Shock occurs when tissues do not receive enough oxygen-rich blood. It progresses from an early compensated stage with symptoms like restlessness to a late decompensated stage with difficult breathing and cyanosis. Causes include cardiovascular issues like pump failure, blood/fluid loss, or poor vessel function as well as non-cardiovascular issues like respiratory problems, allergic reactions, or psychological responses. General care involves treating injuries, keeping the person lying flat or in a recovery position, preventing heat loss, and calling for medical help.

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Shock
CHAPTER 4

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Learning Objectives (1 of 2)
 List the time spans the brain,
abdominal organs, and muscle
cells have before irreparable
damage without oxygen occurs.
 List and describe the
cardiovascular causes of shock.
 List and describe the
noncardiovascular causes of
shock.
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Sequoia and Kings Canyon National Parks, California

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Learning Objectives (2 of 2)
 Describe the difference between compensated and
decompensated shock.
 Describe how shock progresses.
 Describe how to care for shock.

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Introduction to Shock
 Shock occurs when the body’s tissues do not receive enough
oxygen-rich blood.
 Shock is life-threatening.

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Causes of Shock
 Without oxygen:
• The brain would be damaged in 4 to 6 minutes.
• The abdominal organs would be damaged in 45 to 90 minutes.
• The skin and muscle cells would be damaged in 3 to 6 hours.

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Perfusion Triangle
 Think of the circulatory system
as having three components:
• Heart (pump)
• Blood vessels (pipes)
• Blood (fluid)
 Shock occurs when one or more
of the sides are not working
properly.
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FIGURE 4-1 Perfusion triangle.

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Causes of Shock (1 of 2)
 Cardiovascular
• Pump failure
o Cardiogenic shock
• Loss of fluid or blood
o Hypovolemic shock or
hemorrhagic shock
• Poor vessel function
o Neurogenic shock
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FIGURE 4-2 There are three basic cardiovascular causes of shock and impaired tissue
function. A. Pump failure occurs when the heart is damaged by disease, injury, or
obstructive causes. The heart may not generate enough force to move the blood through the
system. B. Low fluid volume, often a result of bleeding, leads to inadequate perfusion. C.
The blood vessels can dilate excessively so that the blood within them, even though it is of
normal volume, is inadequate to fill the systemand provide efficient perfusion.

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Causes of Shock (2 of 2)
 Noncardiovascular
• Respiratory insufficiency
o Chest injury
o Airway obstruction
• Anaphylactic shock
o Medications
o Food
o Insect stings
• Psychogenic shock (fainting)
o Sudden nervous system
reaction
• Fainting, or syncope
o Causes include fear, bad news,
and unpleasant sights

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The Progression of Shock (1 of 2)
 Compensated shock (early stage)
• Agitation
• Anxiety
• Restlessness
• Feeling of impending doom
• Altered mental status
• Weak, rapid, or absent pulse
• Clammy skin
• Paleness compared to baseline,
with cyanosis on lips
• Shallow, rapid breathing
• Shortness of breath
• Nausea or vomiting
• Capillary refill longer than 2
seconds in infants and children
• Thirst

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The Progression of Shock (2 of 2)
 Decompensated shock (late stage)
• Difficulty breathing
• Ashen, mottled, or cyanotic skin compared to baseline
• Dull eyes, dilated pupils
• Falling blood pressure
 Irreversible shock (final stage)
• Terminal

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General Care for Shock (1 of 3)
 Injuries
• Treat injuries
 Responsive and breathing normally
• Flat on their back
• If there is no sign of injury and it does not cause the person pain,
raise the feet 6 to 12 inches (15 to 30 cm).
• DO NOT give anything to eat or drink.

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General Care for Shock (2 of 3)
 Unresponsive and breathing
• Roll person onto their side and into recovery position.
• DO NOT roll the person if there is a neck, back, hip, or pelvic injury.
• Call for outside medical help.
• Prevent heat loss.

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General Care for Shock (3 of 3)
 Shock positions
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FIGURE 4-3 Shock positions. A. Feet can be raised 6 to 12 inches (15 to 30 cm) if it does not cause pain or if the legs or pelvis are not injured. B. For a person with a
head injury, elevate the head (if spinal injury is not suspected). C. Position a person who is unresponsive or has experienced a stroke in the recovery position. D. Use
a half-sitting position for people with breathing difficulties, chest injuries, or a heart attack. E. Keep the person flat if a spinal injury or leg fracture is suspected.