The Shock
In the context of a medical emergency, shock primarily refers not to the colloquial term for the reaction to bad news, but to a potentially life-threatening event that can have various causes. Since shock can be fatal, quick action is necessary.
Essentially, shock is an emergency program of the body. It attempts to maintain blood supply to vital organs by reducing blood flow to the periphery - that is, the arms and legs. This occurs through constriction of the vessels in the limbs and is referred to as centralization. The emergency program is quite sensible, for example, in cases of significant blood loss or when a lot of fluid leaks from the vessels into the surrounding tissue. However, metabolic reactions can lead to further leakage of fluid into the tissue or bleeding in other parts of the body, which further reduces the amount of circulating blood volume. Medical professionals refer to this as the shock spiral. This spiral is difficult to break and can lead to complete circulatory collapse with multiple organ failure. Therefore, early recognition and intervention are crucial.
How do I recognize shock?
There are general signs of shock such as
- Restlessness, nervousness, anxiety
- Paleness
- Cold sweat
- Chills, possibly shivering
- Low blood pressure
- Rapid pulse that is difficult to feel
- Accelerated breathing
- Blue discoloration of the lips
- Later: Apathy, fainting
Depending on the type of shock, the symptoms may vary slightly. Therefore, below you will find the types of shock, how to recognize them, and how to help the affected person. Not all signs may always be observed!
What to do in case of shock?
There are some general measures applicable to shock. We will address specific assistance for certain types of shock in their respective sections. Please note the exceptional situations in which shock positioning is not appropriate.
- Stay with the affected person - talk to them and reassure them.
- If necessary, control the bleeding.
- Place them in the shock position (lying flat, legs elevated) if no exceptional situation exists.
- Maintain warmth: Cover the affected person. A blanket (emergency blanket) may be placed underneath.
- Call emergency services or ensure that the emergency call is made.
- Continuously check consciousness and breathing.
Exceptional situations where shock position is not applied
- Heart diseases, shortness of breath (see cardiogenic shock)
- Head injuries
- Spinal injuries
- Injuries in the chest or abdominal area
- Fractures in the pelvis or legs
- Severe hypothermia
What types of shock are there?
A shock can have various causes and is therefore classified into
- Neurogenic shock (vasovagal syncope as a special form)
- Cardiogenic shock
- Volume deficit shock (hypovolemic shock)
- Allergic shock (anaphylactic shock)
- Septic shock
- Other forms of shock
Neurogenic Shock (shock related to the nervous system)
Neurogenic shock is a disturbance of the central regulation of circulatory function. It results in an imbalance between sympathetic and parasympathetic regulation of heart function and vascular musculature. This is generalized, meaning it expands throughout the body, leading to a relative volume deficit without actual volume loss. Neurogenic shock can occur, for example, as a result of a spinal injury or a traumatic brain injury, but poisoning can also be a cause.
How to recognize?
- The above-mentioned shock symptoms apply, but the skin is rather warm and sweaty.
- Additionally, the accident or finding situation provides clues to a neurogenic shock.
- There are sensory disturbances or numbness (paralysis) in the arms and/or legs.
- Visible head or spinal injuries are present.
What to do?
- No shock position! Do not change the found position if the affected person is conscious and breathing.
- If the position must be changed due to unconsciousness and possibly absent breathing, ensure that the head is stabilized by another helper.
- Call emergency services as soon as possible.
- Continuously check consciousness and breathing.
Vasovagal Syncope (often referred to as fainting)
A special form that falls under neurogenic shock is known as vasovagal syncope. Syncope is the medical term for a brief loss of consciousness or fainting caused by a temporary reduction in blood supply to the brain. Vasovagal syncope refers to an excessive vagal response that results in a brief loss of consciousness. It leads to a temporary dilation of blood vessels, the blood pressure drops, and the return flow to the heart decreases. The affected person faints. In the now horizontal position, blood flows back to the heart, and they regain consciousness. This form can occur when standing for long periods, but also as a result of psychological influences such as shock, fear, pain, or emotional stress, as well as joy and similar situations. Sometimes even the sight of a few drops of blood is enough. Therefore, vasovagal syncope is not a disease but an excessive reaction that does not cause lasting damage, as long as no injury occurs during fainting. However, it should be clarified that there are no other causes behind the fainting.
How to recognize?
Fainting is often preceded by dizziness, nausea, and paleness - the person may appear absent.
What to do?
