Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Shock is a condition in which the blood supply (which carries oxygen and nutrients) to various organs of the body is insufficient to meet metabolic demands. The signs and symptoms are restlessness, low blood pressure, weak and rapid (thready) pulse, altered mental status (restlessness, anxiety, confusion), moist and cool (clammy) skin, rapid shallow breathing, inability to control urination and bowel movements, nausea, and profound weakness. It is a life-threatening condition and may follow a large number of inciting events. Causes of shock include severe internal or external bleeding (25 to 30% acute loss of an adult’s total blood volume, equivalent to 1.5 to 2 liters out of 6 liters), overwhelming infection, burns, dehydration, heart attack or disease, hormonal insufficiency, hypoglycemia, hypothermia, hyperthermia, allergic reaction, drug overdose, and spinal cord injury (loss of sympathetic nervous system support allows blood vessels to dilate as they lose tone).

Shock is a true emergency. Unfortunately, there is little that the rescuer can do in the field. The management of shock includes the following:

1. Position the victim on his back, with the legs elevated about 30 degrees (8 to 12 in or 20 to 30 cm), in order to encourage blood in the leg veins to return to the central circulation (heart) and head (brain) (figure 31). Do not elevate the legs if the victim has a severe head injury, difficulty breathing, a broken leg, neck or back injury, or if such a maneuver causes any pain. If the victim is short of breath because of heart failure, he may be more comfortable in the sitting position.

2. Keep the victim covered and warm. Remove him from harsh weather conditions. Remember to insulate him from below. If insufficient bundling is available, lie next to the victim to share body heat. Take special care to keep his head, neck, and hands covered.

3. Administer oxygen at a flow rate of 10 liters per minute by mask.

4. Control any obvious sources of external bleeding. Splint all broken bones.

5. If the victim is diabetic, consider a hypoglycemic reaction. If the victim is conscious and can purposefully swallow, administer Glutose paste or a sugar-sweetened liquid by mouth in small sips. Otherwise, do not give the victim anything to eat or drink unless he is alert and thirsty or hungry. If the victim is in shock because of diarrhea and dehydration, attempt to initiate oral fluid intake.

6. If the victim has been stung by an insect or appears to be suffering an allergic reaction, treat the allergic reaction.

7. Transport the victim to a hospital as rapidly as possible.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.