Control of Shock

Shock is frequently the most serious consequence of an injury. You should become familiar with the signs and symptoms of shock so that the condition may be anticipated, recognized, and dealt with effectively. The best approach to shock treatment is to treat all survivors suffering from moderate and severe injuries for shock. Act! Don't wait! Anticipate shock and take care of it along with treatment of the specific injury. 

. Giving a survivor fluids by mouth in the treatment of shock is normally not recommended. However, in survival situations, recovery may often depend on adequate hydration. In an early shock incident, giving the survivor small amounts of fluid by mouth maybe beneficial, provided he is conscious, can swallow, and has no internal injuries. Burn victims particularly need large amounts of water to replace their loss of fluids. 

. Emotional shock frequently follows an emergency. This type of shock originates in the mind and may occur even without injury. Resistance to and the impact of this type of shock varies widely. It depends on your physical makeup and is related to the amount of training you have previously received. Comfort and reassurance coupled with rest and relaxation after you are clear of immediate dangers is very effective in management of the survivor suffering from emotional shock.

Symptoms of Shock

A person suffering from shock shows symptoms that are directly or indirectly related to the poor circulation of the blood. The pulse is weak and rapid. Breathing is likely to be shallow, rapid, and irregular, because the poor circulation of the blood affects the breathing center in the brain. The temperature near the surface of the body is lowered because of the poor blood flow; therefore, the face, arms, and legs feel cold to the touch. Sweating is likely to be very noticeable. A person in shock is usually very pale, but in some cases there may be a bluish or reddish color to the skin. The pupils of the eyes are usually dilated (enlarged).

If the victim is conscious, he may complain of thirst. He may have a feeling of weakness, faintness, or dizziness. He may feel nauseous. Also, the person may be very restless and feel frightened and anxious. As shock deepens, these signs gradually disappear and the victim becomes less and less responsive to what is going on around him. Even pain may not arouse him. Finally, the victim may become unconscious.

It is unlikely that you will see all these symptoms of shock in any one case. Some of them appear only in the late stages of shock when the disturbance of the blood flow has become so great that the victim's life is in serious danger. Sometimes the signs of shock maybe disguised by other signs of injury. It is important to know what symptoms indicate the presence of shock, but do not ever wait for symptoms to develop before beginning the treatment for shock. Remember, EVERY SERIOUSLY INJURED PERSON IS LIKELY TO DEVELOP SERIOUS SHOCK.

Treatment of Shock

In many emergency situations, the most helpful thing you can do for an injured person is to begin treatment for shock. If 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 will affect his condition and may even bring on shock. Try to prevent the victim from seeing his injuries, and reassure him that he will be properly cared for. Keep all unnecessary persons away, as their conversation regarding the victim's injuries may increase his agitation.

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, if it will make him more comfortable. But in general, there is no need to give him anything to drink unless you are in a position where medical assistance will not be available for an excessively long period of time.

If medical care will not be 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 be done if 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 liquids. A seriously burned person has an overwhelming need for fluids. It is, therefore, a permissible and even desirable part of first-aid treatment for burns to give water or other liquids. Sweet tea, fruit juices, or sugar water maybe given if the casualty is conscious and able to swallow, if he has no internal injuries, and if vomiting is no problem.

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

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 will have to judge the amount of covering to use by considering the weather and the general circumstances of the accident. Often alight covering will be enough to keep the casualty comfortable. Wet clothing should be removed and dry covering provided, even on a hot day. Use blankets or any dry material to conserve body heat. Artificial means of warming (for example, hot-water bottles, heated bricks, or heated sand) should not be ordinarily used. Artificial heat may cause the loss of body fluids (by sweating), and it brings the blood closer 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.

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

In every case, of course, you will 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 will have to raise his head slightly. If the face is flushed rather than pale, or if you have any reason to suspect head injury, do not raise the feet. Rather, you should keep the head level with or slightly higher than the feet. If the person has broken bones, you will have to judge what position would be best both 5-40 for the fractures and for shock. A fractured spine must be immobilized before the victim is moved at all, if further injuries are to be avoided. If you have any doubts 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.

