what meds to give to a shock trauma person?

what kind of medication should be given to a person going into shock due injuries or severe emotional trauma?

Is tranquilizer an effective method of calming the shock shell person?
does the medication require a trained medic to prescribed it?

There are several types/causes of shock; some have implications for medical treatment (drug treatment in the field by non-medical persons) others do not.

Shock due to trauma, such as hypovolemic shock (due to blood loss-especially internal bleeding) is best treated at a definitive care institution such as a Shock Trauma Center, as surgical intervention may be the only viable treatment. I.V. fluids can increase the chances to get the patient to the Trauma Center, but is not a definitive treatment. I.V. fluids can make a difference in burn cases where fluid loss is significant and causing severe hypotension (low blood pressure).

Shock due to a cardiovascular event (cardiogenic shock), can respond well to drug intervention, but unless you have the drugs, the knowledge and monitoring equipment, I do not think this is even a feasible option.

Hypoglycemic (too little blood sugar) shock/insulin shock does respond very quickly to drug intervention with oral glucose tablets/gel, cake icing, orange juice or hard candy for the conscious patient (this is viable treatment option for even the untrained) or I.V. Dextrose for the unconscious patient. Giving glucose to a patient with too high a blood sugar levels (hyperglycemia), will generally not create a major problem. When in doubt i.e. unable to take blood glucose reading, treat as though they were hypoglycemic and give sugar, their blood glucose levels can be regulated at the hospital.

Shock due some type of mental stress/scare – psychogenic shock is generally transitory due to a temporary interruption to the blood flow to the brain. Placing the victim in the “shock position” with the patient laying down with the legs elevated along with carefully and calmly chosen words will generally correct the situation.

Pete

You can't get much better information than that.

I might add that if you give anything to a person, other than the above mentioned sugar, you can be considered to be practicing medicine without a license, which can get you into all kinds of trouble. As an example, I have been stung by bees numerous times in my life, and have never had an elergic reaction to it. I have however seen several dozen others have a severe reaction, and the only thing that kept them alive was rapid transportation to a medical facility. Having seen the reaction first hand, I know that it is an ugly way to possibly die, and want to avoid that. So, my doctor prescribed a sting kit for me, which I carry in my vehicle or day pack all the time. Should I ever have a reaction I can stick myself. But, should I come upon another person with a reaction and decide to stick him, I might save his life, but would be liable, and could be sued and/or prosecuted.

Once again, I'm not a Dr but I played a Medical Officer in the service, ParamedicPete is as expected right on the money. To treat any unconscious person for shock of any kind other than from an obvious injury is taking a major risk that the Good Samaritan Law will not automatically cover.
If the patient is conscious, they should be able to tell you if they need some sugar or medications (that they probably have in their pockets or purse).
That's my 2 cents worth for today!!

Well put Pete. The only thing that I could add is to calmly talk with the patient, and get the Pros there. People die of shock. It is not something that should be taken lightly. There are a lot of DON'Ts. Don't give them water or anything by mouth unless they are in hypoglycemic / insulin shock and they are able to speak and swallow. Do not move the person unless they are in immediate danger and do not forget that there is something that caused the shock and to treat that as well. Hypovelemic shock (loss of blood) will not reverse itself if the person continues to bleed. You get the idea. I recommend a basic first aid or a first responder course. Both are short in length and are full of information that can be used more often then you realize. Above all else common sence rules when making descisions in a medical emergency.

Absolutely agree with Pete, but I want to add my $.02

1) Shock is due to injury of some sort. Severe emotional distress (e.g. Acute Stress Disorder or Post Traumatic Stress Disorder, or hysteria) is not shock. Nothing like shock, psychologically or physiologically.

2)The only medication ever to give, in the emergency setting, for Psychological "trauma" or "shock" is calm reassurance. No medications are helpful unless the patient absolutely must be sedated emergently to prevent further physical injury. Any medication given to tranquilize a psychologically agitated person may also depress CNS function and may increase risk.

Possibly, as anyone can sue for almost any reason, whether they would win or not is another matter. Still the hassle of having to defend your actions can be both expensive financially and emotionally.

It is unlikely, if you saved the life or was perceived to have saved the life of the person experiencing anaphylaxis from a bee sting (or other allergen) you would be prosecuted.

With asthma and allergies so common now a day, Epipens along with aspirin are likely some of the most widely distributed life-saving medications out in the general public, I would suspect that in most cases where someone gives such medical care and the outcome was positive, that most jurisdictions would simply ignore the “minor legalities” of a lay-person doing so in which they saved someone’s life or increased their chances for survival. But then you never know.

Pete

thanks for the tip pete.

I understand that there is a difference between physical and emotional shock. What I would hate to see is some lay person ASSUMING that a victim is in emotional shock. I would bet that symptoms of both kinds can mimic the other. I'm sure that "invisible" physical trauma does exist, and lay people have no business making a diagnosis between the two kinds. Just because the person is breathing and blood isn't pouring out is no indication that the problem is "only" emotional trauma.

The victim should be kept quiet and warm, and medical assistance should be called ASAP. No judgments as to cause really need to be made. Let medical personnel do that.

Sue

is it necessary to cover a trauma shock person with survival blanket? I am referring to the silver lined blanket.
would a trauma person loose a great deal of body heat?

One of the standard treatments for shock is to keep the patient warm, so, unless it is 100 degees and he/she is in the sun, I would think so. And in that case I would worry about the hot surface and maybe some shade...

The traditional mylar survival blanket is of limited value. As stated by OldBaldGuy, a patient who is in shock should be kept warm and dry or if not dry at least warm. The traditional survival blanket, despite claims of the reflection of as much as 90% of body heat, does little to insulate the patient from heat loss though conduction (contact with the ground, rocks, etc.). It can be helpful in creating a vapor barrier and reduce heat loss through convection (air currents).

