Shock is a very common feature of an infarct, and all degrees may occur. It may be mild and fairly transient in minor infarcts. Or it may be very severe and prolonged.
Simple shock may develop into cardiac shock, which is even more serious and ominous in total outlook.
The common symptoms of shock include a feeling of weakness and dizziness, and the patient may actually faint. Sweating and vomiting may occur. The appearance may be similar to a person in an ordinary faint.
But it may be more marked and more serious. The skin may appear to be pale, cold and clammy. The face is pale, drawn and anxious, and the skin assumes a transparent quality. Or there may be a bluish tinge, as inadequate oxygen is reaching the skin and extremities. But throughout all this, the mental alertness of patients is often surprisingly clear, and they may be well aware of what is taking place around them.
This state of shock may be transient. or more seriously it may persist for hours or even days. The longer it persists, the more critical the implications. With true cardiac shock that persists, the outcome can be very serious, and often death will follow.
As the state of shock passes off, patients will notice a reduction of the pain: they might brighten perceptibly, or indications of heart failure may put in an appearance.
Shock may be a serious condition, indicating a sudden reduction of the blood pressure and a depression of all vital centres, causing weakness, subnormal temperature, sweating and apathy. The skin is pale and cold, the pulse weak and rapid, and the patient may be restless and agitated. He or she may be able to think clearly, but may lie quite still. The immediate causes are usually severe external injuries and internal trauma to major organs. Haemorrhage, crushing injuries and burning are important factors.
These produce loss of fluid, and the amount of circulating blood suddenly lessens. Pain can aggravate the situation. Other important causes include serious conditions such as perforation of the gut, peritonitis, severe diarrhoea and vomiting, overwhelming infections, massive pulmonary embolism or damage to the heart (as by cardiac infarction).
1. Patiem may feel light-headed, giddy or faint.
2. Nausea or votniting may be present. May feel thirsty.
3. Skin becomes cold, pale and clammy.
4. Pulse is slowly becomes rapid and weak. Breathing is weak and shallow.
h. There may be dullness of mentality, which can lapse into unconsciousness. The conditions causing the shock are usually present, and must be .treated if applicable.
Shock is a medical emergency, and treatment must be commenced as early as possible. This is best carried out in a hospital geared to cope with these emergencies. Haemorrhage must be stopped immediately, and blood replacement given by blood transfusion, or by some other replacement fluid if this is not available. In some instances hydrocortisone is given, and appears to be helpful. The patient is kept warm, but not hot.
First-aid treatment that may be given by the casual bystander, pending professional assistance, includes:
• Make certain there is an adequate airway and plenty of fresh air.
• Control haemorrhage as a matter of urgency.
• Ensure maximum blood to the brain by lowering the head and elevating the lower limbs.
• Do not heat the patient, but prevent shivering by use of a blanket or other suitable covering.
• Endeavour to prevent fluid loss through sweating by protecting the patient from evaporation.
• Endeavour to relieve pain by covering wounds, splinting fractures, elevating injured parts and resting them. Handle gently at all times.
• Remain calm, and do not panic or rush. Take your time, but operate efficiently, calmly: and .effectively.
• Make certain air passages are clear. Remove any obstruction if present. Resuscitate if necessary,
• Control bleeding if this is occurring, (See Haemorrhage.)
• Ensure maximum blood supply to centres (heart and brain). Elevate legs on cushions, or some other form of comfortable support if there are no fractures.
• Prevent shivering, but do not overheat. Cover with blanket or rug if cool day.
• Speak encouragingly; This is for the patient already feels poorly, and positive words of encouragement can have a remarkable psychological benefit. Get to emergency medical attention as soon as possible keeping patient comfortable and moving as little as necessary.