as it could inject more venom into the patient causing a worse reaction. Expedite EMS and allow the patient to position themselves to where it is easiest for them to breathe.
This type of shock is also seen in very sick patients who become septic. Sepsis is a subcategory of this type of shock.
The last subcategory of this type of shock is neurogenic shock. This could be observed in patients with a significant head, neck, or spinal cord injury. The important treatment for a patient experiencing this type of shock is rapid transport to a hospital.
· Cardiogenic Shock – As the name implies, this type of shock occurs due to an issue within the cardiac system. Quite simply, the heart is nothing more than a pump that circulates the blood throughout the body. When the pump is not operating optimally, problems begin to develop. For these patients, it is important to loosen restrictive clothing such as neck ties, shoes, belts, etc. It is also important to allow them to get into a position of comfort. Expedite EMS, and again, cover the patient with a blanket.
· Obstructive Shock – This type of shock occurs when pressure is being exerted upon the greater vessels or upon the heart. The most common example that the tactical medicine community first thinks of is tension pneumothorax. If a hole has been made in the lung tissue, air will escape into the chest cavity causing a buildup of pressure. This type of pressure could also be caused by a hemothorax which is blood that is collapsing the lung and placing pressure onto the greater vessels and heart. If there is an open wound, it is absolutely vital to cover that wound with a chest seal. Be sure to check for an exit wound as well. Any hole found from the neck to the waist all around the body should be covered with an occlusive dressing.
Another medical condition that obstructive shock falls under is pericardial tamponade. The heart sits within a protective sac. When the chest has been struck with a significant amount of force, that sac can fill with fluid and obstruct the heart from beating efficiently.
With all of that being said, here are the main pearls of wisdom that bystanders or first responders can apply when treating patients prior to EMS arrival.
1. Shock is way easier to prevent than to treat.
2. The two main indicators that a patient is experiencing shock are: altered mental status, and absent OR abnormal radial pulses.
3. If the patient is a law enforcement officer and they are experiencing an altered mental status, you MUST disarm the officer! (It is best if another officer is present to disarm the downed officer).
4. PLACE A BLANKET ON THE PATIENT TO KEEP THEM WARM!!!!! I cannot stress this enough. I will do a future post discussing the Lethal Triad. One of the elements of the lethal triad is hypothermia. When a person goes into shock, the body loses the ability to conduct temperature regulation. The outside ambient temperature could be 110 degrees, and the patient that is experiencing shock will become hypothermic if it is not treated. If the patient becomes hypothermic, their blood will lose the ability to clot along with a host of other negative impacts. Bottom line….COVER THE PATIENT WITH A BLANKET.
5. It is immensely helpful to the EMS providers if you can keep them updated while they are responding to the scene. The number of patients, what is generally wrong with the patients, and any scene hazards are a few great pieces of information to begin with.
One last note before we conclude this post. It had been taught for many years to elevate the legs of patients in shock. After many medical studies it was found that elevating the legs not only provided no benefit to the patient, in some cases it caused a medical complication called pulmonary edema.
If you have any questions or if you would like to provide further discussion please feel free to reach out!