CARDIOGENIC SHOCKCardiogenic shock is caused by inadequatefunctioning of the heart, not by loss of circulatingblood volume. If the heart muscle is weakened bydisease or damaged by trauma or lack of oxygen (as incases of pulmonary disease, suffocation, or myocardialinfarction), the heart will no longer be able to maintainadequate circulatory pressure, even though the volumeof fluid is unchanged. Shock will develop as thepressure falls. Heart attack is an extreme medicalemergency all Hospital Corpsmen must be ready tohandle. It will be discussed in greater detail in the“Common Medical Emergencies” section of thischapter.SEPTIC SHOCKSeptic shock usually does not develop for 2 to 5days after an injury and the patient is not often seen bythe Corpsman in a first aid situation. Septic shock mayappear during the course of peritonitis caused bypenetrating abdominal wounds or perforation of theappendix. Gross wound contamination, rupture of anulcer, or complications from certain types ofpneumonia may also cause septic shock. Septic shockis the result of vasodilation of small blood vessels inthe wound area, or general vasodilation if the infectionenters the bloodstream. In addition to increasingcirculatory system volume, the walls of the bloodvessels become more permeable, which allows fluidsto escape into the tissues. This type of shock carries apoor prognosis and should be treated under the directsupervision of a medical officer.ANAPHYLACTIC SHOCKAnaphylactic shock occurs when an individual isexposed to a substance to which his body isparticularly sensitive. In the most severe form ofanaphylactic shock, the body goes into an almostinstantaneous violent reaction. A burning sensation,itching, and hives spread across the skin. Severeedema affects body parts and the respiratory system.Blood pressure drops alarmingly, and fainting or comamay occur.The causative agent may be introduced into thebody in a number of ways. The injection of medicines(especially penicillin and horse- or egg-culturedserums) is one route. Another method is the injectionof venoms by stinging insects and animals. Theinhalation of dusts, pollens, or other materials to whicha person is sensitive is a third route. Finally, a slightlyslower but no less severe reaction may develop fromthe ingestion of certain foods and medications.Specific treatment of venoms and poisons will bediscussed in chapter 5, “Poisoning, Drug Abuse, andHazardous Material Exposure.”GENERAL TREATMENT PROCEDURESIntravenous fluid administration is the mostimportant factor in the treatment of all types of shockexcept cardiogenic shock. Ringer’s lactate is the bestsolution to use, although normal saline is adequateuntil properly cross-matched whole blood can beadministered. The electrolyte solutions replace notonly the lost blood volume, but also lost extracellularfluid that has been depleted. If the shock is severeenough to warrant immediate administration ofintravenous fluids, or if transportation to a medicalfacility will be delayed and a medical officer is notavailable to write an administrative order, beconservative: Start the intravenous fluids and let themrun at a slow rate of 50 to 60 drops per minute. Ifintravenous solutions are unavailable or transportationto a medical treatment facility will be delayed, andthere are no contraindications (such as gastrointestinalbleeding or unconsciousness), you may give thepatient an electrolyte solution by mouth. Anelectrolyte solution may be prepared by adding ateaspoon of salt and half a teaspoon of baking soda to aquart or liter of water. Allow the patient to sip thesolution.Other treatment procedures for shock are asfollows:Maintain an open airway. Oxygen may also beadministered if proper equipment is available.Control hemorrhages.Check for other injuries that may have beensustained. Remove the victim from the presenceof identifiable causative agents.Place the victim in a supine position, with thefeet slightly higher than the head (shockposition). Certain problems, such as breathingdifficulties or head injuries, may require otherpositioning.Reduce pain by splinting fractures, providingemotional support, and attending to the victim’scomfort. Unless contraindicated, aspirin may bedispensed.Conserve the patient’s body heat.4-24
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