CARDIOGENIC SHOCK Cardiogenic   shock   is   caused   by   inadequate functioning  of  the  heart,  not  by  loss  of  circulating blood  volume.    If  the  heart  muscle  is  weakened  by disease or damaged by trauma or lack of oxygen (as in cases of pulmonary disease, suffocation, or myocardial infarction), the heart will no longer be able to maintain adequate circulatory pressure, even though the volume of  fluid  is  unchanged. Shock  will  develop  as  the pressure  falls.     Heart  attack  is  an  extreme  medical emergency  all  Hospital  Corpsmen  must  be  ready  to handle.    It  will  be  discussed  in  greater  detail  in  the “Common   Medical   Emergencies”   section   of   this chapter. SEPTIC SHOCK Septic shock usually does not develop for 2 to 5 days after an injury and the patient is not often seen by the Corpsman in a first aid situation.  Septic shock may appear  during  the  course  of  peritonitis  caused  by penetrating  abdominal  wounds  or  perforation  of  the appendix.   Gross wound contamination, rupture of an ulcer,   or   complications   from   certain   types   of pneumonia may also cause septic shock.  Septic shock is the result of vasodilation of small blood vessels in the wound area, or general vasodilation if the infection enters  the  bloodstream. In  addition  to  increasing circulatory  system  volume,  the  walls  of  the  blood vessels become more permeable, which allows fluids to escape into the tissues.  This type of shock carries a poor prognosis and should be treated under the direct supervision of a medical officer. ANAPHYLACTIC SHOCK Anaphylactic shock occurs when an individual is exposed   to   a   substance   to   which   his   body   is particularly  sensitive.     In  the  most  severe  form  of anaphylactic  shock,  the  body  goes  into  an  almost instantaneous violent reaction.   A burning sensation, itching,  and  hives  spread  across  the  skin. Severe edema affects body parts and the respiratory system. Blood pressure drops alarmingly, and fainting or coma may occur. The  causative  agent  may  be  introduced  into  the body in a number of ways.  The injection of medicines (especially   penicillin   and   horse-   or   egg-cultured serums) is one route.  Another method is the injection of   venoms   by   stinging   insects   and   animals. The inhalation of dusts, pollens, or other materials to which a person is sensitive is a third route.  Finally, a slightly slower but no less severe reaction may develop from the   ingestion   of   certain   foods   and   medications. Specific   treatment   of   venoms   and   poisons   will   be discussed in chapter 5, “Poisoning, Drug Abuse, and Hazardous Material Exposure.” GENERAL TREATMENT PROCEDURES Intravenous   fluid   administration   is   the   most important factor in the treatment of all types of shock except cardiogenic shock.  Ringer’s lactate is the best solution  to  use,  although  normal  saline  is  adequate until  properly  cross-matched  whole  blood  can  be administered.    The  electrolyte  solutions  replace  not only the lost blood volume, but also lost extracellular fluid  that  has  been  depleted.    If  the  shock  is  severe enough   to   warrant   immediate   administration   of intravenous  fluids,  or  if  transportation  to  a  medical facility  will  be  delayed  and  a  medical  officer  is  not available   to   write   an   administrative   order,   be conservative:  Start the intravenous fluids and let them run  at  a  slow  rate  of  50  to  60  drops  per  minute.    If intravenous solutions are unavailable or transportation to  a  medical  treatment  facility  will  be  delayed,  and there are no contraindications (such as gastrointestinal bleeding   or   unconsciousness),   you   may   give   the patient   an   electrolyte   solution   by   mouth. An electrolyte  solution  may  be  prepared  by  adding  a teaspoon of salt and half a teaspoon of baking soda to a quart  or  liter  of  water.    Allow  the  patient  to  sip  the solution. Other   treatment   procedures   for   shock   are   as follows: ·   Maintain an open airway.   Oxygen may also be administered if proper equipment is available. ·   Control hemorrhages. ·   Check  for  other  injuries  that  may  have  been sustained.  Remove the victim from the presence of identifiable causative agents. ·   Place the victim in a supine position, with the feet   slightly   higher   than   the   head   (shock position).   Certain problems, such as breathing difficulties or head injuries, may require other positioning. ·   Reduce  pain  by  splinting  fractures,  providing emotional support, and attending to the victim’s comfort. Unless contraindicated, aspirin may be dispensed. ·   Conserve the patient’s body heat. 4-24