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Learning Objectives
After studying the material in this chapter, the
student will be able to:-

1. Define shock

2. Describe the pathophysiology of shock

3. Identify different types of shock

4. Explain signs and symptoms of shock.

5. Describe the first aid management of shock

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 Definition
Shock :-A physiological state characterized by
a significant, systemic reduction in tissue
perfusion, resulting in decreased tissue oxygen
delivery and insufficient removal of cellular
metabolic products, resulting in tissue injury.

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 Shock

Inability to supply Inadequate removal

cells with oxygen of waste
and products from
nutrients cells

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 a. There are three basic mechanisms associated with shock. These

are—

1. The heart is damaged and fails to work as a pump.

2. Blood loss (heavy bleeding) causes the volume of fluid within the
vascular system to be insufficient.

3. The blood vessels dilate (open wider) so that the blood within the
system (even though it is a normal volume [the casualty is not
bleeding or dehydrated]) is insufficient to provide adequate
circulation within the body.
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1. Hemorrhage

2. Severe vomiting and diarrhea.

3. Burn.

4. Infection.

5. Heart attack or stroke.

6. Poisoning by chemicals gases, alcohol or drugs.

7. Other causes like stress, pain, temperature instability, and

delay of treatment. And many other underlining causes.
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 Pathophysiology

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 Signs and Symptoms
 Pale or bluish skin and mucus membrane, cold extremities

to touch except septic shock .

 Moist and clammy skin.

 Weakness.

 Rapid and weak pulse and too faint to fell at the wrist but

perceptible in the carotid artery .

 Rapid and shallow breathing especially in case of

abdominal and chest injury.

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 Cont..
 Low blood pressure.

 Restlessness, anxiety severe thirst, vomiting or retching.

 The victim becomes apathetic and relatively unresponsive.

 The victim’s eyes are sunken with a vacant expression, and his

pupils may be dilated.

 Unconsciousness and hypothermia, finally death.

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How to feel signs and symptoms of shock

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 Stages of Shock
A convenient way to understand the physiologic responses and
subsequent clinical signs and symptoms is to divide the
continuum into separate stages:

compensatory, progressive, and irreversible.

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 COMPENSATORY STAGE
 In the compensatory stage of shock, the patient’s blood
pressure remains within normal limits. Vasoconstriction,
increased heart rate, and increased contractility of the heart
contribute to maintaining adequate cardiac output.
 This results from stimulation of the sympathetic nervous
system and subsequent release of catecholamines (epinephrine
and nor epinephrine).
 The patient displays the often-described “fight or flight”
response.
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 Cont..
 The body shunts blood from organs such as the skin, kidneys,

and gastrointestinal tract to the brain and heart to ensure

adequate blood supply to these vital organs.

 As a result, the patient’s skin is cold and clammy, bowel

sounds are hypoactive, and urine output decreases in response

to the release of aldosterone and ADH.

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 PROGRESSIVE STAGE

In the progressive stage of shock, the mechanisms that

regulate blood pressure can no longer compensate and the
BP below normal limits, with an average systolic blood
pressure of less than 90 mm Hg

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 IRREVERSIBLE STAGE
The irreversible (or refractory) stage of shock represents the
point along the shock continuum at which organ damage is
so severe that the patient does not respond to treatment and
cannot survive.

Despite treatment, blood pressure remains low.

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 CLASSIFICATION OF SHOCK
Shock can be classified by etiology and may be described as

(1) hypovolemic shock

(2) cardiogenic shock

(3) circulatory or distributive shock.

Some authors identify a fourth category, obstructive

shock, that results from disorders that cause mechanical

obstruction to blood flow through the central circulatory system

despite normal myocardial function and intravascular volume.

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 1. Hypovolemic Shock

Hypovolemic shock, the most common type of shock, is

characterized by a decreased intravascular volume.

Body fluid is contained in the intracellular and

extracellular compartments.

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 Hypovolemic shock can be caused by external fluid losses,

such as traumatic blood loss, or by internal fluid shifts, as in

severe dehydration, severe edema, or ascites.

 Intravascular volume can be reduced both by fluid loss and

fluid shifting between the intravascular and interstitial

compartments.

