Shock is a life-threatening medical condition that can occur after a serious physical injury, illness, or allergic reaction. When a person goes into shock, it means their circulatory system is failing and vital organs are not getting enough oxygen and nutrients due to dangerously low blood pressure.
Shock is a true medical emergency requiring hospital treatment. But in a remote setting away from advanced medical care, understanding how to recognize shock, provide emergency first aid, and take steps to prevent shock can help save lives. This comprehensive guide covers everything you need to know about responding to shock in the wilderness until emergency personnel can take over care.
What is Shock?
To understand why shock is so dangerous, it helps to first understand what shock is, what causes it, and how it impacts the body.
What Happens During Shock
Shock occurs when the circulatory system cannot supply enough oxygenated blood to the body’s major organ systems. Normal blood circulation delivers oxygen and nutrients to the tissues and transports carbon dioxide and waste away from cells.
When the circulation system fails, oxygen and nutrient deprivation causes the body’s organs to begin shutting down. The longer this deprivation goes on, the higher the risk of permanent damage or death.
Shock involves complex changes in the body including:
- Severely slowed blood flow due to low blood volume and/or reduced pumping heart function
- Blood vessels expanding and becoming “leaky”, leading to further blood volume loss
- Not enough blood returning to the heart after circulation
- Vital organs and tissues not getting the constant oxygen and nutrients they need
Major Causes of Shock
There are a variety of situations that can progress to shock, with the common cause being a significant reduction of oxygen-rich blood circulating to meet the body’s demands. Major triggers include:
This is shock caused by severe blood or fluid loss. Losing around 20% or more of the body’s normal blood/fluid volume can put a person into hypovolemic shock. Causes include:
- Major external or internal bleeding from traumatic injuries
- Severe burns with extreme fluid and plasma loss
- Dehydration from intense vomiting/diarrhea illness
- Severe fluid loss from diabetes, kidney disorders, or certain medications
This type of shock is caused by the heart being unable to pump enough blood to meet the body’s circulation needs. Heart problems that can impair its pumping ability include:
- Heart attack damaging heart muscle
- Heart infections like myocarditis
- Abnormal heart rhythms like ventricular tachycardia
- Blood clots in the lungs putting strain on the heart
- Heart valve disorders
- Cardiomyopathy causing heart muscle weakness
This is shock induced by an aggressive widespread infection in the body that triggers systemic inflammation and crashes blood pressure. Sources include:
- Bacterial infection spreading in the bloodstream
- Abdominal infection spilling into abdominal cavity
- Pneumonia spreading from lungs to blood
- Kidney infection becoming urosepsis
- Wound infection becoming necrotizing fasciitis
This type of shock is caused by damage to the nervous system that impairs the body’s ability to control blood vessel constriction and blood pressure. Causes include:
- Spinal cord injury disrupting nerve signals
- Brain trauma or stroke affecting regulation
- Severe reaction to spinal or epidural anesthesia
- Nervous system infections like meningitis
This is shock induced by a severe allergic reaction to a food, medication, insect sting, or other allergen. Anaphylaxis causes blood pressure to plummet and severely constricts breathing.
How Shock Impacts the Body
No matter the cause, the hallmark symptom of shock is a dangerous drop in blood pressure that reduces circulation. Here’s a breakdown of how this disrupted circulation impacts the body:
- Brain: Lack of oxygenated blood can cause lightheadedness, confusion, loss of consciousness, seizures, coma and eventual death of brain cells.
- Heart: Deprived of oxygen, the heart muscle attempts to pump faster to increase blood flow. The heart can be permanently damaged.
- Lungs: Low blood flow causes fast, shallow breathing as the body tries to increase oxygen intake. Fluid can build up in lungs.
- Kidneys: The kidneys shut down without sufficient blood flow, causing organ failure. Toxins build up in the body.
- Digestive tract: Blood flow is shunted away from the intestines, causing nausea/vomiting along with paralysis and tissue death in the gut if severe.
- Skin: Pale, clammy, cool skin results from restricted peripheral blood flow. Delayed capillary refill occurs.
Rapid treatment is critical to prevent organ failure and death once shock has set in. Recognizing shock quickly and immediately taking action to improve circulation is vital.
Recognizing the Signs and Symptoms of Shock
Being able to accurately identify when a person is going into shock means intervention can begin right away to try to stabilize them before their condition worsens.
Here are the most common signs and symptoms of shock to look for:
1. Low Blood Pressure
The clearest sign of shock is a dangerously low blood pressure reading. Blood pressure is the force of blood pushing against the walls of arteries as the heart pumps it through the circulatory system.