If the person is still standing, have them lie flat immediately and elevate their legs (shock position). Place the affected person in this position, even if they are already unconscious, and maintain their breathing.
Cardiogenic Shock (shock related to the heart)
Cardiogenic shock is based on insufficient pumping capacity of the heart. The heart is no longer able to pump enough blood into the circulation. Possible causes include a heart attack, pulmonary embolism, myocarditis, a significantly enlarged heart, or certain forms of arrhythmia.
How to recognize?
In addition to the general signs of shock, the following characteristics are present in cardiogenic shock:
On the one hand, the statements and behavior of the affected person provide clues to a possible heart problem. They complain of
- - Tightness and pressure in the chest area
- - Pain
- - Shortness of breath
- - Anxiety
- - Slow pulse - possibly irregular
- - Possible distended neck veins
What to do?
- No shock position! Sit them up and make the affected person comfortable.
- Call emergency services as soon as possible or ensure it is done.
- Shield the affected person from further excitement - ensure calm.
- Remove or loosen constricting clothing.
- Monitor the affected person while constantly checking consciousness and breathing.
- If an AED (defibrillator) is available, have it fetched. These devices are designed for use by laypersons and are very easy to operate. Follow the instructions on the device and adhere to the voice prompts.
Volume Deficit Shock (hypovolemic shock)
Hypovolemic shock is based on a volume deficit. This can occur due to blood loss, significant internal bleeding (for example, from the rupture of a vessel or organ, gastrointestinal bleeding, or a pelvic or thigh fracture, etc.) or external bleeding (severely bleeding wounds) or also due to loss of water and electrolytes (vomiting, diarrhea, or dehydration) or plasma loss (burns, rib or peritoneal inflammation, etc.).
How to recognize?
- The general signs of shock apply.
- Visible external injuries with blood or plasma loss are present.
- The finding or accident situation may provide clues to internal injuries.
- There may be a pelvic or thigh fracture.
What to do?
- Control bleeding
- Shock position, if no exceptional situation exists (injury in the chest or abdominal area, spinal injury, pelvic or thigh fracture, head injury, shortness of breath)
- Continuously check consciousness and breathing
Allergic Shock (anaphylactic shock)
Allergic shock is the most severe form of an allergic reaction. Possible triggers include all kinds of allergens such as insect stings, food, or medications. Anaphylactic shock is currently described as an acute pathological reaction of the immune system to a chemical stimulus that affects the entire organism. It is classified into four grades.
How to recognize?
- Grade 1: generalized hives, itching and/or redness, possibly also dizziness, headaches, and anxiety
- Grade 2: additionally rapid heartbeat and drop in blood pressure, often nausea and vomiting as well as mild shortness of breath
- Grade 3: severe shortness of breath (similar to an asthma attack), significant drop in blood pressure, very rapid heartbeat; a so-called angioedema (formerly: Quincke's edema) may occur; swelling occurs, especially in the area of the eyelids, chin, cheeks, lips, tongue, or genitals; hands and feet may also swell significantly; dangerous is the possible involvement of the airways (especially the vocal cords), which can lead to life-threatening shortness of breath
- Grade 4: respiratory or circulatory arrest
What to do?
- Eliminate the possible cause.
- Call emergency services as soon as possible or ensure it is done.
- Reassure the affected person, provide constant support, and ensure calm.
- Shock position
- Maintain warmth
- Continuously check consciousness and breathing.
- Assist with vomiting if necessary (do not force to vomit, but provide support in terms of holding and preventing inhalation of vomit).
Septic Shock
Septic shock can occur as a result of blood poisoning (sepsis) or a similar condition - for example, a SIRS syndrome - and must be treated immediately in an intensive care setting. People whose immune system is weakened or who are frequently exposed to pathogens are particularly at risk. The diagnosis of septic shock is made through laboratory tests.
Since septic shock is seen as a consequence of existing blood poisoning (sepsis) and the patient is usually already in treatment, we will refrain from further explanations on the points "How to recognize?" and "What to do?".
Other Forms of Shock
Other forms of shock include, for example, endocrine forms due to hormone deficiency or excess, toxic shock syndrome (TSS), hyperglycemic shock caused by high blood sugar, as well as hypoglycemic shock, which is associated with glucose deficiency but is not a classic shock, as there is no imbalance between oxygen supply and demand, but rather the lack of glucose is the trigger.
Sources:
By Sabine Croci.
This article is medically reviewed. Last updated (06/2024).
Information on the website and within the app cannot replace a consultation with a doctor, but can certainly complement it.
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