A patient, who might be in moderate to severe hypothermia, is not producing enough body heat for the mylar survival blanket, by itself to be effective. Using one or more wool/disaster blankets (insulation) along with heat packs placed in the inner groin area and armpits (never in direct contact with bare skin) will assist in the patient from losing additional heat, as they will not really rewarm the body’s core (which is best performed in the hospital setting). Then by wrapping the entire blanket wrapped patient in the mylar survival blanket, you have created both a vapor and wind barrier. Especial attention should be made to insulating the head. A piece of plastic sheeting will accomplish the same thing, although it is generally heavier and bulkier to pack.

Pete

Florida had a legal definition of trauma, and when a "Trauma Alert" was declared, that person must be evacuated to the Level 1 or Level 2 Trauma Center, or Specialized Trauma Center (i.e. burn unit, etc.). Is this common terminology, and/or practice throughout the U.S.?

They had a pretty simple system for determining a "Trauma Alert", they had 2 columns red and blue on a card. If a patient had 1 from the red column, they were automatically a "Trauma Alert". If they had nothing from the red column, but had at least 2 from the Blue column, they were a "Trauma Alert". A paramedic could call "Trauma Alert" under Paramedic Intuition. Normally the reason for the "Trauma Alert" was called over the radio (1 Red or 2 Blue).

Holmes Region Medical Center - Melbourne, FL Medevac Alert Criteria

Is there anyway for the lay person to get fluids for use in hypovolemic or dehydrated people? I've take CLS with the Army, so I can theoretically stick someone (I've atleast stuck a healthy person). But I alway thought IV bags of lactated ringers or some other IV fluid might be useful in an emergency. Its pretty simple to tell who is in shock due to blood lose or dehydration for the most part. So any hints on where to get them anyone?

Best bet is to give oral rehydration formula orally--if they can't keep that down, second best way is via enema.

If you want the job done right, do it yourself? The old saying. I use: If you want the job done right, get a professional to do it. <img src="/images/graemlins/grin.gif" alt="" />

Eh, I'm not trained to give enemas, I am to give IVs.

From a non-military standpoint (I am a retired Army medic), your best shot at getting prescription fluids, tubing, and catheters is to work in the field--EMT/whatever.

After that, you might be able to convince a sympathetic physician to write you a script for those items--but good luck. Also note that in the latter case, you could be held legally liable if you used your rig on others.

In twenty years, I've only had two cases (out of thousands) of dehydration that warranted an IV--that being said, my medics stuck 'em all anyway for practice.

If you are not currently certified to provide IV solutions, I strongly suggest you don't. Even if you had previous military training in administering IV fluids, the legal system frowns on "non-certified" people providing this type of intervention. In addition, if usually is difficult to obtain IV solutions and equipment without medical control authorization.
In New York state, an ALS certified provider or paramedic can administer an IV, nothing lower.
You may not agree, but that's how it is.

"There is nothing so frightening as ignorance in action."

I figured as much, never hurts to ask though, much.

There are a variety of medical supply companies that sell I.V. solutions on the Internet and may sell to the general public in some cases. Just realize you may have to purchase in case lots. However, you potentially leave yourself open for both civil litigation and criminal charges. Keep in mind, just because you can (i.e. military training) perform a medical procedure, does not mean you can do so in the civilian world.

Medical practice of which EMS procedures are included is limited by state and/or local jurisdictional law to those who are either licensed or certified (state level) to carry out such procedures. I would suspect in rare cases such as a State of Emergency or a personal survival situation, that such legal action might be ignored. There are numerious ALS medical procedures that I can perform while on duty with the Medic unit and equipment. However, if I am not on duty, my scope of practice is limited to BLS procedures only. Hence I do not carry I.V. solutions/supplies in my personal vehicle.


Pete

Pete I agree with you, my scope of practice is also limited to BLS outside the hospital (however) one of my ER Docs is medical control for our SAR team that I am on and does issue LIMITED drugs to us (max 2mg morphine, also call on IV's Lifeflight must be within 5min before IV starts) I enjoy SAR and wouldn't trade any of it
Mike

I'm an EMT in NY State. Here's what we do for shock (hypoperfusion):

1. Give oxygen, preferably 10-15 L/minute via non-rebreather mask, or by bag-valve if necessary.

2. Keep the patient warm (put a blanket over them)

3. Have them lie down supine (face up) with legs elevated (exceptions being cardiogenic shock when you don't want to elevate the legs, sometimes in cases of pulmonary edema and other respiratory compromise where lying down inhibits breathing, and trauma cases where leg elevation may compromise the spine - in the latter you can elevate the foot end of the rigid backboard.)

4. Provide calm reassurance

5. RAPID transport to the hospital where definitive care can be obtained, regularly monitoring the patient's vitals.

In particular, we DO NOT push meds, we DO NOT give food or liquids, and we (where I am) do not use shock trousers (MAST).

Read our protocols here: http://www.health.state.ny.us/nysdoh/ems/pdf/emtblsprotocols.pdf

Go to Page 92 for the Hypoperfusion protocol.

Paramedics have a broader scope of training and may have a wider set of tools available, but I'm not a paramedic, and unless you are you shouldn't be providing paramedic care.

Exactly Pete.

There are two possible outcomes when you give treatment to a patient:

(1) It improves the situation

(2) It makes the situation worse.

If (1), then great. If (2) you're in trouble.

If you're going to do something, it pays to be right.

Therefore it makes sense to have the training that you're more likely to be right.

But on the off chance you're wrong, then you better be prepared to explain why you believed your course of action was reasonable given what you knew at the time, AND was within your scope of training, and hope someone else agrees with you that you were reasonable in your action (this is the essense of the good sam laws).