Normal blood pressure in adults is less than 120 systolic (top number) and less than 80 diastolic (bottom number), typically expressed as 120/80 mm Hg.
In shock, significantly reduced pumping function and blood volume lead to plummeting blood pressure below what’s required for adequate circulation.
While a specific blood pressure threshold for shock varies by age and normal baseline, general diagnostic guidelines are:
- Adults: systolic (top number) blood pressure less than 90 mm Hg.
- Children over 10 years old: systolic less than 70 mm Hg.
- Children 1 to 10 years old: systolic less than 70 + (2 x age in years) mm Hg.
So for a 5 year old child for example, a systolic pressure less than 80 mm Hg (70 + 2×5=80) could indicate shock.
Checking blood pressure should be a priority if shock is suspected. Use a BP cuff if available. Compare to normal baseline if known.
2. Rapid Heart Rate
With blood pressure falling, the body tries to compensate by increasing the heart rate to pump more blood.
This surge in heart rate – called tachycardia – is the body’s attempt to increase circulation. But the heart can only increase pumping so much.
A heart rate over 100 beats per minute typically indicates shock in adults. Heart rate also increases by age in children – counting beats for 15 seconds and multiplying by 4 can compare to normal ranges.
Along with a fast heart rate, the pulse often feels weak or “thready” in shock due to lower blood volume.
3. Rapid, Shallow Breathing
Low oxygenation from poor circulation triggers faster, shallower breaths as the body tries urgently to get more oxygen.
Respiratory rate increases to around 22 breaths/minute or more in adults. Children normally have faster breathing – looking for a rate at least 25% higher than normal could signal shock.
Labored breathing with chest retractions may occur as fluid accumulates in the lungs. Irregular breathing patterns or periods of apnea can result.
4. Clammy, Pale, Cool Skin
Restricted peripheral blood flow and widening of blood vessels cause the skin to become pale, clammy or moist, and feel cool to the touch.
Pressed nail beds and lips will appear white or grey as blood has difficulty returning to capillaries, indicating poor perfusion. This is called delayed capillary refill time – normal is less than 2 seconds.
Mottling with patches of pale skin mixed with areas flushed red can occur as blood flow becomes uneven.
5. Altered Mental Status
Deprived of oxygenated blood, the brain functions suffer – causing changes in consciousness that can progress from anxiety, confusion, and weakness to loss of consciousness and coma.
Disorientation, agitation, inability to focus, and impairment of awareness point to shock. In later stages, seizure, fixed/dilated pupils, and loss of reflexes occur before death.
6. Nausea and Vomiting
The gastrointestinal system receives less blood flow during shock. This can lead to nausea, dry heaves, and vomiting.
7. Profuse Sweating
Unexplained, profuse sweating or moist clammy skin indicates the body is under severe stress.
Look for a combination of these signs when assessing a person for shock, especially after major illness, injury, or anaphylactic reaction. The more symptoms present, the clearer and more severe the shock.
Now let’s look at how to provide emergency first aid care while awaiting professional emergency treatment.
Emergency First Aid for Treating Shock
Shock is a rapidly progressive, deadly condition requiring emergency medical intervention. Call for emergency medical help immediately if possible. Evacuate to advanced medical care ASAP.
But in a remote wilderness setting, it may take time for emergency personnel to reach you and transport to a hospital.
In these scenarios, it’s vital to know how to provide emergency first aid to try to stabilize a shock victim until EMS arrives. Here are the key steps:
Step 1) Check for Immediate Life Threats
- Assess the scene for safety. Is the emergency definitely over – such as the animal that bit them leaving? Are you in a safe position to help?
- Check airway and breathing. Perform rescue breaths or CPR if needed.
- Call for emergency medical help if possible. Get medical help responding.
- Control severe external bleeding with direct pressure on the wounds using thick sterile gauze pads.
Step 2) Have the Person Lie Down – Recovery Position
Gently have the person lie down on their back while minimizing unnecessary movement. Bend their knees with feet flat on the ground.
Raise their legs above heart level 10-12 inches by placing a folded jacket, backpack, rolled up blanket or other substitute under their lower legs and feet. Don’t raise just the knees as this can restrict circulation.
This is called the recovery position – it uses gravity to increase blood flow to the brain and heart while taking pressure off the abdomen. Keep the mouth and nose clear to support breathing.
If they are vomiting or severely short of breath, roll them onto their side while keeping legs elevated.
Step 3) Keep Them Warm
Wrap the person in blankets, sleeping bags, or emergency thermal blankets. This helps hold in body heat and raises low blood pressure.
Put insulation like leaves, towels, jacket, or sleeping pad underneath as well as over them. This shields from cold ground drawing away more heat.
