Shock Recognition and Treatment

Hypovolemic shock: Blood or fluid loss. Pale skin, weak pulse, rapid breathing, cold extremities.

Septic shock: Severe infection. May start warm with flushed skin, then progress to cold shock. Fever may be absent.

Anaphylactic shock: Severe allergic reaction. Rapid onset. Hives, swelling, difficulty breathing, wheezing.

Cardiogenic shock: Heart failure. Pale, confused, rapid weak pulse, breathing difficulty.

Ask: What caused this? Bleeding? Infection? Allergy? Chest pain?

Shock is life-threatening. Treat aggressively even with minimal symptoms.

Watch for: Pale or blotchy skin, confusion or anxiety, rapid weak pulse (over 100), rapid shallow breathing, cold clammy skin, nausea, unresponsiveness.

Early shock may show only slight confusion and rapid pulse. Do not wait for obvious signs.

Check: Press fingertip on chest—color should return in under 2 seconds. Slow color return suggests shock.

Shock worsens rapidly. Act immediately on suspicion, not certainty.

Lay flat on back with legs elevated 12 inches (unless head injury, chest wound, or anaphylaxis).

For anaphylaxis: Keep upright or semi-upright to ease breathing.

For breathing difficulty: Semi-upright (45 degrees).

Support head with pillow. Keep neck straight. Loosen tight clothing.

Do not move with head injury unless necessary.

If conscious and able to swallow: Give water or salt water (1 teaspoon salt per liter) slowly in small sips.

If bleeding: Give fluids cautiously—only enough to maintain alert mental state, not to fully restore blood pressure (this can restart bleeding).

If infection: Give fluids freely. Dehydration worsens septic shock.

If anaphylaxis: Small sips only if swallowing works. No fluids if throat swelling.

Watch for vomiting. If it occurs, turn head to side to prevent aspiration.

Do not give fluids if patient cannot swallow or is vomiting.

Cover with blankets. Remove wet clothing. Place on dry surface or insulation.

Use body heat: Have rescuers lie close. Stack blankets above and below.

Warm liquids only if patient is fully alert and can swallow safely—never force.

Do not overheat. Warmth helps, but active rewarming may trigger dangerous heart rhythms in severe shock. Gentle passive warming is safest.

If epinephrine is available: Use immediately. IM dose: 0.3–0.5 mL of 1:1000 into outer thigh. Repeat every 5–15 minutes if no improvement.

If epinephrine unavailable: Use alternatives.

Antihistamine: Diphenhydramine 25–50 mg oral or IM slows reaction. Does not reverse airway swelling.

Improvised options:

• Ice on throat/chest to reduce swelling
• Elevate head and shoulders to ease breathing
• Remove allergen source (stop medication, remove insect stinger)
• Keep airway open: Jaw thrust, position on side if unconscious
• Monitor breathing constantly

Anaphylaxis can recur 4–12 hours later. Watch closely and repeat epinephrine if symptoms return.

Anaphylaxis is life-threatening. Difficulty breathing or swelling of throat/lips is a medical emergency. Without epinephrine, focus on keeping airway open.