4 Shock Recognition and Response

What shock means

Shock is a life-threatening failure of the circulatory system to deliver enough oxygen-rich blood to the body’s tissues and organs. It can follow severe bleeding, a serious injury or illness, or a severe allergic reaction. It may worsen quickly and requires emergency medical care.

Medical shock is not the same as being emotionally startled. A bystander may not be able to identify the cause or judge how severe the condition is, so focus on warning signs and act promptly.

Recognizing possible shock

Possible signs include pale, gray, cool, or clammy skin; a rapid, weak heartbeat or rapid breathing; weakness, dizziness, nausea, or vomiting; restlessness, irritability, confusion, or reduced responsiveness; and excessive thirst.

Not every person will show every sign. Treat suspected shock as an emergency, especially when signs follow serious bleeding, injury, illness, or an allergic reaction. Do not wait for the person to become unconscious.

Immediate priorities

Begin with Scene safety: protect yourself and the person, and use protective equipment if available. Check responsiveness and breathing. If the person is responsive, get consent. Look for serious bleeding or another obvious cause.

Call 911 or your local emergency number promptly. If others are present, assign someone to call and bring an AED or first-aid supplies. Follow the dispatcher’s instructions; a potentially serious illness or injury warrants immediate activation of emergency services.

Address immediate threats within your training. For severe external bleeding, apply firm, direct pressure with a clean dressing or cloth. Continue lifesaving care while help is coming.

Supportive care while help is coming

If the person is alert and breathing normally, help them lie on their back if comfortable. If injury is possible, avoid unnecessary movement. For suspected shock without injury, raising the feet about 6 to 12 inches may be reasonable if it causes no pain, discomfort, or worsening symptoms; raising the feet is not required. If the person has trouble breathing, let them choose a comfortable breathing position.

If they become less alert, are vomiting, or cannot be watched continuously, place them on their side if it is safe to do so, while considering possible injuries. Protect them from cold or heat, and cover them with a blanket if they are cold.

Reassure the person and keep them as still and calm as possible. Do not give food or drink, because vomiting or reduced alertness can make swallowing unsafe. Recheck responsiveness and breathing frequently, watch for worsening symptoms, and tell EMS what you observed and any changes.

If the person’s condition changes

If the person becomes unresponsive and is not breathing normally, call or update 911, begin CPR, and use an AED as soon as available, following its prompts.