Step 4) Maintain Normal Body Temperature
Monitor their temperature. Chilly or cool skin indicates poor circulation. But don’t overly heat – aim to keep their temp around 98-99°F to avoid putting more strain on the heart.
Place hot water bottles, heated stones wrapped in cloth, or chemical hot packs near the groin/armpits or sides of chest. You can also tuck these by ankles and wrists. Avoid direct contact with skin to prevent burns.
Step 5) Give Fluids If Able to Swallow
If the person is fully conscious, not nauseous, and able to swallow, small sips of water or electrolyte sports drinks can help improve blood volume unless they have a significant abdominal injury, vomiting, or head/spine trauma.
Avoid giving fluid to anyone with an altered mental status – they could aspirate it into their lungs. Don’t give fluids if nausea and vomiting are present.
Even 250-500 mL can help – give gradually in small amounts. Cool but not ice cold fluid may be best tolerated. Monitor for worsening nausea or breathing issues.
Step 6) Keep the Person Calm and Minimize Movement
Continue monitoring their vital signs. Reassure them help is on the way and encourage steady relaxed breathing. Have them avoid any exertion or unnecessary movement which uses oxygen and energy reserves.
Step 7) Stay Vigilant for Breathing Problems
Watch closely for signs of worsening respiratory distress or impaired breathing as shock progresses – this can lead to death rapidly.
If they lose consciousness, be prepared to immediately start rescue breathing or CPR. Update EMS on any change in vital signs or level of consciousness when contacted.
Step 8) Don’t Give Food or Medications
Avoid giving anything by mouth except small sips of fluid as above. Don’t give any drugs or remedies. Medicating could interfere with emergency treatment.
An exception would be if they carry a prescribed emergency medication for a specific condition like an epinephrine auto-injector for anaphylaxis. Glucagon for hypoglycemia or nitroglycerin for heart related chest pain may also be indicated.
Step 9) Expect Deterioration and Watch for Complications
Even with first aid, their condition will likely decline without medical treatment. Monitor for seizure, vomiting/choking, or loss of pulse/breathing indicating impending cardiac arrest. Be ready to act.
Complications like organ failure, cardiac arrhythmia, respiratory arrest, pulmonary edema, and sepsis can develop rapidly. Stay vigilant.
Follow these steps until emergency personnel can take over care and arrange urgent transport to a hospital setting. Evacuate the person ASAP once stabilized. Prompt emergency room treatment is vital to stop shock before permanent disability or death.
Now let’s look at ways to try to prevent shock situations when venturing into the wilderness.
Preventing Shock in the Wilderness
Many cases of shock can’t be fully prevented. But there are important precautions you can take to reduce the likelihood of experiencing shock from trauma, illness, or allergic reactions during wilderness activities.
Carry a Well-Stocked Wilderness First Aid Kit
Having the right tools and supplies with you allows prompt treatment of many conditions before they progress to shock. Consider carrying:
- Sterile gauze pads – control severe bleeding by applying direct pressure
- Roller bandages – secure dressings in place
- Adhesive bandages – close small wounds
- Butterfly bandages or steri-strips – help close large wounds
- Medical tape and elastic wraps – secure dressings and stabilize injuries
- Tourniquet – only for life-threatening bleeding not controlled with direct pressure
- Hand sanitizer and latex gloves – keep hands clean when treating others
- Tweezers – remove debris from wounds
- Scissors – cut away clothing from injuries
- Safety pins – secure loose bandages
- Sewing needle – remove splinters
- Thermal blankets – retain body heat
- Instant chemical hot packs – help stabilize body temperature
- Epinephrine auto-injector if prescribed for severe allergies
- Nitroglycerin for chest pain if previously prescribed
- Glucagon injection kits for severe hypoglycemia if diabetic
Quick energy foods
- Glucose tablets, hard candies, electrolyte/sports drinks – boost blood sugar if feeling faint, dizzy, or weak
Make sure all medications are current and stored properly. Restock any used items after each trip. Get training in proper use of all items.
Prevent Dehydration and Overheating
Dehydration from failing to drink enough fluids is a major contributor to hypovolemic shock. Overheating places additional strain on circulation. Prevent these by:
- Drinking plenty of water before, during, and after activities. Carry more water than you think you need.
- Taking frequent cooling and rehydrating breaks in shade. Drink even when not thirsty.
- Avoiding strenuous exercise in high heat indexes or at high altitudes.
- Monitoring for early signs of dehydration like fatigue, headache, and decreased urination. Treat mild symptoms with fluid/electrolytes before they worsen.
