7d • EMT Talk
What Is Shock? Everything you need to know
Shock is poor tissue perfusion. The body is not delivering enough oxygenated blood to the cells.
Important NREMT point:
Shock can exist before the blood pressure drops.
Perfusion Basics
Remember:
Pump + Fluid + Container + Obstruction
General Signs of Shock
Common findings include:
- Altered mental status
- Anxiety or restlessness
- Tachycardia
- Tachypnea
- Pale, cool, clammy skin
- Weak pulses
- Delayed capillary refill
- Hypotension, usually late
Compensated Shock
The body is still maintaining blood pressure.
Key signs:
- Normal blood pressure
- Fast heart rate
- Fast respirations
- Pale, cool, clammy skin
- Anxiety or restlessness
- Weak pulses
Study point:
Compensated shock = shock with a normal blood pressure.
Decompensated Shock
The body can no longer maintain blood pressure.
Key signs:
- Hypotension
- Altered mental status
- Weak or absent peripheral pulses
- Cool, pale, cyanotic, or mottled skin
- Respiratory distress or failure
Study point:
Decompensated shock = shock with failing compensation.
Irreversible Shock
Shock has progressed too far and causes severe cellular damage.
Key signs:
- Profound hypotension
- Unresponsive mental status
- Bradycardia or weak pulse
- Mottled/cyanotic skin
- Organ failure
- Cardiac arrest may occur
Study point:
Irreversible shock = prolonged hypoperfusion with severe organ damage.
Types of Shock
Hypovolemic Shock
Problem:
Not enough circulating volume.
Common causes:
- Bleeding
- Trauma
- Vomiting
- Diarrhea
- Dehydration
- Burns
Key findings:
- Pale, cool, clammy skin
- Tachycardia
- Weak pulses
- Flat neck veins
- Delayed capillary refill
- Hypotension late
EMS care:
- Control bleeding
- Oxygen as needed
- IV/IO access
- Fluids or blood products per protocol
- Prevent hypothermia
- Rapid transport
Distributive Shock
Problem:
Blood vessels dilate or leak, causing poor blood distribution.
Main types:
- Septic shock
- Anaphylactic shock
- Neurogenic shock
Septic Shock
Cause:
Severe infection causing vasodilation and poor perfusion.
Key findings:
- Fever or hypothermia
- Altered mental status
- Tachycardia
- Tachypnea
- Warm skin early
- Cool/mottled skin late
- Hypotension
EMS care:
- Oxygen as needed
- IV/IO access
- Fluids per protocol
- Check glucose
- Sepsis alert if available
- Rapid transport
Anaphylactic Shock
Severe allergic reaction causing vasodilation, airway swelling, and bronchoconstriction.
Key findings:
- Hives
- Itching
- Facial/lip/tongue swelling
- Wheezing
- Stridor
- Hypotension
- GI symptoms may occur
EMS care:
- Epinephrine early
- Airway management
- Oxygen
- Albuterol if wheezing
- IV/IO access
- Fluids for hypotension
Study point:
Epinephrine is the priority medication for anaphylaxis.
Neurogenic Shock
Cause:
Loss of sympathetic tone, usually from spinal cord injury.
Key findings:
- Hypotension
- Bradycardia or normal heart rate
- Warm, dry skin
- Possible paralysis or sensory loss
- Usually associated with spinal trauma
EMS care:
- Spinal motion restriction when indicated
- Oxygen as needed
- IV/IO access
- Fluids per protocol
- Vasopressors if authorized
- Rapid transport
Study point:
Neurogenic shock is classically hypotension with bradycardia and warm, dry skin.
Cardiogenic Shock
The heart cannot pump effectively.
Common causes:
- Myocardial infarction
- Heart failure
- Dysrhythmias
- Cardiomyopathy
- Cardiac trauma
Key findings:
- Chest pain may be present
- Pale, cool, clammy skin
- Hypotension
- Weak pulses
- Crackles may be present
- JVD may be present
- Abnormal ECG or dysrhythmia
EMS care:
- Oxygen/ventilation support
- 12-lead ECG
- Treat dysrhythmias
- Cautious fluids
- Avoid nitroglycerin if hypotensive
- Rapid transport to cardiac-capable facility
Study point:
Do not give large fluid boluses to cardiogenic shock patients with pulmonary edema.
Obstructive Shock
Blood flow is physically blocked.
Main causes:
- Tension pneumothorax
- Cardiac tamponade
- Massive pulmonary embolism
Tension Pneumothorax
Air pressure builds in the chest and decreases venous return to the heart.
Key findings:
- Severe respiratory distress
- Unilateral decreased/absent breath sounds
- Hypotension
- Tachycardia
- Chest trauma
- Worsening after positive-pressure ventilation
EMS care:
- Needle decompression per protocol
- Finger thoracostomy only if authorized
- Oxygen/ventilation support
- Rapid transport
Cardiac Tamponade
Blood or fluid around the heart prevents proper filling.
Key findings:
- Hypotension
- JVD
- Muffled heart sounds may be difficult to hear
- Narrow pulse pressure
- Chest trauma, especially penetrating trauma
- Clear lung sounds
EMS care:
- Oxygen/ventilation support
- IV/IO access
- Fluids may temporarily help if hypotensive
- Rapid transport
Study point:
Penetrating chest trauma + JVD + hypotension + clear lung sounds = suspect tamponade.
Massive Pulmonary Embolism
A clot blocks blood flow through the lungs.
Key findings:
- Sudden shortness of breath
- Chest pain
- Tachycardia
- Tachypnea
- Hypoxia
- Clear lung sounds
- Syncope may occur
- Risk factors for DVT/PE
EMS care:
- Oxygen
- Ventilatory support if needed
- IV/IO access
- Treat hypotension per protocol
- Rapid transport
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What Is Shock? Everything you need to know
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