Cardiogenic shock is caused by inadequate
functioning of the heart, not by loss of circulating
blood volume. If the heart muscle is weakened by
disease or damaged by trauma or lack of oxygen (as in
cases of pulmonary disease, suffocation, or myocardial
infarction), the heart will no longer be able to maintain
adequate circulatory pressure, even though the volume
of fluid is unchanged.
Shock will develop as the
pressure falls. Heart attack is an extreme medical
emergency all Hospital Corpsmen must be ready to
handle. It will be discussed in greater detail in the
Common Medical Emergencies section of this
Septic shock usually does not develop for 2 to 5
days after an injury and the patient is not often seen by
the Corpsman in a first aid situation. Septic shock may
appear during the course of peritonitis caused by
penetrating abdominal wounds or perforation of the
appendix. Gross wound contamination, rupture of an
ulcer, or complications from certain types of
pneumonia may also cause septic shock. Septic shock
is the result of vasodilation of small blood vessels in
the wound area, or general vasodilation if the infection
enters the bloodstream.
In addition to increasing
circulatory system volume, the walls of the blood
vessels become more permeable, which allows fluids
to escape into the tissues. This type of shock carries a
poor prognosis and should be treated under the direct
supervision of a medical officer.
Anaphylactic shock occurs when an individual is
exposed to a substance to which his body is
particularly sensitive. In the most severe form of
anaphylactic shock, the body goes into an almost
instantaneous violent reaction. A burning sensation,
itching, and hives spread across the skin.
edema affects body parts and the respiratory system.
Blood pressure drops alarmingly, and fainting or coma
The causative agent may be introduced into the
body in a number of ways. The injection of medicines
(especially penicillin and horse- or egg-cultured
serums) is one route. Another method is the injection
of venoms by stinging insects and animals.
inhalation of dusts, pollens, or other materials to which
a person is sensitive is a third route. Finally, a slightly
slower but no less severe reaction may develop from
the ingestion of certain foods and medications.
Specific treatment of venoms and poisons will be
discussed in chapter 5, Poisoning, Drug Abuse, and
Hazardous Material Exposure.
GENERAL TREATMENT PROCEDURES
Intravenous fluid administration is the most
important factor in the treatment of all types of shock
except cardiogenic shock. Ringers lactate is the best
solution to use, although normal saline is adequate
until properly cross-matched whole blood can be
administered. The electrolyte solutions replace not
only the lost blood volume, but also lost extracellular
fluid that has been depleted. If the shock is severe
enough to warrant immediate administration of
intravenous fluids, or if transportation to a medical
facility will be delayed and a medical officer is not
available to write an administrative order, be
conservative: Start the intravenous fluids and let them
run at a slow rate of 50 to 60 drops per minute. If
intravenous solutions are unavailable or transportation
to a medical treatment facility will be delayed, and
there are no contraindications (such as gastrointestinal
bleeding or unconsciousness), you may give the
patient an electrolyte solution by mouth.
electrolyte solution may be prepared by adding a
teaspoon of salt and half a teaspoon of baking soda to a
quart or liter of water. Allow the patient to sip the
Other treatment procedures for shock are as
Maintain an open airway. Oxygen may also be
administered if proper equipment is available.
Check for other injuries that may have been
sustained. Remove the victim from the presence
of identifiable causative agents.
Place the victim in a supine position, with the
feet slightly higher than the head (shock
position). Certain problems, such as breathing
difficulties or head injuries, may require other
Reduce pain by splinting fractures, providing
emotional support, and attending to the victims
comfort. Unless contraindicated, aspirin may be
Conserve the patients body heat.