Shock
In a medical emergency, "shock" is not the everyday word for being upset by bad news. Medically, it can be a life-threatening condition with various causes. Because shock can be fatal, quick action is essential.
Essentially, shock is the body's emergency program. The body tries to keep blood flowing to the vital organs by reducing blood flow to the periphery the arms and legs. This happens when the blood vessels in the limbs constrict and is called centralization. This response makes sense when there is a lot of blood loss or a lot of fluid leaks out of the vessels into the surrounding tissues. However, metabolic reactions can cause even more fluid to leak into the tissues or cause bleeding in other parts of the body, which further reduces the circulating blood volume. Doctors call this the "shock spiral" a vicious cycle that's hard to stop and can lead to complete circulatory collapse and multiple organ failure. That's why recognizing shock early and intervening quickly is so important.
How can I recognize shock?
There are general signs of shock such as
- restlessness, nervousness, anxiety
- pale skin
- cold and sweaty
- feeling cold, possibly shivering
- low blood pressure
- rapid pulse that is hard to feel
- fast breathing
- bluish lips
- later: listlessness, fainting
Depending on the type of shock, the symptoms can vary. Below you will find the different types of shock, how to recognize them, and what you can do to help. Not all signs are always present!
What to do if someone is in shock?
There are some measures that apply to most types of shock. We will point out special actions for specific types of shock where needed. Please note the exceptions where the shock position should not be used.
- Stay with the person talk to them and keep them calm.
- If necessary, stop any bleeding.
- Place them in the shock position (lying flat with legs elevated) if there is no exceptional situation.
- Keep them warm: cover the person. You can also place a blanket (or rescue blanket) underneath if available.
- Call emergency services right away or arrange for someone to do so.
- Check consciousness and breathing repeatedly.
Exceptions when you should not use the shock position
- heart disease, difficulty breathing (see cardiogenic shock)
- head injuries
- spinal injuries
- injuries to the chest or abdomen
- fractures of the pelvis or legs
- severe hypothermia
What types of shock are there?
Shock can have different causes and is therefore classified into
- neurogenic shock (vasovagal syncope as a special form)
- cardiogenic shock
- volume-depletion shock (hypovolemic shock)
- allergic shock (anaphylactic shock)
- septic shock
- other types of shock
Neurogenic shock (shock affecting the nervous system)
Neurogenic shock is a disturbance of the central regulation of circulation. There's an imbalance between the sympathetic and parasympathetic control of heart function and the vessel muscles. This leads to generalized vessel dilation throughout the body, causing a relative loss of blood volume without an actual loss of blood. Neurogenic shock can occur after a spinal injury or a traumatic brain injury, and poisoning can also be a cause.
How to recognize it?
- The general signs of shock listed above apply, but the skin is more likely to be warm and sweaty.
- The circumstances of the accident or how the person was found can point to neurogenic shock.
- Sensory disturbances or numbness (paralysis) in the arms and/or legs may be present.
- Visible head or spinal injuries may be present.
What to do?
- Do not use the shock position! Do not move the person from the position you found them in if they are conscious and breathing.
- If you must change their position because they are unconscious and not breathing, make sure another helper stabilizes the head.
- Call emergency services immediately.
- Continuously check consciousness and breathing.
Vasovagal syncope (commonly called fainting)
A special form of neurogenic shock is the vasovagal syncope. "Syncope" is the medical term for a short fainting episode caused by a temporary decrease of blood flow to the brain. A vasovagal syncope is an excessive vagal reaction that leads to a brief loss of consciousness. The blood vessels dilate temporarily, the Blood pressure drops and less blood returns to the heart. The person faints and falls. Once lying flat, blood flows back to the heart and the person regains consciousness. This can happen after standing for a long time, or due to psychological triggers such as fright, anxiety, pain, emotional stress, or even strong positive emotions. Sometimes even the sight of a few drops of blood is enough. Vasovagal syncope is not a disease but an exaggerated reaction that usually doesn't cause lasting damage, unless the person was injured when they fell. It should still be checked to rule out other causes of fainting.
How to recognize it?
Fainting is often preceded by dizziness, nausea and paleness the person may seem absent.