Distinguishing Characteristics of Poisonous Snakes

The first step to treating a snakebite is to determine whether the snake is poisonous. Many harmless snakes bite in self-defense. Distinguishing characteristics that help to determine if the snake is poisonous follow:

VIPERS.\ The viper has two long, folding fangs at the front of the upper jaw. A pit viper also has a small, deep pit between the eyes and the nostrils, slit-like pupils of the eyes, and a flat, triangular head; the scales behind the anus are in one piece. Rattlesnakes, copperheads, and moccasins are pit vipers; all vipers are poisonous.

CORALS.\ The coral snake has a black nose and brightly colored bands of either red, black, and yellow or red, black, and white. On coral snakes the black and red are separated by yellow or white; on the nonpoisonous (false coral) snake, the yellow and red are separated by black. It has short, grooved fangs and must chew into its victim before the poison can be injected. The coral snake is related to the cobra and the krait.

COBRAS.\ The combat attitude of the cobra is with the forepart of the body raised vertically and the head tilted sharply forward. Usually the neck is flattened to form a hood. These snakes are very poisonous and should be avoided. Adders are related to the cobra and can be found throughout the continental United States.

TREATMENT OF SNAKEBITES.\ Prompt action to reduce the effects of poisonous snakebites is essential. The following is a step-bystep treatment for snakebites:

1. Avoid undue exertion. If circumstances allow it, lie down and remain quiet. A snug tourniquet (tight enough to impede the venous return of blood to the trunk, yet loose enough to allow arterial supply to the extremity) will further delay systematic absorption of the poison. Place a tourniquet between the bite and the heart, about 2 inches above the bite. A tourniquet should only be used if competent medical help is reasonably expected to take over management of a snakebite victim.

2. Clean a knife or razor blade and the fang marks by daubing with antiseptic, if available.

3. Make a small cut over each fang mark (deep enough, one-fourth of an inch or more, to

penetrate the skin). Orient each cut parallel to vital structures (generally parallel to the long axis of the limb).

4. Apply suction. Suction can best be applied

by mouth, but not if there are open oral lesions

present. In this case, some other means of applying suction must be found. After 30 minutes, suction is of little benefit.

CARE OF WOUNDS.\ Open wounds are a serious hazard in a survival situation, not only because of the tissue damage and blood loss, but also because of the increased possibility of infection. Little can be done to prevent wound contamination at the time of the injury. Proper wound care can minimize further contamination and promote healing and preservation of function in the injured part. 

. Clothing should be cut or torn away from a wound; drawing clothes over the wound may introduce bacteria into the wound. 

l Whenever possible, avoid touching the wound with fingers or any unsterile object. All water and instruments used in wound care should be sterilized by boiling. Washing your hands before you treat any wound is very important in keeping down infection. 

. Clean all wounds as soon after occurrence as possible. Only antiseptics especially designed to use in open wounds should be used directly in the wound.

NOTE: Common antiseptics such as Merthiolate, iodine, and Mercurochrome should never be applied directly to a wound. These solutions destroy only part of the bacteria and actually damage the exposed tissues. . When cleansing solutions for wounds are not available, a suitable substitute may be a poultice made of fern root. To prepare a poultice, you boil finely chopped roots in water until syrupy. Allow the poultice to cool and apply directly to the wound. 

. The "open treatment" method is the safest way to manage wounds in a survival situation. No attempt should be made to close a wound by stitching. The wound should be left open to permit drainage of pus from infection. As long as a wound can drain, it generally will not become life threatening. If a wound is gaping, the edges can be brought together with adhesive tape cut in the form of a butterfly or dumbbell. When a butterfly bandage is applied properly, only a small portion of the adhesive is in contact with the wound; but a large surface of the tape is in contact with the skin on either side of the wound, providing traction that pulls the edges of the wound together. The narrow center permits some free drainage from the wound, and the strips can be removed easily if the wound has to be opened should infection develop.