169 lines
8.5 KiB
Plaintext
169 lines
8.5 KiB
Plaintext
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Treating for Shock
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The following material may assist you in treating a victim for shock.
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This information is derived from "Advanced First Aid & Emergency Care," 2nd
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edition, by the American Red Cross. To obtain a copy of this book and to
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take instruction in first aid, please contact the local office of the
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American Red Cross. They are listed in the white pages of your telephone
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book.
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=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
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Define what is "shock"
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Shock is a condition resulting from a depressed state of many
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vital body functions. It can threaten life even though the injuries or
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conditions that caused the depression may not otherwise be fatal. The
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body's vital functions are depressed when there is a loss of blood
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volume, a reduced rate of blood flow or an insufficient supply of
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oxygen. Injury-related shock, commonly referred to as traumatic shock,
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is decidedly different from electric shock, insulin shock, and other
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special forms of shock.
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The degrees of shock is increased by abnormal changes in body
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temperature, by poor resistance of the victim to stress, by pain, by
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rough handling and by delay in treatment.
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What are the causes of shock?
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Shock may be caused by severe injuries of all types - hemorrhage,
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loss of blood plasma in burns, muscle swelling, loss of body fluids
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other than blood (as in prolonged vomiting and dysentery), by
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infection, by heart attack or stroke, by perforation of a stomach
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ulcer, by rupture of a tubal pregnancy, by anaphylaxis or by poisoning
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involving chemicals, gases, alcohol or drugs. Shock also results from
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lack of oxygen caused by obstruction of air passages or injury to the
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respiratory system.
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What are the EARLY stages and signs of shock?
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In the early stages of shock, the body compensates for a
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decreased blood flow to the tissues by constricting the blood vessels
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in the skin, soft tissues and skeletal muscles. Their constriction
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causes an emergency redistribution of blood flow to the heart, brain
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and other vital organs and may lead to the following signs:
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a. Pale (or bluish) skin, cold to the touch and possibly moist and
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clammy. In the case of victims with dark skin pigmentation, it
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may be necessary to rely primarily on the color of the mucous
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membranes on the inside of the mouth, on the inside of the
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eyelids or in the fingernail or toenail beds.
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b. Weakness.
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c. Rapid pulse (usually over 100 beats per minute or over about 17
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beats in 10 seconds), often too faint (due to decreased blood
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pressure) to be felt at the wrist but perceptible in the carotid
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artery at the side of the neck or in the femoral artery near the
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groin.
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d. Increased rate of breathing, possibly shallow, possibly deep and
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irregular. If there has been an injury to the chest or abdomen,
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breathing will almost certainly be shallow because of the pain
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involved in breathing deeply. A person in shock from hemorrhage
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may be restless and anxious (early signs of lack of oxygen),
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thrashing about and complaining of severe thirst and he may vomit
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or retch from nausea.
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What are the LATE stages and signs of shock?
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If the victim's condition deteriorates, he may become apathetic
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and relatively unresponsive because his brain is not receiving enough
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oxygen. His eyes will be sunken, with a vacant expression, and his
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pupils may be widely dilated. Some of the blood vessels in the skin
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may be congested, producing a mottled appearance; this condition is a
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sign that the victim's blood pressure has fallen to a very low level.
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If untreated, the victim eventually loses consciousness, his body
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temperature falls and he may die.
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What are the objectives in the treatment for shock?
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The objectives of first aid care in shock are to improve
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circulation of the blood, to ensure an adequate supply of oxygen and
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to maintain normal body temperature.
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What is the proper first aid treatment for shock?
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Give urgent first aid to eliminate causes of shock, such as
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stoppage of breathing, hemorrhaging and severe pain. Steps for
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preventing shock and for giving first aid for shock are as follows:
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a. Keep the victim lying down.
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b. Keep him covered only enough to prevent loss of body heat.
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c. Summon/obtain professional medical help.
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The victim's position must be based on his injuries. Generally,
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the most satisfactory position for the injured person will be lying
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down, to improve blood circulation. If injuries of the neck or lower
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spine are suspected, do NOT move the victim until he is properly
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prepared for transportation, unless it is necessary to protect him
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from further injury or to provide urgent first aid care.
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A victim who has severe wounds on the lower part of the face and
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jaw or who is unconscious should be placed on his side to allow
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drainage of fluids and to avoid blockage of the airway by vomitus and
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blood. Extreme care must be taken to provide an open airway and to
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prevent asphyxia. Place a victim who is having difficulty in breathing
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on his back, with his head and shoulders raised. A person with a back
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injury may be kept flat or propped up, but his head must NOT be lower
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than the rest of his body. A victim with severe brain injury may be
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unconscious, but unconsciousness is not itself a cause of shock unless
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he also has associated fractures or major wounds. IF IN DOUBT
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CONCERNING THE CORRECT POSITION ON THE BASIS OF THE INJURIES, KEEP THE
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VICTIM LYING FLAT.
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A victim in shock may improve with his feet (or the foot of the
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stretcher) raised from 8 to 12 inches. This position helps to improve
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blood flow from the lower extremities. If in doubt as to whether the
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victim's feet should be raised, keep the victim flat. If he has
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increased difficulty in breathing or experiences additional pain after
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his feet are raised, lower them again.
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Keep the victim warm enough to overcome or avoid chilling. If he
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is exposed to cold or dampness, place blankets or additional clothing
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over and under him to prevent chilling.
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Do NOT add extra heat, because raising the surface temperature of
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the body is harmful to shock victims. Heat draws the diverted blood
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supply back to the skin from the more vital organs, thus robbing them
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of critically needed blood.
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What are the cautions and prohibitions about giving fluids to the victim?
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Although giving fluid by mouth has value in shock, fluids should
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ONLY be given when medical help or trained ambulance personnel will
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not reach the scene for an hour or more. Other exceptions are when
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victims are unconscious, have convulsions, are vomiting or are likely
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to vomit. (They may aspirate fluids into the lungs if given fluids by
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mouth under these conditions.) Do not give fluids to victims who are
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likely to require surgery or a general anesthetic or who appear to
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have an abdominal injury. Oral fluids are harmful after injury to the
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brain, because additional fluids in the body may increase swelling of
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the brain. (A person with brain injury is likely to be unconscious or
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vomiting.) Fluids may be given by mouth ONLY if medical care is
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delayed for an hour or more and none of the above contraindications
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exist.
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Water, preferably water that contains salt and baking soda (1
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level teaspoon of salt and 1/2 level teaspoon of baking soda to each
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quart of water) and that is neither hot nor cold - is recommended.
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Adults may be given about 4 ounces (1/2 glass) every 15 minutes;
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children, ages 1 to 12, 2 ounces; infants, 1 year or less, 1 ounce.
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Discontinue if nausea or vomiting occurs.
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The preferred method of is by intravenous administration of
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fluids, a technique that provides intravascular volume restoration.
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However, this technique must only be used by individuals with
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specialized training and with authority.
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