- Wearing breathable, loose fitting, light colored clothing that allows sweat evaporation and ventilation.
- Using cooling gear like sweat-wicking clothes, cooling towels/caps, and spray bottles.
Use Proper Safety Precautions for the Environment
Many cases of shock follow traumatic injuries that could potentially have been prevented with better safety:
- Research the area, trails, weather, and potential hazards. Gauge your skill level honestly and don’t take unnecessary risks.
- Tell someone your plans including precise location, route, expected return time, and means to call for help if overdue.
- Stay on marked trails. Follow warning signs and posted rules. Avoid going out alone.
- Bring maps, compass, GPS devices, charged cell phone, and signaling devices like a whistle, signal mirror, or personal locator beacon.
- Prepare for emergencies by packing adequate food, water, first aid supplies, fire-starting ability, and emergency shelter.
Get Wilderness First Aid Training
Take a wilderness first aid class from a provider like the American Red Cross, National Outdoor Leadership School (NOLS), or SOLO. You’ll learn:
- How to assess scene/patient and recognize medical emergencies
- Lifesaving skills like CPR, rescue breathing, bleeding control
- How to monitor vital signs
- Treating shock, allergic reactions, and other conditions
- Moving/stabilizing injured patients for transport
- Improvised splints/stretchers from gear
- Signaling rescuers
This knowledge could make the difference in saving someone’s life in a delayed care situation until EMTs arrive.
Know Underlying Health Conditions
Be aware of any members of your group who may have chronic medical conditions or prior injuries/illnesses that could increase susceptibility to shock, such as:
- Cardiac problems that could trigger cardiogenic shock with overexertion
- History of anaphylaxis putting them at higher risk
- Dehydration risk from diabetes mellitus or kidney disease
- Higher bleeding risks due to blood thinners or hemophilia
For those with significant medical conditions, additional precautions include:
- Carrying emergency medications like nitroglycerin tablets, inhalers, or EpiPens. Know correct administration.
- Avoiding triggers like food allergens, extreme temperatures, high altitudes, or heavy exertion beyond limits.
- Closely monitoring for signs of symptoms escalating – treat issues early before they worsen.
- Having companions know about their conditions and how to respond in an emergency.
- Wearing medical alert jewelry describing conditions, medications, and emergency contacts.
- Checking in with doctors prior to trips to address any concerns and have conditions well-controlled.
Prepare for Anaphylactic Emergencies
For wilderness goers at risk for severe, life-threatening allergic reactions (anaphylaxis), preparation is key. Steps include:
- Having injectable epinephrine (EpiPens) on hand at all times and ensuring companions know how to administer it in an emergency. Carry multiple doses in case additional shots are needed.
- Avoiding contact with known allergen triggers as much as possible – e.g. peanuts, bee stings, certain medications.
- Wearing a medical identification bracelet or necklace describing allergy risks.
- Learning allergen avoidance and seeking medical care promptly if reactions develop.
- Knowing anaphylaxis signs: skin flushing, swelling/hives, wheezing, severe stomach cramping, heart racing, loss of consciousness indicating shock.
- Carrying antihistamines like Benadryl to slow allergic reactions after epinephrine but not as a sole treatment.
With anaphylactic allergies, avoidance, preparedness with epinephrine, and urgent treatment of reactions are vital to prevent life-threatening shock in the wilderness until emergency care can be reached.
Handle and Prepare Food Safely
Foodborne illness is a common trigger of shock from dehydration, vomiting, diarrhea or infections leading to septic shock. Prevent this by:
- Thoroughly cooking meats, fish, eggs, and dairy. Ensure hot foods stay above 140°F.
- Keeping cold foods chilled below 40°F in coolers or insulated bags.
- Avoiding raw sprouts, unpasteurized dairy/juice, and contaminated water. Filter water.
- Not letting food sit in the “danger zone” between 40-140°F. Keep perishables chilled.
- Washing hands and surfaces often when preparing food.
- Separating raw and cooked foods to avoid cross contamination.
- Packing foods that don’t easily spoil like canned goods, peanut butter, dried fruit/meats.
- Refrigerating leftovers promptly. Use ice to keep coolers cold.
Food safety helps prevent gastrointestinal infections that can progress to severely dehydrating diarrhea, vomiting, and septic shock.
Shock is a complex medical emergency requiring advanced hospital treatment to stabilize low blood pressure and oxygen deprivation before permanent organ damage or death occur. But prompt recognition of shock signs combined with proper emergency first aid can significantly improve survival chances in a remote setting until EMTs arrive. Having the right knowledge, supplies, and emergency action plan allows you to assist a shock victim long enough to get them the care they desperately need – ultimately saving their life.