 The sequence of events in hypovolemic shock begins with a

decrease in the intravascular volume.

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 Cont…
 This results in decreased venous return of blood to the

heart and subsequent decreased ventricular filling.

 Decreased ventricular filling results in decreased stroke

volume (amount of blood ejected from the heart) and

decreased cardiac output.

 When cardiac output drops, blood pressure drops and

tissues cannot be adequately perfused.

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 Risk Factors for Hypovolemic Shock
External: Fluid Losses
 Trauma
 Surgery
 Vomiting
 Diarrhea
 Diuresis
 Diabetes insipidus
Internal: Fluid Shifts
 Burns
 Ascites
 Peritonitis

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 Dehydration
2. Cardiogenic Shock

 Cardiogenic shock occurs when the heart’s ability to

contract and to pump blood is impaired and the

supply of oxygen is inadequate for the heart and tissues.

 The causes of cardiogenic shock are known as either

coronary or noncoronary.

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 Pathophysiology
 In cardiogenic shock, cardiac output, which is a function of

both stroke volume and heart rate, is compromised.

 When stroke volume and heart rate decrease or become erratic,

blood pressure drops and tissue perfusion is compromised.

 Along with other tissues and organs being deprived of

adequate blood supply, the heart muscle itself receives

inadequate blood.

 The result is impaired tissue perfusion.

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 3. Circulatory Shock
Circulatory or distributive shock occurs when blood volume
is abnormally displaced in the vasculature—for example,
when blood volume pools in peripheral blood vessels.

The displacement of blood volume causes a relative

hypovolemia because not enough blood returns to the heart,
which leads to subsequent inadequate tissue perfusion.

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Cont..
The varied mechanisms leading to the initial vasodilation in
circulatory shock further subdivide this classification of
shock into three types:

(1) septic shock

(2) neurogenic shock and

(3) anaphylactic shock.

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 First Aid Measures
A. Body Position
It must be based on type of injuries.

 DO NOT move the casualty or his limbs if suspected fractures have

not been splinted.

 The most satisfactory position for the injured person will be lying

down to improve the circulation of the body.

 If injury is on the neck or spine, don’t move the victim until he is

prepared for transportation.

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 Cont..
A victim with severe wounds of the lower part of the face

and jaw or who is unconscious should be placed on his

side to facilitate drainage of fluids and to avoid air way
blockage.

A person with a head injury may be kept flat or propped

up but his head must not be lower than the rest of his
body.

 Raise foot of the stretcher or bed from 20-30 inches for

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other types of injuries.
 Cont…

A casualty in shock from a chest wound or one who is experiencing

breathing difficulty, may breathe easier in a sitting position.

If this is the case, allow him to sit upright, but monitor carefully

in case his condition worsens.

Elevate the casualty’s feet higher than the level of his heart.

Use a stable object (field pack or rolled up clothing) so that his feet

will not slip off

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 Shock - position

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 WARNING

 Check casualty for leg fracture(s) and splint, if necessary,

before elevating his feet.

 For a casualty with an abdominal wound, place his knees in

an upright (flexed) position.

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 B. Regulating Body Temperature

 Keep the victim warm enough to avoid or over come chilling.

 If the victim is exposed to cold or dampness, blankets or

additional clothing should be placed over and under him to

prevent chilling.

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 Cont…
 In hot weather, place the casualty in the shade and protect him

from becoming chilled; however, avoid the excessive use of

blankets or other coverings.

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 Body temperature maintained

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 C. Administering Fluids
 Give fluids by mouth if there is no medical help near by,

discontinue fluids if the victim becomes nauseated or

vomits.

 Don't give fluid by mouth if:

1. Victim is unconscious ,
2. Victim is vomiting and
3. having a convulsion.
4. When a victim likely to have surgery or anesthetic or abdominal
injury.

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 Cont..
 N.B. When the victim is conscious give plenty of fluids

prepared from half teaspoon of salt, two to three table

spoon of sugar or honey and some orange or lemon juice
in a litter of water.

 Encourage the victim to drink as often as possible

especially

 until he/ she urinates frequently.

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