Now, we're going to cover the topic of shock. In my opinion as a paramedic, shock is one
of the most lethal syndromes that a person can go into, in that it is multi-symptom.
It is complex, and in the end, everybody dies from the same thing. Shock from one form or
another. Now why is that? Well, it's because shock is basically the failure of the body
to circulate oxygenated blood to the level of which it needs to keep cells alive. For
whatever reason, and that reason could be that it's anaphylactic in nature. It could
be that they have Hypovolemia, which is low blood pressure, which is due to low volume
of blood. It could also be a form of that, because they didn't lose any blood, but the
heart isn't beating strong enough; we call that Cardiogenic shock. And, another one that
we see in multi-trauma or severe trauma systems is when they go into Spinal shock or Neurogenic
shock, when we have a spinal cord injury or severance and there is no communication from
the brain to the rest of the body to fight or flight, which is what keeps people, um,
basically stable, it keeps their blood pressure up, it makes their heart beat faster, it keeps
their heart vessels constrict, and so on and so fourth. So, what do we do save these individuals
lives or to at least buy them time until we can get them to definitive care and fix the
reason that they're actually in shock in the first place? There are several things we can
do and they're very helpful. First thing is to recognize it. What are the sings or symptoms
of shock? They kind of have a progression. They'll start at very minimum: nervousness.
Um, there might be a little bit of a rapid heart beat. They're a little sweaty, anxious,
they're fearful that they might be in trouble. If I notice that I'm going to keep an eye
on them. They then begin to become more pale, more rapid breathing, rapid pulse, maybe clammy,
and they're very cold. That coldness comes primarily because the body is shunting blood
away from its extremities to keep it in the vital organ area. But because of that, the
blood is not flowing out to the extremities and the individual may feel cold. They may
also begin to show signs of blow colored nail beds. If we pinch the nail bed and it takes
more than 3 to 4 seconds to refill or the timing which it takes to say, capillary refill,
we call that delayed capillary response. And this response is what shows us that they may
actually be showing the next stage and sign of shock. Now when we get into that situation,
our treatment plan has got to be pretty confident and it has to be pretty quick. We're going
to maintain their airway, make sure it's open, help them breath if they're not breathing
normally, and we're going to help them with their circulation by stopping major bleeding
that's external that we can control. We're going to lay them down as long as they're
not having trouble breathing and we're going to elevate the legs above their heart, in
the cases where they do not have long bone fractures, hip or pelvis fractures, or back
and neck injuries. If they don't have those injuries, and I would even leave the exception
of an arm fracture, if they have an arm fracture, and it doesn't relate to their lower limbs,
or their body from where it interacts with the spinal cord, I'm still going to elevate
the legs. So we elevate the legs and then if you don't have a stretch of that elevate,
you could always use a box, or pillow, or something to put their feet on. And then we're
going to cover the patient with a sheet, coat, or blanket. If all you have is newspaper or
something to help the person stay warm, it's still going to help inc elate better if you
didn't do anything at all. Remember, there's cooling, clammy, they're starting to expire
because of the eternal dump and all the fighter flight mechanism, but this warming of the
patient helps them with their own internal abilities to fight the shock symptoms. At
this time that we need to make sure that we've already activated EMS or 911. We've done so
now to get them to definitive care and get them back on track.