Episode # 396, Treating Shock In A Pre-hospital Setting"
Today we are going to begin several episodes on prepping skills, starting with some first aid topics.
In our first of the series, we're going to be talking about treating shock.
First, we updated the listeners on Carlee Russell, the 25 year old who was apparently abducted from the interstate in Birmingham, Alabama. She was missing for four days and was returned safe to her parents home Saturday night.
Episode Notes:
Shock is a serious medical condition that requires immediate attention.
It can be caused by a sudden drop in blood pressure, severe dehydration, severe injury, infection, or an allergic reaction.
There are several common types of shock that can occur.
On this episode we are going to discuss two, anaphylactic shock, and hypovolemic shock.
Anaphylactic shock is a severe reaction to some substance causing ttching, rash, swelling, even severe difficulty breathing.
It can be caused by exposure to certain plants, bee stings, or food allergies such as nut allergies.
Treatment:
For mild reactions, with symptoms such as itching, hives, and swelling, antihistamines such as Benadryl, Zyrtec, or Allegra are often effective
Corticosteroids can be effective as well, such as prednisone, and hydrocortisone.
Hydrocortisone cream is particularly effect for topical relief.
We carry both Benadryl & hydrocortisone cream in our bags.
For severe reactions, epinephrine is the primary quick acting medication to be used. It is available in self injector pens. Many who are aware of their sever reactions regularly carry epi pens.
HYPOVOLEMIC SHOCK occurs when the body is not getting enough blood flow, and can lead to damage to multiple organs, and even death
We need to know the common signs and symptoms of shock:
Cool, clammy skin:
This is often pale or gray in color. The skin may also be sweaty or moist.
Rapid or irregular heartbeat:
The heart may beat too fast as it tries to pump more blood to the body's organs.
Rapid breathing:
This is the body's response to a lack of oxygen due to reduced blood flow.
Weak or absent pulse:
Due to reduced blood flow through the body.
Don’t start CPR based on no pulse at the wrist. Check Carotid artery
Dilated pupils:
This is a response to reduced blood flow to the brain.
Confusion or lack of alertness:
This can occur as the brain is deprived of oxygen and nutrients.
Weakness, dizziness or fainting:
This can occur due to a drop in blood pressure.
Low blood pressure:
Particularly from blood loss
Nausea or vomiting:
This can be a response to the body's overall stress.
Thirst:
This can be a response to dehydration, which can occur in shock.
Loss of consciousness:
Again, due to a lack of blood flow to the brain
How should Shock be treated in the field?
Assess the situation and ensure that the person is no longer in immediate danger. If it is safe, treat them where they are. If not, move them to safety, if possible
Then to treat shock we go to the basic ABCs of first aid
Airway
Be sure the airway is open
Breathing
Is the patient breathing?
Circulation
Do they have a pulse? Is blood running out somewhere?
Keep the person lying down and elevate their legs, to improve blood flow to the vital organs.
In hypovolemic shock we must stop the bleeding!
We do that by applying direct pressure to the bleeding. We can use bandages, a clean cloth, even our hand, if necessary.
If it bleeds through the bandages, add more bandages. Do not remove and replace. Add on top of the bandages you already have on the wound.
Hemostatic dressings, or clotting agents, such as QuickClot or Bleed Stop, are designed to control severe bleeding and are particularly useful in trauma situations.
Rolled gauze or a compression bandage can be used to hold the bandages in place, and to continue the pressure on the wound.
Keep the person warm by covering them with a blanket or jacket to prevent further heat loss.
Avoid giving the person anything to eat or drink as they may require surgery.
Using a tourniquet
A tourniquet is the last resort for bleeding from an extremity! It can cause tissue damage, and should not be left in place for an extended period of time.
We stress that a tourniquet is for significant; arterial bleeding that cannot be controlled by any other means. It is for when direct pressure and other methods have failed.
The tourniquet is placed high and tight on the limb, between the wound and the heart, and is tightened until the arterial bleeding stops or there is no pulse at the wrist or foot, depending on whether the tourniquet is placed on the arm or the leg.
There are contraindications, or situations where the use of a tourniquet should not be used.
If there is a distal pulse: it indicates that blood flow is still reaching the extremity.
A tourniquet should not be used for minor bleeding, nor for any non-life-threatening injuries.
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