LESSON 8

PERFORM FIRST AID TO PREVENT OR CONTROL SHOCK

 

TASK

Identify the procedures for preventing/controlling shock.

CONDITIONS

Given multiple-choice examination items pertaining to shock.

STANDARD

Score 70 or more points on the 100-point written examination.

REFERENCES

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

 

8-1. INTRODUCTION

There are several causes of shock. On the battlefield, hypovolemic (low blood volume) shock will be the primary type of shock present. If not properly treated, shock can result in death.

 

8-2. IDENTIFY THE SIGNS AND SYMPTOMS OF SHOCK

Hypovolemic shock is usually caused by severe bleeding, but it can also be caused by a severe loss of body fluids from other causes such as severe burns (second and third degree burns on 20 percent or more of the body surface), vomiting, diarrhea, and excessive sweating. Other indications of hypovolemic shock include:

Sweaty but cool (clammy) skin, pale skin color, and/or blotchy or bluish skin around the mouth.

Nausea.

Anxiety (casualty restless or agitated).

Change in level of consciousness such as mental confusion.

Increased breathing rate.

Unusual thirst.

 

8-3. POSITION THE CASUALTY TO PREVENT/CONTROL SHOCK

After you restore breathing to the casualty (if needed), control any major bleeding, and dress any major wounds, you must take measures to prevent or control shock. The procedures for preventing shock are basically the same as those for controlling (treating) shock.

a. Normal Shock Position

Move the casualty to cover, if possible.

Position the casualty on his back. If possible, place a poncho or blanket under the casualty to protect him from the temperature or dampness of the ground.

FIGURE 8-1. NORMAL POSITIONING OF CASUALTY TO CONTROL SHOCK

 

Elevate the casualty's legs so that his feet are slightly higher than the level of his heart. (This helps the blood in the veins of his legs to return to his heart.) Place a small log, field pack, box, rolled field jacket, or other stable object under the casualty's feet or ankles in order to maintain the elevation.

 

WARNING

Check for fractures of the lower limbs (Lesson 10) before elevating the legs). Do not elevate the legs until all lower limb fractures have been splinted.

 

b. Shock Positions for Special Injuries

Certain casualties are not placed in the normal position for shock.

Suspected Fracture of the Spine. Do not move a casualty with a suspected spinal fracture unless it is necessary for the safety of the casualty and the rescuers. Do not elevate his legs. Immobilize his head, neck, and back (Lesson 11), if possible.

Open Chest Wound. If the casualty wants to sit up, help him to sit with his back to a wall, tree, or other support. If the casualty wants to lie down, position him so that he is lying on his injured side.

 

WARNING

Check for fractures of the arms and forearms before allowing the casualty to sit up. Check for fractures of the limbs before turning the casualty on his side.

 

Open Abdominal Wound. Keep the casualty on his back with his knees flexed.

Head Wound. Treat a severe head wound as though a spinal injury is present. A casualty with a minor head wound should be allowed to sit up. If the casualty has bleeding into the mouth or if he does not want to sit up, position him on his side with his wound up and his head turned so that fluid can drain from his mouth.

Unconsciousness. Position an unconscious casualty on his side with his head turned so fluids can drain from his mouth. If the casualty vomits, quickly perform a finger sweep to clear his airway.

 

8-4. TAKE ADDITIONAL MEASURES TO PREVENT/CONTROL SHOCK

a. Reassure the Casualty

Keep the casualty calm. Tell the casualty that you are helping him. Be confident in your ability to help the casualty and have a "take charge" attitude. Your words and actions can do much to reassure the casualty and reduce his anxiety. Be careful of any comments you make regarding the casualty's condition.

b. Loosen the Casualty's Clothing

Loosen any binding clothing, including boots. Tight clothing can interfere with blood circulation.

WARNING

Do not loosen or remove the casualty's clothing in a chemical environment.

 

c. Keep the Casualty From Being Too Warm or Too Cool

In warm weather, keep the casualty in the shade. If natural shade is not available, erect an improvised shade using a poncho and sticks or other available materials. Fan him if needed. Fanning promotes the evaporation of perspiration and cools the casualty.

In cool weather, cover the casualty with a blanket, poncho, or other available materials to keep him warm and dry. Place covering under the casualty to prevent chilling due to contact with cold or wet ground.


FIGURE 8-2. CASUALTY BEING TREATED FOR SHOCK

IN COOL WEATHER

 

d. Seek Help or Evacuate Casualty

If the casualty is showing signs and symptoms of hypovolemic shock, he needs more fluid in his blood circulatory system. Fluid volume can be increased by putting fluids into the casualty's veins [administering an intravenous infusion (I.V.)] to replace lost body fluids. A combat lifesaver or combat medic can administer fluids intravenously. Do not give a casualty in shock anything to eat or drink.

If you leave the casualty alone in order to get help, tell him you are going to get medical help and will return. Turn the casualty's head to one side before you leave. This will help to keep the casualty from choking should he vomit.

If additional help is not available, evacuate the casualty if practical.