Shock Control and PreventionThe essence of shock control and prevention is torecognize the onset of the condition and to starttreatment before the symptoms fully develop. Thefollowing are general signs and symptoms of thedevelopment of shock (see figure 4-19):Restlessness and apprehension are earlysymptoms, often followed by apathy.Eyes may be glassy and dull. Pupils may bedilated. (These are also the symptoms ofmorphine use.)Breathing may be rapid or labored, often of thegasping, “air hunger” type. In the advancedstages of shock, breathing becomes shallow andirregular.The face and skin may be very pale or ashengray; in the dark complexioned, the mucousmembranes may be pale. The lips are oftencyanotic.The skin feels cool and is covered with clammysweat. The skin’s coolness is related to adecrease in the peripheral circulation.The pulse tends to become rapid, weak, andthready. If the blood pressure is severelylowered, the peripheral pulse may be absent.The pulse rate in hemorrhagic shock mayreach 140 or higher. In neurogenic shock,however, the pulse rate is slowed, oftenbelow 60.The blood pressure is usually lowered inmoderately severe shock; the systolicpressure drops below 100, while the pulserises above 100. The body is compensatingfor circulatory fluid loss by peripheralvasoconstriction. This process tends tomaintain the blood pressure at a nearlynormal level despite a moderately severe lossof circulating blood volume. A point comes,however, when decompensation occurs, anda small amount of additional blood loss willproduce a sudden, alarming fall in bloodpressure.There may be nausea, vomiting, and drynessof the mouth, lips, and tongue.Surface veins may collapse. Veins normallyvisible at the front of the elbow, forearms,4-22ApproximateDeficit (ml)Decrease in BloodVolume %Degree Signs0-500 0-10 None None500-1200 10-25 Mild Slight tachycardiaPostural changes in blood pressureMild peripheral vasoconstrictionIncreased respirations1200-1800 25-35 Moderate Thready pulse 100-120Systolic blood pressure 90-100Marked vasoconstrictionLabored breathingDiaphoresis (profuse perspiration)Anxiety and restlessnessDecreased urine output1800-2500 35-50 Severe Thready pulse > 120Systolic blood pressure < 60Weakened respirationsIncreased diaphoresisChanges in levels of consciousnessNo urine outputTable 4-2.—Correlation of Magnitude of Volume Deficit and Clinical Presentation
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