6.3 First aid interventions for shock management

Shock can be life-threatening, requiring quick action. First aid for shock focuses on positioning the patient, controlling bleeding, and maintaining body temperature. These interventions aim to improve circulation and prevent further deterioration.

Monitoring vital signs and providing reassurance are crucial. Treating the underlying cause, if possible, and activating emergency services promptly are essential steps. Remember, early recognition and intervention can significantly improve outcomes for shock patients.

Positioning and Comfort

Patient Positioning

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• Position the patient in a comfortable position that allows for optimal circulation and breathing, often with the head slightly lower than the feet
• Place the patient in the Trendelenburg position by elevating the feet and legs 8-12 inches above the level of the heart using a pillow or blanket, which helps increase blood flow to the brain and heart
• Avoid laying the patient completely flat as this can worsen breathing difficulties and cause the patient to feel more anxious or restless

Maintaining Body Temperature and Providing Reassurance

• Maintain the patient's normal body temperature by covering them with a blanket or coat to prevent heat loss and further decline in circulation
• Remove any wet clothing and replace with dry, warm coverings (blankets, coats) to prevent hypothermia, which can worsen shock
• Provide reassurance to the patient by speaking calmly, explaining what is happening and what you are doing to help, and staying with them until emergency medical services arrive, as this can help reduce anxiety and stress

Bleeding Control and Resuscitation

Controlling Bleeding

• Control any external bleeding by applying direct pressure to the wound using a clean cloth or dressing and elevating the affected limb above the level of the heart
• If bleeding is severe or not controlled by direct pressure, apply a tourniquet proximal to the wound (between the wound and the heart) and tighten until bleeding stops
• Monitor for signs of internal bleeding such as bruising, swelling, or tenderness in the abdomen or chest, and report any findings to emergency medical services

Oxygen Administration and Fluid Resuscitation

• Administer supplemental oxygen if available using a non-rebreather mask at 10-15 liters per minute to improve oxygenation and tissue perfusion
• If the patient is conscious and able to swallow, provide small sips of water or an electrolyte solution (sports drink) to help maintain fluid balance and prevent dehydration
• Avoid giving the patient anything by mouth if they are unconscious, have a decreased level of consciousness, or are likely to need surgery, as this can increase the risk of aspiration

Monitoring and Treatment

Monitoring Vital Signs

• Monitor the patient's vital signs every 5-10 minutes including blood pressure, heart rate, respiratory rate, and level of consciousness
• Report any changes in vital signs or patient condition to emergency medical services, as this can indicate worsening shock or development of complications
• Keep a record of the patient's vital signs and any interventions provided to assist with ongoing care and treatment

Treating the Underlying Cause and Activating Emergency Medical Services

• Identify and treat any underlying causes of shock if possible, such as providing epinephrine for anaphylaxis or glucose for hypoglycemia
• If the underlying cause cannot be identified or treated, focus on supportive care measures such as positioning, oxygen administration, and fluid resuscitation until emergency medical services arrive
• Call for emergency medical services (911) immediately if shock is suspected, and provide a clear and concise report of the patient's condition, vital signs, and any interventions provided