Patient Assessment for Shock

• In incidents involving violence, such as assaults or gunshot wounds, make sure that police are on scene. At times, you may need to stage several blocks away until law enforcement personnel have secured the area.
• When you first see the patient

  Observe the scene and patient for clues to determine the nature of the illness or the mechanism of injury. This could help you anticipate the potential for development of shock
• Primary Assessment


  1. Rapid exam to look for evidence of severe or exsanguinating hemorrhage

  2. Determine level of consciousness

  3. Identify and manage life-threatening concerns as they are found

  4. Determine priority of the patient and transport
• A patient with massive hemorrhage may require a tourniquet or wound packing before the airway is opened. If the patient has obvious life-threatening external bleeding, it should be addressed first (even before airway and breathing) by controlling it quickly, then the ABCS can be assessed and treated
• Provide high-flow oxygen


  To assist in perfusion of damaged tissues. If the patient has bled out, saturating the red blood cells they have left will help prevent hypoxia.
• If the patient has signs of hypoperfusion, treat aggressively and provide rapid transport to the hospital. Request advanced life support (ALS) as necessary to assist with more aggressive shock management.
• Do not delay transport of the seriously injured trauma patient to complete non-lifesaving treatments in the field, such as splinting extremity fractures; instead, complete these types of treatments en route to the hospital.
• When you first visually inspect your patient, quickly form an initial general impression. This will help you develop an early sense of urgency for care of a patient who appears sick.
• A patient who has an altered level of consciousness (LOC) may need emergency airway management.
• An increased respiratory rate is often an early sign of impending shock and can be overlooked even by experienced providers.
• A rapid pulse suggests compensated shock. In shock, the skin may be cool, clammy, or ashen.
• If the patient has no pulse and is not breathing, immediately begin CPR
• If the shock patient's mental status is starting to deteriorate, the brain is no longer receiving adequate blood flow and the patient is progressing from compensated to decompensated shock.
• Anticoagulants can increase bleeding and worsen shock. Blood pressure medicines such as beta blockers can prevent the heart rate from rising to compensate for shock
• The secondary assessment is a more detailed, comprehensive examination of the patient that is used to uncover injuries that were not identified during the primary assessment.