First aid for shock

5 Jun 2021

Curtain Hug

-Dr. Dyuti Datta Gupta

Niels Bohr once said: “If quantum mechanics hasn’t profoundly shocked you, you haven’t understood it yet.” That’s how our body is; we all ignore its small indications unless the situation becomes worse. So, to avoid all such problems, we have to be very careful with our body, mind and quality of life.

Mainly the word SHOCK portrays our mental health. Still, everybody should know that it’s not just a simple matter which can be solved through attending motivational talk sessions or appointments with a psychologist. “Shock” can create situations even more dangerous, leading to cardiac arrest because it is a critical condition brought by the sudden drop in blood flow throughout the body. The organs aren’t getting enough blood or oxygen because of problems in the circulatory system.

The causative effects of shock may be trauma, heatstroke, blood loss, an allergic reaction, severe infections, poisoning, severe burns or other causes, including weakness, fast heart rate, fast breathing, sweating, anxiety and increased thirst. Confusion, unconsciousness, or even cardiac arrest may follow it as complications worsen.

The main types of shock include: Cardiogenic Shock caused because of heart-related problems, Hypovolemic shock caused by too little blood volume, Anaphylactic shock caused by an allergic reaction, Septic shock happened because of severe infections and Neurogenic shock caused by damage to the nervous system.

Shock is usually fatal if neglected or untreated. The symptoms include cold and sweaty skin that may turn pale or grey, having a weak but rapid pulse with irregular breathing, anxiety and irritability, confusion with dizziness. The patient feels thirsty because of profuse sweating and gets fatigued rapidly. Dilated pupils with lacklustre eyes, nausea, and reduced urine flow are observed. When a body gets into a shock, vasoconstriction occurs to conserve blood flow to the vital organs.

During shock, a variety of pathologic processes happen that may be categorised as four stages: initial, compensatory, progressive, and refractory. At the initial stage, cardiac output (CO) decreases, and tissue perfusion is threatened. Almost immediately, the compensatory stage begins with the vasoconstriction of vessels except for coronary and cerebral vessels. The kidney starts fluid conservation as the body’s homeostatic mechanisms attempt to maintain cardiac output, blood pressure, and tissue perfusion but fail to meet these tissue metabolic needs.

The shock cycle becomes continuous. Dilatation of arterioles, venules, and capillary bed occurs because fluid leaks out of the capillaries into the interstitium. There is a studding of blood that reduces the tissue perfusion resulting in hypoxia. In the refractory stage, there is no response to therapy and thus considered irreversible. Hypoxia and ischemic cell injury cause leakage of lysosomal enzymes, which further aggravates the condition. Myocardial infarction and synthesis of Nitric Oxide took place, which further worsens the situation. Acute tubular necrosis occurs in the kidney, which causes decreased pH and decreased urine output, moving forward towards excessive organ and tissue damage resulting in multi-organ failure.

We should perform some immediate first aid techniques for the treatment before admitting him/her to the hospital. At first, the patient should be laid down with no head, neck, back or bony injury. The patient’s feet only should be elevated about 12 inches if he/she feels comfortable. Restrictive clothes should be loosed, and the person should be kept still unless there is danger and not given any food or drink. If the person vomits or begins bleeding from the mouth, he/she should be turned aside to prevent choking. A coat or blanket should cover the patient to avoid hypothermia. If the person is bleeding, using a towel or sheet, hold pressure over the bleeding area to stop bleeding.

Reassure the patient that he/she will be fine within hours. If the patient is not breathing or breathing seems dangerously weak, cardiopulmonary resuscitation (CRP) should be started and continued until the person wakes up or medical help arrives. In severe cases, the patient should be admitted to the hospital, where treatment should be done according to the nature/type of shock. Vasopressors like dopamine, norepinephrine may be used if blood pressure does not improve with fluid administration. The goal of treatment is to achieve a urine output of greater than 0.5 ml/kg/h, a central venous pressure of 8–12 mmHg and a mean arterial pressure of 65–95 mmHg.

The aim is to stop the bleeding, which in many cases requires surgical interventions. A good urine output shows that the kidneys are getting enough blood flow and working fine. Different pathological tests, X-ray and CT scan should be performed, and additional mechanical support like Intra-Aortic Balloon Pump (IABP), Ventricular Assist Device, Extra Corporal Membrane Oxygenation (ECMO) should be used if required.