Shock Control and Prevention
The essence of shock control and prevention is to
recognize the onset of the condition and to start
treatment before the symptoms fully develop. The
following are general signs and symptoms of the
development of shock (see figure 4-19):
Restlessness and apprehension are early
symptoms, often followed by apathy.
Eyes may be glassy and dull. Pupils may be
dilated.
(These are also the symptoms of
morphine use.)
Breathing may be rapid or labored, often of the
gasping, air hunger type. In the advanced
stages of shock, breathing becomes shallow and
irregular.
The face and skin may be very pale or ashen
gray; in the dark complexioned, the mucous
membranes may be pale. The lips are often
cyanotic.
The skin feels cool and is covered with clammy
sweat.
The skins coolness is related to a
decrease in the peripheral circulation.
The pulse tends to become rapid, weak, and
thready. If the blood pressure is severely
lowered, the peripheral pulse may be absent.
The pulse rate in hemorrhagic shock may
reach 140 or higher. In neurogenic shock,
however, the pulse rate is slowed, often
below 60.
The blood pressure is usually lowered in
moderately severe shock; the systolic
pressure drops below 100, while the pulse
rises above 100. The body is compensating
for circulatory fluid loss by peripheral
vasoconstriction.
This process tends to
maintain the blood pressure at a nearly
normal level despite a moderately severe loss
of circulating blood volume. A point comes,
however, when decompensation occurs, and
a small amount of additional blood loss will
produce a sudden, alarming fall in blood
pressure.
There may be nausea, vomiting, and dryness
of the mouth, lips, and tongue.
Surface veins may collapse. Veins normally
visible at the front of the elbow, forearms,
4-22
Approximate
Deficit (ml)
Decrease in Blood
Volume %
Degree
Signs
0-500
0-10
None
None
500-1200
10-25
Mild
Slight tachycardia
Postural changes in blood pressure
Mild peripheral vasoconstriction
Increased respirations
1200-1800
25-35
Moderate
Thready pulse 100-120
Systolic blood pressure 90-100
Marked vasoconstriction
Labored breathing
Diaphoresis (profuse perspiration)
Anxiety and restlessness
Decreased urine output
1800-2500
35-50
Severe
Thready pulse > 120
Systolic blood pressure < 60
Weakened respirations
Increased diaphoresis
Changes in levels of consciousness
No urine output
Table 4-2.Correlation of Magnitude of Volume Deficit and Clinical Presentation