How to Recognize and Treat Traumatic Shock

Traumatic shock is caused by extreme blood loss resulting from a severe injury that makes it unable for the heart to pump enough blood throughout your body or severe anemia that causes there to be a lack of blood to pump throughout the body. This can also result in a lack of oxygen that your vital organs need. This lack of oxygen can cause lactic acidosis or a build up of acid in your system, which can affect blood clotting and your body’s ability to regulate its temperature. If your body is unable to properly control its temperature, it will be easier for hypothermia to set in, which also affects blood clotting. You can see how much traumatic shock can wreak havoc on a patient’s body and wellbeing.

photo/ Darko Stojanovic

In order to treat your patient properly, you will need to be able to recognize the signs of traumatic shock. Here are a few things you should look for in your patient:

• Patients will typically show signs of severe hemorrhage- confusion, a fast and faint pulse, cool and pale skin, hypotension and quick respiration.
• The body will also try to fight the effects of shock, which may result in an increased heart rate or peripheral vasoconstriction.

If left untreated, traumatic shock and the body’s response to traumatic shock can leave the victim to exhaust all of their reserves and eventually experience decompensation. Once the body reaches decompensation, medical intervention will almost always be necessary to prevent death. The lethal triad or the triad of death for a trauma patient is composed of acidosis, coagulopathy and hypothermia. These three will bring about each other and give rise to each other, which will eventually result in your patient’s predictable yet irreversible death. This makes it of the utmost importance to treat these symptoms of shock immediately. According to Dr. Gerecht there are steps you should follow to prevent hypothermia in shock patients:

• Always assume the victim’s body temperature is failing right before your eyes because it is, and it will be much faster than you would ever expect. You should always be prepared to quickly combat this sudden drop.
• Quickly strip down your victim and examine their wounds and vitals. Do not be so fast as to do your examination with reckless abandon, but get to it as fast as you can. Also, only expose the parts of the victim’s body you are examining at that moment and keep the rest of their body covered.
• Remember a patient can and will become hypothermic in conditions we consider warm, and you should always try to limit a patient’s exposure to the environment, especially during longer transports.
• Remember to put a warm blanket between your patient and the cold, hard backboard to keep them warm and comfortable at all times.
• Remember to adjust the heat appropriately in your ambulance. If you are not sweating, then it is definitely not warm enough for your patient.
• Immediately remove bloody or wet clothing from your patient and cover them with a warm blanket. When a patient is shivering, they are wasting valuable energy and oxygen in an attempt to stay warm. They are also producing more lactate, which will cause acidosis.
• Use and administer warmed IV fluids whenever possible to help keep the patient’s temperature from falling even more.

These steps are important to follow to ensure your patient does not fall into the lethal triad of death. As an EMS worker, we need to ensure the safety of our patients. This means being able to properly recognize and treat the symptoms of traumatic shock. If we do not properly assess traumatic shock, the patient could experience irreversible effects or even death. Remember it is the responsibility of all EMS workers to become familiar with all of the necessary treatments and symptoms in order to do their job properly.

Author: Tom Starke