What is “Shock”?

Shock is more than one thing. Because the primary care steps are easy to implement compared to other emergency aid, shock might seem simple from an Emergency First Responder point of view.But it’s actually a complex condition that affects the entire body, and can be emotional – shock that occurs following a traumatic or frightening emotional event – or medical, and can be associated with severe injury or illness.

Medical shock is a life-threatening condition due to insufficient blood flow throughout the body, making it a medical emergency because it can lead to other conditions such as lack of oxygen in the body’s tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment (while following the AB-CABS) because it can worsen rapidly.

There are five types of medical shock:

Septic shock results when bacteria multiply in the blood and release toxins. Common causes of this are pneumonia, urinary tract infections, skin infections (cellulitis), intra-abdominal infections (such as a ruptured appendix), and meningitis.

Anaphylactic shock is a severe hypersensitivity to something or allergic reaction. Allergy causes for anaphylactic shock include insect stings, medicines, or foods such as nuts, berries and seafood.

Cardiogenic shock can result from a heart attack, congestive heart failure or other cause, but it occurs when a patient’s heart cannot supply sufficient blood to the body.

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily injury, leaving an inadequate supply to provide oxygen to the vital organs. It can also be caused by severe anemia, in which there is no blood loss but the patient either has a deficiency of blood cells or the cells can’t carry as much oxygen as usual. Severe dehydration can deplete the water component of blood, leaving an inadequate volume to sufficiently circulate the blood. In all of these cases, not enough oxygen reaches the tissues. Heat exhaustion and heat stroke have shock associated with them.

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or injury. It can interfere with breathing, affect the heart beat and cause hypothermia.

Note that diabetic shock is not considered medical shock, but instead refers to a state of severe hypoglycaemia, which occurs when blood sugar levels drop dangerously low.  A person experiencing diabetic shock may lose consciousness and needs treatment to avoid seizures or diabetic coma.

Causes and Treatment

There are several main causes of shock and the different types of shock clearly guide us in understanding what these are. These are:

Heart conditions (heart attack, heart failure)
Heavy internal or external bleeding, such as from a serious injury or rupture of a blood vessel
Dehydration, especially when severe or related to heat illness
Infection (septic shock)
Severe allergic reaction (anaphylactic shock)
Spinal injuries (neurogenic shock)
Burns
Persistent vomiting or diarrhoea

While Emergency Responders don’t diagnose the type of medical shock, it is important to understand the contributing factors that can lead to the onset of shock, and that serious consequences including death can occur in a patient who doesn’t receive emergency medical care as soon as possible.

For this reason, when conducting Emergency First Response® Primary Care Skill #7, don’t gloss over this skill just because you can cover it much more simply and quickly than a skill like CPR or bandaging. Although lay responder shock treatment is much the same regardless of cause, creating shock scenarios based on the causes you’ve just read – especially apart from conditions requiring CPR or bleed control – trains participants to look for and treat shock as seriously as they watch for other conditions. This gives emphasis on both the need to identify and treat shock, and to activate EMS early as soon as potential shock is identified.

Sample Scenario

Here is a sample scenario for you to try out in your classes.

A runner at a marathon collapses, responsive, and controls their fall to land gently, but is clearly unwell. The Emergency Responder assesses the scene, approaches and gives the medical statement, then asks the patient how they feel. The patient says they’re feeling weak, and gives the responder permission to conduct an illness assessment. The assessment finds cool, clammy skin, an elevated pulse and ashen skin. The patient said they had been feeling fine for most of the race, but admits that they didn’t stop to rehydrate even after running and sweating for four hours. The responder treats for shock and contacts EMS.

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