LESSON 11
PERFORM FIRST AID TO PREVENT OR CONTROL SHOCK
(TASK 081-831-1005)

TASK:

Identify the procedures for preventing/controlling shock.

CONDITIONS:

Given multiple-choice examination items pertaining to shock.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCES:

NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.

11-1. INTRODUCTION

Shock occurs when the tissues or organs of the body do not receive enough oxygen and nutrients from the blood circulatory system. There are several causes of shock. On the battlefield, low blood volume (hypovolemic) shock will be the primary type of shock treated by buddy-aid. Hypovolemic shock is usually caused by severe bleeding, but it can also be caused by a severe loss of body fluids from other causes (vomiting, diarrhea, excessive sweating, severe burns, etc.). Other types of shock can be caused by infections; by allergic reactions to drugs, food, or insect bites; and by heart failure. Shock, if not properly treated, can result in death.

When treating a casualty , assume that shock is present or will occur shortly. By waiting until actual signs/symptoms of shock are noticeable, the rescuer may jeopardize the casualty's life.

11-2. IDENTIFY THE SIGNS AND SYMPTOMS OF SHOCK

Signs and symptoms of shock include the following:

Sweaty but cool (clammy) skin.

Pale skin color.

Blotchy or bluish skin, especially around the mouth.

Rapid or severe bleeding.

Nausea/vomiting.

Anxiety. (Anxiety causes the heart to beat faster, thus increasing the rate of blood circulation and the rate of blood loss. Anxiety can increase as the casualty's condition worsens. He may become restless, agitated, and may even become violent and fight the people around him.)

Mental confusion. (Mental confusion is especially dangerous because the casualty may not comprehend his surroundings and may expose himself and others to danger needlessly.)

Increased breathing rate.

Unusual thirst.

11-3. POSITION THE CASUALTY TO PREVENT/CONTROL SHOCK

Shock is a life-threatening condition. Once you have ensured that the casualty is breathing and have controlled any major bleeding, dressed any major wounds, and splinted any major fractures, you must take measures to prevent shock if it is not present or to control shock if it is present. The procedures for preventing shock are the same as the procedures for controlling (treating) shock.

Normal Shock Position

Most casualties should be placed in the normal shock position described below.

FIGURE 11-1. NORMAL POSITIONING OF CASUALTY TO CONTROL SHOCK

Move the casualty to cover if it is available and the situation permits.

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.

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.

Shock Positions for Special Injuries

Certain casualties are not placed in the normal position for shock. Proper positioning of casualties with special injuries is discussed below.

Suspected Fracture of the Spine. Do not move a casualty with a suspected spinal fracture. Do not elevate his legs. Immobilize his head, neck, and back if possible.

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

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

Heart Attack. Allow the casualty to sit up with his back to a wall or other support if he wants to do so. Otherwise, position the casualty on his side.

Head Wound. Treat a major head wound as though a spinal injury is present. A casualty with a minor head wound should be allowed to sit up if there is no bleeding into the mouth. If the casualty has bleeding into the mouth or if he does not want to sit up, position him on his side with his head turned so that the blood can drain from his mouth. Position him with his wound up.

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

FIGURE 11-2. UNCONSCIOUS CASUALTY POSITIONED ON HIS SIDE

11-4. TAKE ADDITIONAL MEASURES TO PREVENT/CONTROL SHOCK

Additional actions for preventing or controlling hypovolemic shock are given below.

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 that you make regarding the casualty's condition since unguarded comments could increase the casualty's anxiety.

Loosen the Casualty's Clothing

Loosen the casualty's clothing at his neck, waist, feet, or anywhere that it may be binding. Tight clothing can interfere with blood circulation.

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 cover under the casualty to prevent chilling due to contact with cold or wet ground. (Note: Dress and bandage any serious burns before covering them.)

FIGURE 11-3. CASUALTY BEING TREATED FOR SHOCK IN COOL WEATHER

Seek Aid

Send another person to get a combat medic or combat lifesaver. If you cannot send someone, complete your treatment of the casualty. If you must go to get help (casualty cannot be moved due to a spinal injury, for example), reassure the casualty by telling him that you are going to get medical aid and will return. Turn the casualty's head to one side before you leave. This will help to keep the casualty from choking on his own vomitus should he vomit. Do not give the casualty food or water.

Evacuate the Casualty

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