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Shock
Jennifer L. Doherty, MS, LAT, ATC
Management of Medical Emergencies
Overview
 Shock occurs when a diminished amount
of blood is available to the circulatory
system
 The vascular system fails to hold the fluid
portion of the blood
 Vasodilation of the blood vessels occurs
and disrupts the osmotic fluid balance in
the body
Overview
 Plasma cells leave the blood and enter
the interstitial spaces
 The formed elements remain in the blood
 Blood viscosity increases
 The rate of blood flow decreases
 Insufficient amounts of O2 are being
transported in the blood
Predisposing Factors
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Extreme fatigue
Extreme exposure to heat or cold
Extreme dehydration
Illness
Severe injury
Signs and Symptoms
 Low Blood Pressure
 Systolic BP is usually below 90 mmHg
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Pulse is rapid and weak
Respiration is rapid and shallow
Skin is pale, cool, and clammy
Drowsiness
Types of Shock
Hypovolemic Shock
 Results from trauma in which there is
blood loss
 Decreased blood volume causes a
decrease in blood pressure
 Insufficient amounts of O2 is being
transported to body tissues and organs
Types of Shock
Respiratory Shock
 Results when the lungs are unable to
supply enough O2 the circulating blood
 Trauma that may produce respiratory
shock include:
 Pneumothorax
 Injury to the respiratory control center
Types of Shock
Neurogenic Shock
 Results due to the overall dilation of the
blood vessels within the cardiovascular
system
 Decreased blood pressure
 Insufficient amounts of O2 is being
transported to body tissues and organs
Types of Shock
Psychogenic Shock
 Commonly known as “fainting” (syncope)
 Results due to a temporary dilation of the
blood vessels in the body causing a
decrease in the blood flow to the brain
Types of Shock
Cardiogenic Shock
 Results due to the inability of the heart to
pump enough blood to the body
 Decreased cardiac output
 Decreased blood pressure
 Insufficient amounts of O2 is being
transported to body tissues and organs
Types of Shock
Septic Shock
 Results due to a severe infection
 Usually a bacterial infection
 Toxins released by the bacteria cause dilation
of the blood vessels within the cardiovascular
system
 Decreased blood pressure
 Insufficient amounts of O2 is being transported
to body tissues and organs
Types of Shock
Anaphylactic Shock
 Results due to a severe allergic reaction
 Allergic reaction may be caused by:
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Foods
Insect bites
Drugs
Inhaling dusts, pollens, etc…
Types of Shock
Metabolic Shock
 Results due to a severe illness that goes
untreated
 For example, untreated diabetes
 Results due to an extreme loss of bodily fluid
 For example, excessive urination, diarrhea, or
vomiting
Psychological Impact
 Shock can be compounded, or produced
by the psychological reaction to an injury
or a situation
 Fear is the common
 Provide reassurance and comfort
Immediate Management
Immediate Management
 Maintain normal body temperature
 In most cases, elevate the feet and legs above
the level of the heart
 Exceptions include:
 Neck injury – immobilize in the position found
 Head injury – elevate the head and shoulders
 Leg fracture – splint and elevate
Secondary Management
Secondary Management
Vital Signs
 Pulse
 Respiration
 Blood pressure
 Temperature
 Skin color
 Pupils
 Level of
consciousness
 Movement
 Abnormal nerve
response
Pulse
 A direct extension of
the functioning of the
heart
 Normal pulse rate for
adults
 60 – 80 bpm
 Normal pulse rate in
children
 80 – 100 bpm
Abnormal Pulse
 Rapid and weak
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Shock
Bleeding
Diabetic coma
Heat exhaustion
 Rapid and strong
 Heatstroke
 Severe fright
 Slow and strong
 Skull fracture
 Stroke
 No pulse
 Cardiac arrest
 Death
Respiration
 Normal respiration rate for adults
 ~ 12 breaths per minute
 Normal respiration rate for children
 ~ 20 breaths per minute
 Rapid and shallow respiration is
indicative of shock
Blood Pressure
 Normal systolic blood
pressure in adults
 Males: 115 – 120 mm Hg
 Females: 105 – 110 mm Hg
 Normal diastolic blood
pressure in adults
 Males: 75 – 80 mm Hg
 Females: 65 – 70 mm Hg
Blood Pressure
 High Blood Pressure
 Systolic BP > 140 mm Hg
 Diastolic BP > 90 mm Hg
 Low Blood Pressure
 Systolic BP < 100 mm Hg
 Diastolic BP < 60 mm Hg
Temperature
 Normal body temperature
 ~ 98.6°F (~ 37°C)
 Core temperature is most accurately
measured at the tympanic membrane of the
ear
 Changes in body temperature are reflected in
the skin
Skin: Temperature
 Cool, clammy skin
 Shock
 Trauma
 Heat exhaustion
 Cool, dry skin
 Overexposure to cold
 Hot, dry skin
 Disease
 Infection
 Overexposure to environmental heat
Skin: Color
 Three skin colors are
commonly identified
in medical
emergencies:
 Red
 White
 Blue
 Red skin color
 Heatstroke
 High blood pressure
 Elevated body
temperature
Skin: Color
 White skin color
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Shock
Insufficient circulation
Fright
Hemorrhage
Heat exhaustion
Insulin shock
 Blue skin color
 Airway obstruction
 Respiratory
insufficiency
Pupils
 Pupils are extremely sensitive to changes in
the nervous system
 If one or both pupils are dilated…
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Shock
Head injury
Heatstroke
Hemorrhage
CNS stimulant drug
 One constricted pupil…
 CNS depressant drug
Pupils
 If one or both pupils fail to respond to
light…
 Brain injury
 Alcohol
 Drug poisoning
 Pupil response to light is more critical
than the evaluation of pupil size
Level of Consciousness
 In normal conditions, the athlete is…
 Alert
 Aware of the surrounding environment
 Responds quickly to vocal stimulation
 Abnormal levels of consciousness may result
due to…
 Shock
 Head injury
 Heatstroke
Summary
 May not be able to determine the type of
shock
 Immediate management of shock is
universal
 Provide reassurance and comfort
 Maintain normal body temperature
 In most cases, elevate the feet and legs
above the level of the heart