Shock

Shock can be caused by any condition that reduces blood flow, including:

• Heart problems (such as heart attack or heart failure)
• Low blood volume (as with heavy bleeding or dehydration)
• Changes in blood vessels (as with infection or severe allergic reactions)
• Certain medicines that significantly reduce heart function or blood pressure

Shock is often associated with heavy external or internal bleeding from a serious injury. Spinal injuries can also cause shock.

Toxic shock syndrome is an example of a type of shock from an infection.

A person in shock has extremely low blood pressure. Depending on the specific cause and type of shock, symptoms will include one or more of the following:

• Anxiety or agitation/restlessness
• Bluish lips and fingernails
• Chest pain
• Confusion
• Dizziness, lightheadedness, or faintness
• Pale, cool, clammy skin
• Low or no urine output
• Profuse sweating, moist skin
• Rapid but weak pulse
• Shallow breathing
• Unconsciousness

Take the following steps if you think a person is in shock:

• Call 911 for immediate medical help.
• Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
• Even if the person is able to breathe on their own, continue to check rate of breathing at least every 5 minutes until help arrives.
• If the person is conscious and DOES NOT have an injury to the head, leg, neck, or spine, place the person in the shock position. Lay the person on the back and elevate the legs about 12 inches (30 centimeters). DO NOT elevate the head. If raising the legs will cause pain or potential harm, leave the person lying flat.
• Give appropriate first aid for any wounds, injuries, or illnesses.
• Keep the person warm and comfortable. Loosen tight clothing.

IF THE PERSON VOMITS OR DROOLS

• Turn the head to one side to prevent choking. Do this as long as you do not suspect an injury to the spine.
• If a spinal injury is suspected, "log roll" the person instead. To do this, keep the person's head, neck, and back in line, and roll the body and head as a unit.

In case of shock:

• DO NOT give the person anything by mouth, including anything to eat or drink.
• DO NOT move the person with a known or suspected spinal injury.
• DO NOT wait for milder shock symptoms to worsen before calling for emergency medical help.

Call 911 any time a person has symptoms of shock. Stay with the person and follow the first aid steps until medical help arrives.

Learn ways to prevent heart disease, falls, injuries, dehydration, and other causes of shock. If you have a known allergy (for example, to insect bites or stings), carry an epinephrine pen. Your health care provider will teach you how and when to use it.

Puskarich MA, Jones AE. Shock. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 6.

Rivers EP. Approach to the patient with shock. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 106.