Shock

Chapter 5: Circulatory Conditions

First Aid Training Department | St John Brigade

 Introduction

2 First Aid Training Department | St John Brigade

 Types of Shock
Shock is a state of inadequate blood and oxygen supply to
tissues of the body.
Hypovolemic
Cardiogenic
Loss of blood / fluid reduces blood
Failure of heart pump results in
volume and flow
inadequate blood / oxygen flow
E.g. bleeding wound, severe
E.g. heart attack
diarrhea

Types of Shock

Anaphylactic
Blood and fluid are lost from leaky blood vessels, and do not get to vital
organs, e.g. severe allergic reaction

3 First Aid Training Department | St John Brigade

 Hypovolemic shock
• Average adult has about 5L of blood in the body.
• Significant blood / fluid loss (>15% of total blood volume) 🡪 less
blood available to deliver oxygen to tissues in the body.

Blood Loss Effect

< 1.5L (30%) Heart rate increases to compensate for loss
in blood volume.
> 1.5L (massive bleeding) Increase in heart rate no longer able to
compensate for volume loss, resulting in
weak / thready pulse.

* Other types of shock are discussed at the end of this topic

4 First Aid Training Department | St John Brigade
 Case Scenario

5 First Aid Training Department | St John Brigade

 You were buying lunch from a hawker centre near your
house when you heard someone screaming. You turn
towards the direction and you see a stall owner holding
on to his right hand, with blood dripping from it.

Bleeding hand. Digital image.

https://www.shutterstock.com/image-photo/bloody-
hand-against-light-background-halloween-1200077782

6 First Aid Training Department | St John Brigade

 Primary Survey
Danger Situation: Danger, Mechanism of injury

Response Level of Response: Alert, Voice, Pain or Unresponsive

Shout Call for Help: Ambulance, Fire Brigade, Seniors

Airway Clear or Obstructed: Able to speak or Hoarseness

Breathing Normal or Abnormal: Speaking in sentences/phrases/words or Wheezing

Circulation Major Bleeding or Signs of Shock: Rapid weak pulse

Disability Oriented or Confused: Time, Place, Person

Exposure Other Life or Limb-Threatening Injury

7 First Aid Training Department | St John Brigade

 Primary Survey
Situation:
Danger Danger | Mechanism of injury

Response Responder Casualty

Ensure no:
1) No surrounding sharp objects (e.g.
Shout 1) Surrounding dangerous
knives, fork).
equipment
2) No surrounding crowds.
2) Crowds
Airway
There is no Danger.
Breathing
Circulation Normal
Abnormal
To clear the
Proceed to Danger
Disability assess
casualty
Exposure
8 First Aid Training Department | St John Brigade
 Primary Survey
Situation:
Danger Danger | Mechanism of injury

Response
You see a blood-stained knife at the sink. The casualty was most likely cut by
the knife.
Shout
Airway
Breathing
Circulation
Disability
Exposure
9 First Aid Training Department | St John Brigade
 Primary Survey
Level of Response:
Danger Alert | Voice | Pain | Unresponsive

Response Responder Casualty

Approach casualty. Casualty looks at you spontaneously.
Shout
The casualty is Alert.
Airway
Breathing
Circulation
Disability
Exposure
10 First Aid Training Department | St John Brigade
 Primary Survey
Call for Help:
Danger Ambulance | Fire Brigade | Seniors

Response
Casualty does not look well and there is profuse bleeding.
Call the ambulance 995 and get an AED.
Shout
Airway
Breathing
Circulation
Disability
Exposure
11 First Aid Training Department | St John Brigade
 Primary Survey
Clear / Obstructed:
Danger Able to speak | Hoarseness

Response Responder Casualty

“Hello sir, what happened here?” “I cut my hand accidentally with the knife.”
Shout
Airway The casualty is able to speak without hoarseness.

Breathing
Abnormal
Normal Treat Airway
Circulation Proceed to disorder
assess
Disability Breathing

Exposure
12 First Aid Training Department | St John Brigade
 Primary Survey
Present / Normal:
Danger Speaking in sentences/phrases/words | Wheezing

Response Responder Casualty

“What were you doing when “I was trying to cut the meat for my
that happened?” customer.”
Shout
Airway Breathing is present. Casualty is able to speak in sentences with no wheezing
observed.
Breathing
Abnormal
Circulation Normal Treat Breathing
Proceed to assess disorder
Circulation
Disability
Exposure
13 First Aid Training Department | St John Brigade
 Primary Survey
Major Bleeding | Signs of Shock:
Danger Rapid weak pulse

Response Responder Casualty

1) Look out for major 1) Blood is flowing out
Shout bleeding wounds.
2) Assess radial pulse
of the hand wound
rapidly.
of the unaffected 2) Pulse is rapid and
Airway hand. weak.