What to do?
If the person is still standing, lay them down flat right away and raise their legs (shock position). Place them in this position even if they are already unconscious, and make sure they keep breathing.
Cardiogenic shock (shock related to the heart)
Cardiogenic shock is caused by the heart's inability to pump enough blood through the circulation. Causes include a heart attack, pulmonary embolism, myocarditis, a severely enlarged heart, or certain heart rhythm disorders.
How to recognize it?
In addition to the general signs of shock, cardiogenic shock shows these specific signs:
First, the person's complaints and behavior can indicate a heart problem. They may report
- - a tight or heavy feeling and pressure in the chest
- - pain
- - shortness of breath
- - anxiety
- - slow pulse - possibly irregular
- - possible engorged neck veins
What to do?
- Do not use the shock position! Seat the person upright and make them comfortable.
- Call emergency services immediately or arrange for someone to do so.
- Protect the person from further excitement keep the scene calm.
- Loosen tight clothing.
- Monitor the person continuously for consciousness and breathing.
- If an AED (automated external defibrillator) is available, have it brought. These devices are designed for use by laypeople and are very easy to use. Follow the device prompts and voice instructions.
Volume-depletion shock (hypovolemic shock)
Hypovolemic shock is caused by a loss of blood volume. This can be due to internal bleeding (for example from a torn vessel or organ, a gastrointestinal bleed, or from pelvic or thigh fractures) or external bleeding (severely bleeding wounds). It can also result from loss of water and electrolytes (vomiting, diarrhea, or dehydration) or plasma loss (burns, pleuritis or peritonitis, etc.).
How to recognize it?
- The general signs of shock apply.
- Visible external injuries with blood or plasma loss may be present.
- The circumstances of the accident or how the person was found may suggest internal injuries.
- There may be a pelvic or thigh fracture.
What to do?
- Stop the bleeding
- Use the shock position if no exceptional situation exists (injury to the chest or abdomen, spinal injury, pelvic or thigh fracture, head injury, breathing difficulty)
- Check consciousness and breathing repeatedly
Allergic shock (anaphylactic shock)
Allergic shock is the most severe form of an allergic reaction. Triggers can include insect stings, foods, or medications. Anaphylactic shock is currently described as an acute pathological immune reaction to a chemical trigger that affects the entire body. It is classified into four grades.
How to recognize it?
- Grade 1: widespread hives, itching and/or redness, possibly dizziness, headache and anxiety
- Grade 2: in addition, fast heartbeat and drop in blood pressure, often nausea and vomiting as well as mild breathing difficulties
- Grade 3: severe breathing difficulty (similar to an asthma attack), large drop in blood pressure, very fast heartbeat; angioedema (formerly Quincke's edema) may occur swelling especially of the eyelids, chin, cheeks, lips, tongue or genital area; hands and feet can also swell significantly; involvement of the airways (especially the vocal cords) is dangerous and can cause life-threatening breathing problems
- Grade 4: respiratory or circulatory arrest
What to do?
- Remove or stop exposure to the suspected cause if possible.
- Call emergency services immediately or arrange for someone to do so.
- Calm and reassure the person, stay with them and keep the situation calm.
- Place them in the shock position
- Keep them warm
- Monitor consciousness and breathing continuously.
- Help with vomiting if necessary (do not force vomiting; help to hold and prevent inhalation of vomit).
Septic shock
Septic shock can occur as a result of blood poisoning (sepsis) or a similar condition for example SIRS and requires immediate intensive medical treatment. People with weakened immune systems or those who are heavily exposed to pathogens are especially at risk. Septic shock is diagnosed with laboratory tests.
Because septic shock is seen as a consequence of an existing blood infection (sepsis) and the patient is usually already under medical care, we will omit detailed explanations here of "How to recognize?" and "What to do?".
Other types of shock
Other types of shock include endocrine forms caused by hormone deficiency or excess, toxic shock syndrome (TSS), hyperglycemic shock caused by very high blood sugar, and hypoglycemic shock related to glucose deficiency the latter is not a classic shock since it is caused by a lack of glucose rather than a mismatch between oxygen supply and demand.
Sources:
This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 06/2024).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.
