Shock can take many forms (no not the electric
one) but the one we are most likely to see and have to deal with is acute shock from trauma. Other types of shock are more likely slower onset, and as such can be dealt with on shore. Yes I know Anaphylactic shock is rapid onset, but I gotta hold back some material for another edition
Traumatic shock is deadly! Per the NIH,
Originally Posted by NIH
What is shock?
Shock often accompanies trauma. Also known as “circulatory collapse,” shock can occur when the blood pressure in a person’s arteries is too low to maintain an adequate supply of blood to organs and tissues.
So in laymen’s terms... there isn’t enough blood! It can be because there is too little blood (from hemorrhage) or the “container” has gotten too big for the normal quantity of blood. The first is pretty straightforward... STOP THE LEAK! The later is a bit more complicated. Our circulatory system is capable of compensating and adapting to the circulating volume of blood... to a point. There are muscles around out blood vessels that shrink or expand the system as necessary to maintain circulation and perfusion (oxygenation of tissues).
Shock comes about when the compensatory mechanisms become overwhelmed. Signs of shock include cold & clammy skin, weak and rapid pulse, irregular breathing, dry mouth, faintness, decreased urine output. Traumatic shock can progress very rapidly. There are stages of shock which are progressive (and beyond the scope
of this thread) but the idea remains to recognize the symptoms and take steps to mitigate the progression as soon as possible..... before it is too late! It is an arguable point that people don’t bleed to death, because they die of shock first!
There are two types of bleeding: internal and external. In a boat
at sea without advanced medical
capabilities, there isn’t much you can do with internal bleeding other than supportive care, so we won’t go into that other than to say getting the patient to a physician’s care as soon as possible is the best treatment. External bleeding is best controlled with direct pressure. Make a compress out of absorbent material and use the heel of your hand to press it down directly over the wound. Failing that, on extremities, in spite of the bad press given tourniquets, a wide elastic applied just tight enough to stem the flow may save a life (we use SWAT-T). A narrow tourniquet may cause damage to underlying tissues and should be avoided. If you have a blood pressure cuff aboard, these are excellent!
There are also commercial
coagulative agents available (we use TraumaDEX and Celox), but if you don’t have any, simple cornstarch or flour will help (remember we are thinking outside the box). They work
be absorbing the liquid components of blood and allowing the solids to form a clot faster.
Without advanced life support, shock management is limited to elevating the feet, keeping the patient warm, oxygen if available, and rapid evacuation to medical
So here’s the Outside the Box section.....
This happened to me in Cozumel Mexico
fifteen years ago:
A 25 year old male was in a skiff circling and jumping his own wake between the two piers to the island (yup before the cruise ship
pier was built). He managed to loose his balance and fall overboard
while his skiff continued to circle. I was on one of the piers filling my boat
(from 5 gallon cans!); I heard the commotion just in time to see the poor guy run down by his own boat. There was so much blood, you could see it in the water
. Literally dozens of men
jumped in from shore to help, but the circling boat was keeping them at bay. A good samaritan in a sportfisherman saw what was going on and literally rammed the skiff with his boat sinking it. The shore rescuers towed the unconscious and bleeding man to shore..... THEN STOOD AROUND AND DID NOTHING TO STOP THE BLEEDING!
I took off down the pier (ignoring the objections of my now EX-wife). The crowd was so large by now that I had trouble getting to the patient “Yo soy paramedico” didn’t count for much. When I got to his side, I realized all I had to work
with was...... NOTHING! I was wearing a pair of nylon running shorts, and a pair of topsiders. I asked a bystander for his guayabera shirt.. he was reluctant until I gestured at my shorts! I folded the shirt into a thick pad and applied it to the patient’s right shoulder. Blood turned the shirt crimson in seconds, and blood continued to flow............
What did I do next?