Breathing
There is Circulation disorder with shock. Abnormal
Identify and treat
Circulation abnormal
Normal Circulation before
Disability Proceed to proceeding with
assess
primary survey
Exposure Disability

14 First Aid Training Department | St John Brigade

 Shock – Signs & Symptoms

15 First Aid Training Department | St John Brigade

 Signs & Symptoms
Fast pulse
Weak pulse
Body reacts to reduced blood flow by
increasing heart rate to keep vital organs Due to reduced blood volume throughout
adequately supplied with blood and the body.
oxygen.

Confusion Event history

Due to reduced blood flow to the brain. Shock is typically a result of a serious
Occurs as a late sign of shock. injuries (e.g. major bleeding).

16 First Aid Training Department | St John Brigade

 Shock – Treatment

17 First Aid Training Department | St John Brigade

 Treatment Principles and Procedure
1. Treat underlying cause
a) Identify and treat cause of shock.
i. Hypovolemic shock – control massive
bleeding (refer to Chapter 5.1 Bleeding).
ii. Anaphylactic shock – remove source
and assist in administering EpiPen if
available.
iii. Cardiogenic shock
2. Improve blood supply to brain
a) Lie casualty down in supine position.
b) Elevate both legs if possible.

3. Early evacuation
a) Call ambulance 995 if signs of shock
present.
4. Monitor vitals
a) Monitor vital signs closely.
b) Be ready to commence CPR in case of
cardiac arrest.

18 First Aid Training Department | St John Brigade

 Completing the Primary Survey

19 First Aid Training Department | St John Brigade

 Primary Survey
Oriented / Confused:
Danger Time | Place | Person

Response Responder Casualty

“What is your name?” “My name is Michael.”
Shout
“Do you know where are you now?” “I am at my stall.”
Airway
“Do you know what time is it now?” “It’s about 12.30pm now.”
Breathing
The casualty is oriented to time, place and person.
Circulation
Normal
Disability Proceed to
Abnormal
Treat Disability
assess disorder
Exposure Exposure
20 First Aid Training Department | St John Brigade
 Primary Survey
Danger Other Life / Limb Threatening Injury

Response Responder Casualty

1) “Do you feel pain or

Shout uncomfortable anywhere else?”
1) “No, I just cut my fingers”
2) No other obvious injuries found.
2) Look from head to toe.
Airway
No obvious life / limb threatening injury.
Breathing
Circulation Normal
Abnormal
Treat life / limb
threatening injuries
Proceed to
Disability secondary survey
found

& treat for other

Exposure injuries
21 First Aid Training Department | St John Brigade
 Anaphylactic Shock

22 First Aid Training Department | St John Brigade

 Steps Leading to Anaphylactic Shock
1. Body encounters allergen, which triggers allergic reaction.

2. Body produces chemicals which cause blood vessels to dilate

and become leaky.

3. Blood pressure drops due to:

a. Blood vessels dilating

b. Losing volume as fluid will leak out of blood vessels

4. This reduces blood and oxygen flow to vital organs.

23 First Aid Training Department | St John Brigade

 Additional Signs & Symptoms
• Swelling of face, lips, mouth

• Rashes

• Abdominal pain, vomiting, diarrhea

• History of known allergy (e.g.

peanuts, bee stings)
Anaphylaxis. Digital image.
https://teachmesurgery.com/perioperative/general-complications/anaphylaxis/

* Refer to Chapter 3.1 Anaphylaxis for recognition and management of allergic reactions
24 First Aid Training Department | St John Brigade
 Administering EpiPen (Adrenaline)
EpiPen contains adrenaline (also known as epinephrine)
• Reduces airway swelling 🡪 relieves difficulty breathing
• Constricts blood vessels 🡪 increases blood flow to organs

How to use an Epi-pen. Digital image.

https://edrugsearch.com/how-to-use-an-
epipen/

25 First Aid Training Department | St John Brigade

 Cardiogenic Shock

26 First Aid Training Department | St John Brigade

 Cardiogenic Shock
• Occurs during or after a massive heart attack / cardiac arrest.

• The heart is so severely damaged that it fails as a pump to

deliver blood and oxygen to vital organs.

27 First Aid Training Department | St John Brigade

 Cardiogenic Shock
• Casualty will show signs and symptoms of a heart attack.

• Treat the casualty for both a heart attack and shock.

* Refer to Chapter 5.3 Heart Attack for recognition and management of heart attacks
28 First Aid Training Department | St John Brigade
 Shock – Summary

29 First Aid Training Department | St John Brigade

 Summary
• Recognise shock by a fast and weak pulse, confusion
and a possibly history of major bleeding.
• Understand that there are several types of shock –
hypovolemic, anaphylactic, cardiogenic.
• To treat shock, treat the underlying cause and improve
blood supply to the brain.
• All casualties with shock require early evacuation.

30 First Aid Training Department | St John Brigade