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Don’t Be Shocked!
Posted: Wednesday, September 21, 2011 5:41 PM
Joined: 02/05/2008
Posts: 392

Most people associate shock with traumatic events, such as a heart attack or uncontrolled bleeding. However, a sting from a jellyfish, a fall on a slippery deck, even extreme seasickness can cause someone to go into shock.  

Understanding the different categories of shock and knowing how to provide initial first aid treatment can be critical to saving a life, especially when you’re at sea with limited access to emergency facilities.

If you suspect shock after an injury, even if the person seems to be okay, immediately act on your suspicions. The sooner shock is treated, the more likely it is that the victim will recover.

Types of Shock

Anaphylactic Shock
is a life-threatening allergic reaction with symptoms that rapidly develop, often within seconds or minutes. Frequent causes include allergies to insect bites, medicines, foods (nuts, berries and seafood) and cleaning products. After coming into contact with a “causative agent,” the body releases histamine and other substances, which cause airway constriction, wheezing and difficulty breathing, hives, nasal congestion, vomiting, a drop in blood pressure and even death. It’s highly recommended crew keep a list of all known owner and crew allergies and make sure all guests write down their known allergies on their preference sheets prior to going to sea.

Cardiogenic Shock
occurs when the heart is damaged and unable to supply sufficient blood to the body; this is often the result of complications of a heart attack or a blood clot in the lungs (pulmonary embolism). Other causes include a malfunctioning heart valve (particularly an artificial valve), an abnormal heart rhythm (arrhythmia) or an infection (sepsis). 

Neurogenic Shock
occurs after injury to the spinal cord. Crew often are at greater risk of spinal cord injuries, given potential falls on slippery deck surfaces that can lead to a direct head strike and spinal compression. An electrical shock strong enough to throw a person some distance can cause trauma to the spine, resulting in neurogenic shock.

Hypovolemic shock
is caused by fluid loss, either through persistent vomiting and diarrhea, or by uncontrolled bleeding from trauma. Persistent seasickness can result in severe dehydration, as can certain medications, which cause an increase in urination.

Septic Shock
is a life-threatening reaction to a severe infection and occurs when body tissues do not receive enough blood and oxygen. The problem may begin as a small infection, but may spread to overwhelm the body’s defenses. If you develop a small infection, localized symptoms may include redness, swelling and tenderness. Indicators that the infection has spread include fever, rapid breathing, an altered level of consciousness and a faster-than-normal heart rate. Some causes of septic shock result from an infection of the lung (pneumonia), bladder and/or kidneys (urinary tract infections), or the abdomen (such as a ruptured appendix).

Signs and Symptoms

Symptoms of shock are similar when the cause is low blood volume (hypovolemic shock) or inadequate pumping action of the heart (cardiogenic shock).

The condition may begin with lethargy, sleepiness and confusion. The skin may become cold and sweaty; it’s often pale with a bluish hue. When the skin is pressed, its color returns much slower than normal. Blood vessels may become more apparent as a bluish network of lines under the skin. The pulse is weak, but rapid, unless a slow heartbeat is causing the shock.

In most cases, the person cannot sit up without feeling light-headed or passing out. Blood pressure may drop so low that it cannot be measured with a blood pressure cuff.

When shock results from excessive dilation of blood vessels (such as anaphylactic shock), the symptoms are somewhat different. The skin may be warm and flushed, and the pulse may be strong and forceful rather than weak, particularly at first. However, over time, shock due to excessive dilation of blood vessels also produces cold, clammy skin and lethargy.

As shock develops, there may be:

  • Weakness and giddiness
  • Nausea and, occasionally, vomiting
  • Thirst
  • Rapid, shallow breathing
  • A weak pulse. When the pulse at the wrist disappears, fluid loss may equal half of the blood volume.

As the oxygen supply to the brain weakens, the victim may become restless, anxious and aggressive. The victim may yawn and gasp for air (air hunger).  Eventually the victim will become unconscious and finally, the heart will stop.

How to respond:

  • Address all obvious causes of shock, such as external bleeding
  • Make sure the victim is kept warm
  • Loosen tight clothing, braces, straps or belts to reduce constriction at the neck, chest and waist
  • Check and record breathing, pulse, respirations, blood pressure and level of response every five minutes
  • Do not administer food or drink by mouth unless directed to do so by the physician.

The standard position
for giving care for shock is feet up, with the injured area elevated. Warning: Do not elevate the injury if you think a bone may be broken. Do not elevate any fracture that is not splinted.

If you think a bone may be broken and it’s not splinted, if elevation is painful or if you’re not sure which position is correct, position the victim to be flat on his/her back.

Note:  If the victim has a head wound or is having trouble breathing, elevate the head and shoulders. Do not elevate the feet and the head at the same time.  Stay with the victim until further medical recommendations have been made.

By identifying possible shock and making an early call to your yacht’s telemedicine service, you very well may save a life. A solid understanding of first aid when shock is suspected is critical.

Your observations and an objective description of the person’s symptoms will help the telemedicine doctor make basic decisions regarding the first line of treatment, using the medical equipment available onboard your vessel.

By Robin Drake, RN, nurse case manager for MedAire, with more than two decades of experience in emergency medical management.

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