Shock is a constitutional state characterized by lowered blood pressure due to vaso-motor paralysis. Peripheral impulses traveling along the afferent nerves reach the spinal cord and overwhelm those centers which regulate the blood pressure. In practice, the term “shock” includes the complex of symptoms arising from the vaso-motor paralysis, hemorrhage, mechanical interference with circulation and respiration, and beginning infection. Tt may not be possible to analyze the symptoms, determining the part played by each of these various conditions, nor is it necessary to do so. Nevertheless, the proper understanding of shock as a separate entity is essential in emergency surgery next to akill in hemostasis.
<Callout type="important" title="Key Symptoms">Thirst, pallor, subnormal temperature, shallow breathing, frequent sighing or yawning, rapid pulse, relaxed sphincters, faintness, nausea or vomiting, and unconsciousness are common symptoms.</Callout>
Crushing injuries with mangled nerves sending impulses to the exhausted vaso-motor centers furnish a means of fatal shock. Railroad accidents as a means of producing such severe symptoms of shock, for violent emotions even without injury may be followed by vasomotor paralysis.
Certain tissues resent insult more than others, Those which line the body cavities are most sensitive with respect to injury; the peritoneum, the pleura, the dura, and the synovial membranes of the large joints. This is true whether the trauma be accidental or operative.
The diagnosis of shock as distinct from hemorrhage and collapse cannot always be made with certainty. As Waite says, the diagnosis of shock is simply the recognition of the clinical phenomena, for we have no chemical or pathological findings to aid us.
In many instances it may be differentiated from collapse by the history of the case. In collapse the heart action is slow and feeble, whereas in shock it is rapid and feeble. In hemorrhage the symptoms may be rapidly progressive, but in uncomplicated shock the symptoms are stationary or improve. Observe, therefore, the action of the pulse and the movement of the temperature. In hemorrhage the temperature falls and the pulse rate increases. In shock the pulse becomes gradually slower; the temperature gradually rises.
<Callout type="risk" title="Symptom Aggravation">Any aggravation of the symptoms after reaction is once under way never indicates a return of the shock, but points to hemorrhage or infection.</Callout>
The prognosis in severe cases will be for a little time decidedly uncertain. The sufferer from traumatic shock may give the doctor an erroneous notion of the gravity of the case, unless the condition of the pulse is carefully noted; for he may complain of no pain, despite his calamity, discusses the need of operative measures quite coolly and directs the management of his case generally.
<Callout type="tip" title="Treatment Tips">Adrenalin chloride is the most generally useful substance to raise blood pressure in shock pure and simple. Given hypodermically or intravenously, it very seldom completely fails.</Callout>
Crile was enabled by means of intravenous infusion of adrenalin and salt solution, combined with artificial respiration and thoracic pressure, to arouse a human heart after it had ceased to beat for nine minutes, and its action was thus sustained for one-half hour.
It must be given in small doses, frequently repeated. The effects are powerful but fleeting. Hypodermically, give 5 to 10 minims of the 1/1000 adrenalin solution and repeat every 20 or 30 minutes. In intravenous infusion is even more satisfactory and certain. Give continuous infusion of adrenalin salt solution until there are signs of reaction.
Normal salt solution alone is effective within certain limits, but finds its greatest field of usefulness in shock coexistent with infection. In shock uncomplicated by extensive loss of blood, the saline solution must be used sparingly, perhaps better by enema or by being injected intravenously in large quantities, it may eventually defeat an end for which it is employed by acting as a mechanical obstruction to respiration.
For technic of intravenous infusion, see page 56. Crile’s pneumatic suit seems to be entirely trustworthy as a means of raising blood pressure; but, of course, cannot be used in the shock occurring in emergency practice.
The prevention of shock is always something to be considered in operative work. Morphia, 1/4 grain hypodermically, before the anesthesia, is a real aid. Blocking the nerves by cocaine injections above the site of operation is likewise advantageous and is recommended by Cushing and Crile. The nerve may be exposed in its course under local anesthesia and in turn injected.
In abdominal work the viscera must be handled with care; for, as Byron Robinson has shown, shock from this source is directly proportional to the amount of manipulation or traction upon the viscera.
Key Takeaways
- Recognize symptoms such as pallor, rapid pulse, and unconsciousness
- Use adrenalin chloride for shock treatment
- Monitor the patient's temperature and pulse
Practical Tips
- Always keep a supply of adrenalin chloride on hand in case of emergencies.
- Maintain body warmth to help stabilize the patient during shock.
- Be cautious when handling internal organs to prevent additional trauma.
Warnings & Risks
- Do not overuse normal salt solution, as it can interfere with breathing.
- Be aware that symptoms may worsen after initial improvement in shock cases.
- Avoid unnecessary operations until the patient's condition improves.
Modern Application
While the techniques described here are rooted in historical practices, understanding shock and its treatment remains crucial for modern survival preparedness. The principles of recognizing symptoms and using adrenalin chloride still apply, but modern medical equipment and protocols offer more precise and safer methods.
Frequently Asked Questions
Q: What are the key symptoms to look for when diagnosing shock?
Key symptoms include thirst, pallor, subnormal temperature, shallow breathing, frequent sighing or yawning, rapid pulse, relaxed sphincters, faintness, nausea or vomiting, and unconsciousness. These can vary in severity from slight manifestations to life-threatening conditions.
Q: How should adrenalin chloride be administered for shock treatment?
Adrenalin chloride can be given hypodermically with 5 to 10 minims of the 1/1000 solution every 20 or 30 minutes. For intravenous infusion, use one teaspoonful of 1-1000 adrenalin added to one quart of normal salt solution.
Q: What precautions should be taken during abdominal surgery to prevent shock?
Viscera must be handled with care to minimize manipulation and traction. Cocaine injections above the site of operation can help block nerves, reducing vasomotor paralysis risk.