In many emergency situations, the most helpful thing you can do for an injured person is to begin treatment for shock. When shock has not yet developed, the treatment may actually prevent its occurrence; if it has developed, you may be able to keep it from reaching a critical point. As we have seen, shock creates a vicious cycle; that is, the worse it is, the worse it becomes. It is extremely important that you begin treatment at the earliest opportunity.

It is important to keep the victim as calm as possible because excitement and fright affects his condition and may even bring on shock. Try to prevent the victim from seeing his injuries, and reassure him that he will receive proper care. Keep unnecessary persons away, as their conversation regarding the victim's injuries may increase his agitation.

Fluids

A person in shock is often thirsty. No particular harm will be done if you allow the victim to moisten his mouth and lips with cool water. But, in general, there is no need to give him anything to drink unless you are in a position whereby medical assistance will not be available for along period of time.

When medical care is not available, you should give the victim SMALL AMOUNTS of warm water, preferably mixed with 1 teaspoon of salt and 1/2 teaspoon of baking soda per quart or liter. This should only be done when he is conscious, able to swallow, and has not suffered internal injuries.

In the case of burns, an exception must be made to the rule of not giving a person liquids. A seriously burned person has an overwhelming need for fluids. It is, therefore, a permissible and even desirable part of first-aid treatment. Sweet tea, fruit juices, or sugar water may be given when the casualty is conscious and able to swallow, has no internal injuries, and vomiting is not a problem.

One final precaution must be given concerning the use of liquids: NEVER GIVE ALCOHOL TO A PERSON IN SHOCK OR A PERSON WHO MAY GO INTO SHOCK. Alcohol increases the blood supply to surface vessels, and it diminishes the blood supply to the brain and other vital organs.

Heat

Heat is important in the treatment of shock to the extent that the injured person's body heat must be conserved. Exposure to cold, with resulting loss of body heat, can cause shock to develop or to become worse. You must judge the amount of covering to use by considering the weather and the general circumstances of the accident. Often a light covering is enough to keep the casualty comfortable. Wet clothing should be removed and dry covering provided, even on a hot day. Use blankets or other dry material to conserve body heat. Under normal circumstances, artificial means of warming (for example, hot-water bottles, heated bricks, or heated sand) should not be used. Artificial heat can cause the loss of body fluids (by sweating), and it brings the blood close to the surface, thus defeating the body's own efforts to supply blood to the vital organs and to the brain. Also, the warming agent may burn the victim. KEEP AN INJURED PERSON WARM ENOUGH FOR COMFORT, BUT DO NOT OVERHEAT HIM.

Figure 10-42.-Position for treatment of shock.

Position

The best position to use for the prevention or treatment of shock is one that encourages the flow of blood to the brain. When it is possible to place the injured person on his back on a bed, cot, or stretcher, you should raise the lower end of the support about 12 inches so his feet are higher than his head, as shown in figure 10-42. When the circumstances of the accident make it impossible to do this, you should still endeavor to raise his feet and legs enough to help the blood flow to his brain. Sometimes it is possible to take advantage of a natural slope of ground and place the casualty so his head is lower than his feet.

In every case, of course, you have to consider what type of injury is present before you can decide on the best position; for example, a person with a chest wound may have so much trouble breathing that you must raise his head slightly. When his face is flushed rather than pale or if you have any reason to suspect head injury, do not raise his feet. Rather, you should keep his head level with or slightly higher than his feet. When the person has broken bones, you will have to judge what position is best both for the fractures and for shock. A fractured spine must be immobilized before the victim is moved to avoid further injuries. When you are in doubt about the correct position to use, have the victim lie flat on his back. THE BASIC POSITION FOR TREATING SHOCK IS ONE IN WHICH THE HEAD IS LOWER THAN THE FEET. Do the best you can, under the particular circumstances, to get the injured person into this position. In any case, never let a seriously injured person sit, stand, or walk around.