-
ANZCOR Scientific Statements
-
Algorithms and Flowcharts
-
Guideline Development
-
Basic Life Support
-
First Aid Management of Injuries
-
First Aid for the Environment
-
First Aid for Bites, Stings and Poisoning
-
Education and Implementation
-
Adult Advanced Life Support
-
Paediatric Advanced Life Support
-
Newborn Resuscitation
-
Acute Coronary Syndromes
Search
Guideline 9.2.3 – Shock: First Aid Management of the Seriously Ill or Injured Person
Guideline
Who does this guideline apply to?
This guideline applies to adults, children and infants
Who is the audience for this guideline?
This guideline is for use by bystanders, first aiders and first aid providers.
Recommendations
The Australian and New Zealand Committee on Resuscitation (ANZCOR) make the following recommendations:
- Control any bleeding promptly (Guideline 9.1.1).
- Send for an ambulance.
- Reassure and constantly re-check the person’s condition for any change.
Level of Evidence
Low quality
Class of Recommendation
Weak
Introduction
Shock is a loss of effective circulation resulting in impaired tissue oxygen and nutrient delivery1 and causes life threatening organ failure. Any seriously ill or seriously injured person is at risk of developing shock.
Causes
Some conditions which may cause shock include2:
Loss of circulating blood volume (hypovolaemic shock), e.g.:
- severe bleeding (internal and / or external)
- major or multiple fractures or major trauma
- severe burns or scalds
- severe diarrhoea and vomiting
- severe sweating and dehydration.
Cardiac causes (cardiogenic shock), e.g.:
- heart attack
- abnormal heart rhythm.
Abnormal dilation of blood vessels (distributive shock), e.g.:
- severe infection (sepsis)
- severe allergic reactions (anaphylaxis)
- severe brain / spinal injuries
- fainting (generally short lived).
Blockage of blood flow in or out of heart (obstructive shock), e.g.:
- punctured lung causing increased pressure in chest causing reducing return of blood to the heart (tension pneumothorax)
- severe injury to the heart with weak heart muscle (cardiomyopathy) or blood around the heart reducing blood return to the heart (cardiac tamponade)
- blood clot in the lung (pulmonary embolus)
- compression of the large abdominal veins by the uterus in pregnancy.
Recognition
Early recognition of the seriously ill or seriously injured person should alert the first aider to the risk of developing shock.
The symptoms, signs and rate of onset of shock vary widely depending on the nature and severity of the underlying cause3. Shock is a condition that may be difficult to identify.
Symptoms may include:
- dizziness
- thirst
- anxiety
- restlessness
- nausea
- breathlessness
- feeling cold, shivering or chills.
- extreme discomfort or pain
Signs may include:
- collapse
- rapid breathing
- rapid pulse which may become weak or slow
- fever or abnormally low temperature
- cool, sweaty skin that may appear pale or discoloured
- skin rash
- confusion or agitation
- decreased or deteriorating level of consciousness
- vomiting
- decreased urine output
Management
- Ensure safety of all at the scene
- Lie the person down. If unconscious place the person on their side (Guideline 3).
- Control any bleeding promptly (Guideline 9.1.1).
- Send for an ambulance.
- Administer treatments relevant to the cause of the shock.
- Administer oxygen if available and trained to do so (Guideline 9.2.10).
- Maintain body temperature (prevent hypothermia).
- Reassure and constantly re-check the person’s condition for any change.
- If the person is unresponsive and not breathing normally, follow the Basic Life Support Flowchart (ANZCOR Guideline 8).
Positioning of people with shock
If possible, lie the person down rather than sitting them upright4 (CoSTR 2015, weak recommendation, low-quality evidence).
For individuals with shock who are in the supine (lying) position and with no evidence of trauma, the use of passive leg raise (PLR) may provide a transient (less than 7 minutes) improvement.
The clinical significance of this transient improvement is uncertain; however, no study reported adverse effects due to PLR4. Because improvement with PLR is brief and its clinical significance uncertain, ANZCOR recommends the supine (lying) position without leg raising for those in shock4 (CoSTR 2015, values and preferences statement).
References
- Skinner, B. & Joans, M. (2007). Causes and Management of Shock. Anesthesia and Intensive Care Medicine. 8(12): 520-524.
- Graham, C.A. & Parke, T.R. (2005). Critical care in the emergency department: shock and circulatory support. Emergency Medicine Journal. 22:17-21.
- Moore, F.A., McKinley, B.A. & Moore, E.E. (2004). The next generation in shock resuscitation. The Lancet 363:1988-96.
- Zideman, D. A., Singletary, E. M., De Buck, E., et al. (2015). Part 9: First aid: 2015 International Consensus on First Aid Science with Treatment Recommendations. Resuscitation, 95, e225. http://www.cprguidelines.eu/assets/downloads/costr/S0300-9572(15)00368-8_main.pdf Accessed 19/11/2015.
About this Guideline:
|
Search date/s |
2015-2019 Evidence update |
|
Question/PICO: |
There was no PICO for the Evidence update |
|
Method: |
Both GRADE on SR (for CoSTR 2015) and recent literature review |
|
Primary reviewers: |
Jason Bendall; Natalie Hood |
|
Other consultation |
None |
|
Worksheet |
No worksheet |
|
Approved: |
November 2019 |
|
Guidelines superseded: |
9.2.3 (January 2016) |
