1. Jennifer L. Doherty, MS, LAT, ATC Management of Medical Emergencies
Shock
Jennifer L. Doherty, MS, LAT, ATC
Management of Medical Emergencies

2. Overview
Shock occurs when a diminished amount of blood is available to the circulatory system
The vascular system fails to hold the fluid portion of the blood
Vasodilation of the blood vessels occurs and disrupts the osmotic fluid balance in the body

3. Overview
Plasma cells leave the blood and enter the interstitial spaces
The formed elements remain in the blood
Blood viscosity increases
The rate of blood flow decreases
Insufficient amounts of O2 are being transported in the blood

4. Predisposing Factors Extreme fatigue Extreme exposure to heat or cold
Extreme dehydration
Illness
Severe injury

5. Signs and Symptoms Low Blood Pressure Pulse is rapid and weak
Systolic BP is usually below 90 mmHg
Pulse is rapid and weak
Respiration is rapid and shallow
Skin is pale, cool, and clammy
Drowsiness

6. Types of Shock Hypovolemic Shock
Results from trauma in which there is blood loss
Decreased blood volume causes a decrease in blood pressure
Insufficient amounts of O2 is being transported to body tissues and organs

7. Types of Shock Respiratory Shock
Results when the lungs are unable to supply enough O2 the circulating blood
Trauma that may produce respiratory shock include:
Pneumothorax
Injury to the respiratory control center

8. Types of Shock Neurogenic Shock
Results due to the overall dilation of the blood vessels within the cardiovascular system
Decreased blood pressure
Insufficient amounts of O2 is being transported to body tissues and organs

9. Types of Shock Psychogenic Shock
Commonly known as “fainting” (syncope)
Results due to a temporary dilation of the blood vessels in the body causing a decrease in the blood flow to the brain

10. Types of Shock Cardiogenic Shock
Results due to the inability of the heart to pump enough blood to the body
Decreased cardiac output
Decreased blood pressure
Insufficient amounts of O2 is being transported to body tissues and organs

11. Types of Shock Septic Shock Results due to a severe infection
Usually a bacterial infection
Toxins released by the bacteria cause dilation of the blood vessels within the cardiovascular system
Decreased blood pressure
Insufficient amounts of O2 is being transported to body tissues and organs

12. Types of Shock Anaphylactic Shock
Results due to a severe allergic reaction
Allergic reaction may be caused by:
Foods
Insect bites
Drugs
Inhaling dusts, pollens, etc…

13. Types of Shock Metabolic Shock
Results due to a severe illness that goes untreated
For example, untreated diabetes
Results due to an extreme loss of bodily fluid
For example, excessive urination, diarrhea, or vomiting

14. Psychological Impact
Shock can be compounded, or produced by the psychological reaction to an injury or a situation
Fear is the common
Provide reassurance and comfort

15. Immediate Management

16. Immediate Management Maintain normal body temperature
In most cases, elevate the feet and legs above the level of the heart
Exceptions include:
Neck injury – immobilize in the position found
Head injury – elevate the head and shoulders
Leg fracture – splint and elevate

17. Secondary Management

18. Secondary Management Vital Signs Pulse Respiration Blood pressure
Temperature
Skin color
Pupils
Level of consciousness
Movement
Abnormal nerve response

19. Pulse A direct extension of the functioning of the heart
Normal pulse rate for adults
60 – 80 bpm
Normal pulse rate in children
80 – 100 bpm

20. Abnormal Pulse Rapid and weak Rapid and strong Slow and strong
Shock
Bleeding
Diabetic coma
Heat exhaustion
Rapid and strong
Heatstroke
Severe fright
Slow and strong
Skull fracture
Stroke
No pulse
Cardiac arrest
Death

21. Respiration Normal respiration rate for adults
~ 12 breaths per minute
Normal respiration rate for children
~ 20 breaths per minute
Rapid and shallow respiration is indicative of shock

22. Blood Pressure Normal systolic blood pressure in adults
Males: 115 – 120 mm Hg
Females: 105 – 110 mm Hg
Normal diastolic blood pressure in adults
Males: 75 – 80 mm Hg
Females: 65 – 70 mm Hg

23. Blood Pressure High Blood Pressure Low Blood Pressure
Systolic BP > 140 mm Hg
Diastolic BP > 90 mm Hg
Low Blood Pressure
Systolic BP < 100 mm Hg
Diastolic BP < 60 mm Hg

24. Temperature Normal body temperature
~ 98.6°F (~ 37°C)
Core temperature is most accurately measured at the tympanic membrane of the ear
Changes in body temperature are reflected in the skin

25. Skin: Temperature Cool, clammy skin Cool, dry skin Hot, dry skin Shock
Trauma
Heat exhaustion
Cool, dry skin
Overexposure to cold
Hot, dry skin
Disease
Infection
Overexposure to environmental heat

26. Skin: Color
Three skin colors are commonly identified in medical emergencies:
Red
White
Blue
Red skin color
Heatstroke
High blood pressure
Elevated body temperature

27. Skin: Color White skin color Blue skin color Shock
Insufficient circulation
Fright
Hemorrhage
Heat exhaustion
Insulin shock
Blue skin color
Airway obstruction
Respiratory insufficiency

28. Pupils Pupils are extremely sensitive to changes in the nervous system
If one or both pupils are dilated…
Shock
Head injury
Heatstroke
Hemorrhage
CNS stimulant drug
One constricted pupil…
CNS depressant drug

29. Pupils If one or both pupils fail to respond to light…
Brain injury
Alcohol
Drug poisoning
Pupil response to light is more critical than the evaluation of pupil size

30. Level of Consciousness
In normal conditions, the athlete is…
Alert
Aware of the surrounding environment
Responds quickly to vocal stimulation
Abnormal levels of consciousness may result due to…
Shock
Head injury
Heatstroke

31. Summary May not be able to determine the type of shock
Immediate management of shock is universal
Provide reassurance and comfort
Maintain normal body temperature
In most cases, elevate the feet and legs above the level of the heart