A person experiences shock when their circulation system fails and major organs and tissues do not receive enough blood (and therefore, oxygen). A common cause of shock is Severe bleeding, including external and internal bleeding. Very serious burns cause leaking of fluids from the blood vessels into the burn and may result in shock. A person experiencing problems with their heart (e.g., a heart attack) may not have enough blood pumped around the body, which may also cause shock. Anaphylaxis is also a cause of shock as the blood vessels dilate which causes low blood pressure. The first aid provider’s priority needs to be on identifying shock and initiating care of the cause if it is evident.
Guidelines
- The person in shock should be placed in a supine position (lying on their back). **
Good practice points
- Emergency medical care should be accessed immediately if it appears the person shows signs of shock.
- As shock is caused by another condition, the first aid provider’s priority should be to identify and manage the cause if possible.
- If a known heart attack is causing shock, a supine position with the upper body slightly elevated should be considered.
- If the person has difficulty breathing or is uncomfortable in lying on their back, they may be placed in the position most comfortable to them, such as sitting while leaning back or leaning forward.
- After the person has been helped to lie on their back, if it makes the person feel better, the first aid provider may raise the person’s legs 30 to 60 degrees (also called passive leg raising), provided they are uninjured.
- First aid providers should prevent heat loss from a person experiencing (or with potential to experience) shock.
Chain of survival behaviours
Prevent and prepare
- If a person is losing a lot of blood, the first aid provider should apply pressure to the Bleeding and keep the person warm. Observe for signs of shock.
- If the person is having a severe allergic reaction, help them to take their medication.
- If the person is having a heart attack access EMS immediately.
Early recognition
Shock, a failure of the circulation system, will be caused by another condition, usually Severe bleeding. Sometimes heart attack (see Chest pain), severe Burns, an infection such as sepsis or a severe Allergic reaction.
In addition to the signs of one of these conditions, the person may also:
- have ashen or pale skin with bluish lips, ears and fingers
- have cool or clammy skin
- sweat and shiver
- feel weak, tired, or dizzy
- have a rapid pulse and breathing
- display an altered mental status (anxious, sleepy).
First aid steps
- Help the person to lay down on their back (or in a comfortable position).
- Provide care for the cause of shock if possible. For example, apply pressure to a severe bleed or help them take their medication if they are having a severe allergic reaction.
- Access EMS immediately.
- Continue to provide care for the cause of the shock if possible.
- Keep the person warm. Cover them with a blanket or clothing and protect them from the ground if it’s cold.
- Reassure the person by talking to them. Monitor their responsiveness and breathing regularly.
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NOTE
- If the person is unresponsive with abnormal breathing, begin CPR.
- After the person has been moved to lie on their back, if it makes the person feel better, you could raise their legs 30 to 60 degrees if they are uninjured.
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Access help
- Clearly explain to EMS about the person’s condition, signs of shock, and what the cause may be.
- Shock is a life-threatening condition so emergency medical care is needed.
Education considerations
Facilitation tips and tools
- As many illnesses or injuries can lead to shock, facilitate the treatment for shock early in the programme and re-emphasise it throughout the learning.
- Because shock is always present with another condition, and clinically speaking, there are several different types of shock, learners may find the topic confusing and their confidence to act may be reduced. Try to keep the topic simple, emphasising the common cause (failure of getting oxygenated blood to the body), the common recognition points (see recognition) and the first aid steps.
- Emphasise that the best way to treat shock is to effectively treat the condition causing the shock, for example, to apply pressure to a bleed.
- Learners’ actions in treating shock should not interfere with their treatment of the causing condition and should not negatively impact on the comfort of the ill or injured person. For example, a person experiencing shock due to a heart attack may be more comfortable sitting than laying down.
- Clarify if necessary that shock, as described here, is different from emotional shock. Shock is a life-threatening condition caused by a severe illness or injury in which the circulation system fails. Whereas emotional shock or feeling shocked is a psychological response to an event. See Traumatic event.
Learning connections
- Help learners make connections to the causes of shock including a heart attack (see Chest pain), Severe bleeding, Fractures, severe Allergic reaction, infection such as sepsis.
Scientific foundation
Systematic reviews
A formal scientific review on the optimal position for shock was carried out in 2015 by the International Liaison Committee on Resuscitation (ILCOR), (Zideman et al., 2015). A recent review by ILCOR did not identify any new evidence (Singletary et al., 2020).
Low-certainty evidence from one randomised controlled trial and five observational studies was identified with benefits for the supine position (lying on the back) to improve vital signs and cardiac function, compared to an alternative position.
ILCOR recognised that for people with no evidence of trauma, the use of passive leg raising may provide additional, temporary improvement. The clinical significance of this improvement is uncertain. Therefore, ILCOR did not make a recommendation concerning passive leg raising. They were also unable to identify an optimal degree of elevation; studies range between 30 to 60 degrees elevated. No study has reported negative effects due to passive leg raising.
References
Systematic reviews
Singletary, E.M., Zideman, D.A., Bendall, J.C., Berry, D.C., Borra, V., Carlson, J.N., Cassan, P., … Woodin, J. A. (2020). 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation,142 (suppl 1):S284–S334.
DOI https://doi.org/10.1161/CIR.0000000000000897
Singletary, E.M., Zideman, D.A., Bendall, J.C., Berry, D.C., Borra, V., Carlson, J.N., Cassan, P., … Lee, C.C. (2020). 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation. 2020 Nov;156:A240-A282.
DOI https://doi.org/10.1016/j.resuscitation.2020.09.016
Singletary, E. M., Zideman, D. A., De Buck, E. D., Chang, W. T., Jensen, J. L., Swain, J. M., … & Hood, N. A. (2015). Part 9: first aid: 2015 international consensus on first aid science with treatment recommendations. Circulation, 132 (16_suppl_1), S269-S31.
DOI https://doi.org/10.1161/CIR.0000000000000278
Zideman, D. A., Singletary, E. M., De Buck, E. D., Chang, W. T., Jensen, J. L., Swain, J. M., … & Hood, N. A. (2015). Part 9: first aid: 2015 international consensus on first aid science with treatment recommendations. Resuscitation, 95, e225-e261.
DOI https://doi.org/10.1016/j.resuscitation.2015.07.047
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Published: 15 February 2021
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