Shock Control and Prevention The essence of shock control and prevention is to recognize   the   onset   of   the   condition   and   to   start treatment  before  the  symptoms  fully  develop.     The following   are   general   signs   and   symptoms   of   the development of shock (see figure 4-19): ·   Restlessness   and   apprehension   are   early symptoms, often followed by apathy. ·   Eyes  may  be  glassy  and  dull.    Pupils  may  be dilated. (These   are   also   the   symptoms   of morphine use.) ·   Breathing may be rapid or labored, often of the gasping,   “air   hunger”   type.   In   the   advanced stages of shock, breathing becomes shallow and irregular. ·   The  face  and  skin  may  be  very  pale  or  ashen gray;  in  the  dark  complexioned,  the  mucous membranes  may  be  pale.     The  lips  are  often cyanotic. ·   The skin feels cool and is covered with clammy sweat. The   skin’s   coolness   is   related   to   a decrease in the peripheral circulation. ·   The pulse tends to become rapid, weak, and thready.   If   the   blood   pressure   is   severely lowered, the peripheral pulse may be absent. The  pulse  rate  in  hemorrhagic  shock  may reach  140  or  higher.    In  neurogenic  shock, however,   the   pulse   rate   is   slowed,   often below 60. ·   The  blood  pressure  is  usually  lowered  in moderately   severe   shock;   the   systolic pressure  drops  below  100,  while  the  pulse rises above 100.   The body is compensating for   circulatory   fluid   loss   by   peripheral vasoconstriction. This   process   tends   to maintain   the   blood   pressure   at   a   nearly normal level despite a moderately severe loss of circulating blood volume.  A point comes, however, when decompensation occurs, and a small amount of additional blood loss will produce   a   sudden,   alarming   fall   in   blood pressure. ·   There may be nausea, vomiting, and dryness of the mouth, lips, and tongue. ·   Surface veins may collapse.  Veins normally visible  at  the  front  of  the  elbow,  forearms, 4-22 Approximate Deficit (ml) Decrease in Blood Volume % Degree Signs 0-500 0-10 None None 500-1200 10-25 Mild Slight tachycardia Postural changes in blood pressure Mild peripheral vasoconstriction Increased respirations 1200-1800 25-35 Moderate Thready pulse 100-120 Systolic blood pressure 90-100 Marked vasoconstriction Labored breathing Diaphoresis (profuse perspiration) Anxiety and restlessness Decreased urine output 1800-2500 35-50 Severe Thready pulse > 120 Systolic blood pressure < 60 Weakened respirations Increased diaphoresis Changes in levels of consciousness No urine output Table 4-2.—Correlation of Magnitude of Volume Deficit and Clinical Presentation