Treating for Shock Information for Paddlers

DISCLAIMER: The following information is not intended, nor should it be assumed to be, a substitute for formal training in First Aid treatment and procedures. This information is presented to raise awareness of some medical conditions which can arise on canoeing, camping or hiking trips so that participants may better prepare themselves for all eventualities. The information presented is not intended to replace advice or instructions given by trained professional medical personnel. Information herein is gleened from various professional medical resources including the US Navy On-line Hospital web site, the American Red Cross web site and other reliable resources. It must be realized that improper or inadequate treatment of injuries can result in damages that sometimes are greater than doing nothing at all. Whenever possible and practical the assistance of trained, professional medical personnel should be summoned to administer treatment for serious injuries. The nature of outdoor recreation is such that injuries sometimes occur in remote areas far from available professional assistance. The information in this section is intended to be a helpful guide for treatment of injuries in such cases when getting professional help is not immediate and the nature of the injuries requires prompt attention. Marc McCord is not a trained medical practitioner, and makes no claim of expertise in treatment of injuries. Marc McCord and Southwest Paddler are not responsible for improper treatment of injuries and resulting damages that may occur.DISCLAIMER: The following information is not intended, nor should it be assumed to be, a substitute for formal training in First Aid treatment and procedures. This information is presented to raise awareness of some medical conditions which can arise on canoeing, camping or hiking trips so that participants may better prepare themselves for all eventualities. The information presented is not intended to replace advice or instructions given by trained professional medical personnel.

Shock occurs whenever the heart and blood vessels fail to supply an adequate amount of oxygen-rich bllod to the other vital organs of the body. Studies have shown that there is some degree of shock in almost every illness or injury.Shock can be life-threatening, and left untreated (or mistreated) it can cause death. Depending upon the nature and severity of illnesses or injuries one sustains shock will have varying symptoms and effects, some of which will appear immediately and others that may be delayed by several hours.

There are four basic types of shock that the body may endure - hypovolemic, neurogenic, psychogenic and anaphylactic, each brought on by differing circumstances and resulting in different effects on the body. Hypovolemic shock is the result of fluid and/or blood losses resulting from internal or external bleeding, dehydration caused by diarrhea and vomiting, or burn-induced fluid losses. Neurogenic shock is caused by abnormal enlargement of blood vessels and the pooling of blood such that adequate blood flow ceases, as in the case of fainting caused by standing up too quickly, resulting in a loss of blood flow to the brain. Psychogenic shock is the type known commonly as "a state of shock", and may be induced by excessive grief, joy, anger, fear or other excitable emotions. Shell shock, such as soldiers suffer during wartime, is a form of psychogenic shock. Anaphylactic shock, also referred to as "toxic shock", is the result of exposure to substances to which the body is allergic or sensitive. Some examples of anaphylactic shock include injections of some medicines, venoms from snake and insect bites, inhalation of mold, pollen and dust particles and the ingestion of some foods and medicines, rsulting in symptoms that may include loss of voice control, hives, itching, a burning sensation, breathing difficulties, severe swelling or other allergic reactions.

Common signs of shock may include one or more of the following symptoms:

1. Anxiety, restlessness or fainting;
2. Nausea and vomiting;
3. Excessive thirst;
4. Eyes with dilated pupils that do not seem to focus on anything, as if staring blankly into outer space;
5. Shallow, rapid and irregular breating, possibly leading to hyperventilation;
6. Clammy, cold, pale, pasty skin;
7. A rapid, weak or absent pulse.
Shock is a serious medical condition that must be treated immediately to prevent a fatality. It is very important for the person or persons providing treatment, and anybody else around the victim, to remain cool, calm and collected! Time is critical, and the victim must not see excessive concern from those nearby to prevent his or her overreaction that worsens the problem. If there is anybody nearby who loses their composure, then remove them from the vicinity of the victim at once and keep them away. If the onset of shock is present, but a shock condition has not yet developed, then the quick and proper First Aid treatment may prevent shock from occurring. If shock has already developed, then the quick and proper First Aid treatment may reduce the symptoms and prevent a fatality.

If a shock condition occurs, then these actions should be taken immediately:

1. Place the victim on his or her back and elevate the legs about 6-12 inches to keep blood flowing to the brain. If the victim is vomiting or bleeding from the mouth, then place him or her on their side, or place them on their back with the head turned to one side to expel the vomit or blood and prevent choking. If a head or neck injury is known or suspected, then keep the victim lying flat on their back and still;
2.Remove any unnecessary and/or hysterical people as far away from the victim as possible;
3. Use a head tilt, chin lift or jaw thrust to maintain an open airway for breathing;
4. Using either direct pressure, elevation, indirect pressure or a tourniquet, as required by the circumstances, control any bleeding that may be occurring;
5. Splint any broken bones to relieve pain and prevent further injury;
6. Make the victim as comfortable as possible, and try to maintain a normal (98.6° F) body temperature. If possible, remove any wet or restrictive clothing, and place blankets or other padding under the victim. Cover the victim with blankets, if necessary, to maintain normal body temperature. Use NO artificial means to warm the shock victim's body;
7. Keep the victim calm and as comfortable as possible. Do not allow the victim to see his or her injuries. Avoid any excitement of the victim or anybody else nearby. Avoid excessive handling, as that may aggrevate the problem leading to more serious complications. Make sure the victim knows that somebody is already calling for professional medical assistance, and that it is actually being done by somebody who can provide a clear and concise description of the problems as well as giving directions to where the victim is located;
8. Administer mouth-to-mouth resuscitation, if necessary;
9. Do NOT give a shock victim ANY food or drink. If the victim indicates thirst, then wet a towel and use it to wet his or her lips;
10. Have somebody with leadership and organizational skills working to organize the group, gear and boats, and begin making preparations for whatever actions must be taken next, including transportation of the victim if in a remote area where professional medical assistance will not be readily available.

As always, advance preparations will minimize confusion at a time when treatment for shock is necessary. Planning trips in advance, and having assigned responsibilities in the event of an emergency, with a primary lead person and a backup in the event the lead person becomes the victim, will require a lot of logistical and preliminary preparation, and may not be needed. However, in the event it is needed, advance preparation will increase efficiency and give members of a group a pre-determined sequence of actions that will divert their attention away from the victim and toward helping prepare for whatever must be done after First Aid has been administered. Just as with Swiftwater Rescue Training, the practices of First Aid need to be formally acquired and rehearsed periodically. Doing so may save a life!