Shock
Shock following an injury results from a decrease in the vital functions of various organs of the body. These functions are impaired due to inadequate blood circulation or a deficiency of oxygen.

Shock usually follows severe injuries such as extensive burns, major crushing injuries (particularly of the chest and abdomen), fractures of large bones, and other extensive or extremely painful injuries. It may also result from the loss of large amounts of blood; allergic reactions; poisoning from drugs, gases, and other chemicals; alcohol intoxication; and rupture of a stomach ulcer. In addition, shock may be associated with serious illnesses such as infections, strokes, and heart attacks.

In some individuals, the emotional response to minor injuries or even the sight of blood may be so strong that they feel weak, nauseated, and may faint. This reaction can be considered a very mild form of shock and is not serious; it usually resolves quickly if the patient lies down.

Severe shock is a serious condition that threatens life.

Signs and symptoms of shock are:

• Paleness: The skin appears pale, cold, and often moist. Later, it may develop a bluish or ashen colour. In individuals with dark skin, the colour of the mucous membranes and nail beds should be checked.
• Rapid and shallow breathing: Alternatively, breathing may be irregular and deep.
• Thirst, nausea, and vomiting: These symptoms commonly occur in a patient with haemorrhage and shock.
• Weak and rapid pulse: The pulse rate is usually over 100.
• Restlessness, excitement, and anxiety: These occur in the early stages, followed by mental dullness, and eventually unconsciousness. In the later stage, the pupils are dilated, giving the patient a vacant, glassy appearance.

Even if these symptoms are not clearly present, all seriously injured persons should be treated for shock to prevent its development.

Treatment

• Eliminate the causes of shock. This includes controlling bleeding, restoring breathing, and relieving severe pain.
• Make the injured person lie down. The patient should be placed in a horizontal position. The legs may be raised about 30 cm to help blood flow to the heart and head. However, the legs should not be elevated if there is injury to the head, pelvis, spine, or chest, or if the patient has difficulty breathing.
• Keep the patient warm, but not overheated. Excessive heat increases the surface temperature of the body and diverts blood away from vital organs to the skin.
• Relieve pain as quickly as possible. If the pain is severe, 10 mg of morphine sulfate may be given by intramuscular injection. If blood pressure is low, morphine sulfate should not be given, as it may further reduce blood pressure. It should not be administered unless the pain is severe. The dose should be repeated only after obtaining RADIO MEDICAL ADVICE.
• Administer fluids. Fluids should not be given by mouth if the patient is unconscious, drowsy, convulsing, or likely to undergo surgery. Fluids should also not be given if there is a puncture or crush injury to the abdomen, or a brain injury. If none of these conditions are present, give the patient an oral rehydration solution (half a glass every 15 minutes).
• Alcohol should NEVER be given.
• Intravenous fluids are preferable in treating shock, if a trained person is available to administer them. Dextran (60 g/litre, 6%) and sodium chloride solution (9 g/litre, 0.9%) may be given intravenously.
• In cases of suspected shock, obtain RADIO MEDICAL ADVICE.