13. THE TREATMENT OF SHOCK

Severe bleeding, bad burns, broken bones, crushing injuries, shell, bomb and bullet wounds all call for treatment of shock. And because shock is easier to prevent than to cure, first aiders are taught to bring treatment immediately without waiting for symptoms of shock to develop.

The work shock is used to describe many different conditions, and some of you may therefore be confused about it. We speak of a person having a great shock when he has suddenly received bad news. Emotional or nervous shock may cause fainting. Fainting is in some ways like the shock from severe injury, but is different in being quickly reversible. Lowering the patient's head usually revives him at once.

Electric shock is a definite injury for which first aiders get special instruction. A kind of shock called chemical shock is caused by poisons, and many persons have heard of insulin shock, suffered by diabetics who get too big a dose of insulin. The kind of shock that comes with severe injuries is a state of collapse in which all body functions are depressed due to failure of the circulation. Severe shock is always serious and may be fatal.

Besides the original injury, the following factors may contribute to shock: pain, rough handling, improper transportation, continued bleeding, exposure to excessive heat or cold, and fatigue. The aged, the very young and the discouraged are apt to suffer more from shock. Remember these factors when you are giving first aid to an injured person, so that you do not add to the shock he has already suffered.

SYMPTOMS

Most common symptoms of shock are paleness, a cool, clammy skin and a feeling of weakness or faintness. Perspiration on the forehead, around the lips and on the palms of the hands is another symptom. A weak, sometimes rapid pulse, nausea and vomiting are symptoms of shock. The patient in shock is often indifferent to what is going on around him and to questioning. Unconsciousness is also a symptom of shock.

These symptoms may not all show in one patient. Usually they develop gradually and the victim may seem perfectly all right at first, only to collapse later. Even a patient in deep shock may not show signs that the first aider can detect.

For these reasons, first aiders are taught that persons with even minor injuries should lie down, and that in every case of serious injury, shock should be treated. The only possible exception to this rule would be in the event of an atomic attack or other large scale disaster in which the first aider's first job after stopping severe bleeding might be to get the injured person out of the hazard area.

Loss of blood is one cause of shock, so when you stop the bleeding you are also helping to overcome the shock, or at least to keep it from getting worse.

FIRST AID FOR SHOCK

First aid directions for treating and preventing shock cover four points:

1. Position. Keep the patient lying down flat. If the injury is severe, raise the lower part of the body a foot or so. If a chest injury makes it hard for the patient to breathe, raise his head and shoulders slightly and keep the legs flat. Never force an injured person to stand or walk except in the unusual situation where you may have to get him away from flames or falling walls. Even then, it would be better to have him carried.

2. Heat. The idea is to keep the patient comfortable but not too hot. The old idea of applying heat to a patient in shock has been revised because it is now known that coldness of hands and feet in such cases is due in part to constriction of the blood vessels. This is the body's way of making up for the deficiency in circulation. So you try to conserve the body's heat without adding too much to it. The simplest method of doing this is to cover the patient with blankets, coats, newspapers or whatever is at hand. Remember to put the covering under as well as over him, to protect him from the coolness and possible dampness of the ground. In hot weather, a small amount of covering may be enough. You do not want your shocked patient sweating. In very cold weather you may use hot water bottles to keep his body from losing heat. Be careful not to burn him. He may not feel the heat or be able to tell you it is too hot, but can nevertheless get a burn from too hot a water bottle.

3. Fluids. Don't give an unconscious patient anything to swallow and don't try to pour fluids down his throat. But if the patient is conscious and can swallow, and is not nauseated, small amounts of warm water, broth, milk, tea or coffee may be given. The fluids will help keep him warm and will help replace the fluids he may have lost in blood due to the injury. A cupful every half hour is enough. You may need to feed it from a spoon.

4. Other measures. Do not give stimulants. They have no value in the first aid treatment of shock. Avoid unnecessary questioning and handling of the patient, but care for other injuries.