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Thread: paramedics treating shock

  1. #1
    Mr. Boo is watching you. rosehips's Avatar
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    paramedics treating shock

    My mc is going to go into shock after nearly getting shot at an outdoor celebration. I intend to cut to a while later when the paramedics are taking care of her, as well as a bystander who was shot in the shoulder, and perhaps a few other people with some minor injuries.

    First off, I have my mc feel dizzy after the shooting and sit down. This is supposed to be just the start of her going into shock, and is based on my memory of going into shock once. However, if there are any other initial signs of shock I should include, please let me know.

    Secondly, what sorts of things would the paramedics do once they are there, for my mc?

    What would they do for the man who got shot in the shoulder, that my mc, who has no medical training, would observe?

    Thanks a million in advance.

  2. #2
    practical experience, FTW Plains Pen's Avatar
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    The term "shock" is commonly used to describe the trauma of seeing something awful, but paramedics use "shock" to mean blood loss from an injury or some other reason that the heart stops pumping blood well.

    These are two different things. I think its fine to talk about either one, but don't have your paramedics call it "shock" if she hasn't been physically injured.

    Now what else might she experience? Shakes, dizziness, distraction and trouble focussing.

    What would paramedics do? They'd check her blood pressure and pulse, they'd make sure she wasn't physically injurred in any way. They would ask about what happened until they were sure she was just scared/traumatized, and then likely they would move on to anyone else who was injurred.

    For the man who was shot: He would get blood pressure, pulse. Pressure on bleeding to stop it. An IV would be started and IV fluids given. Bloodwork would be drawn to be run at the hospital. He likely would get a c-spine collar attached. He would be examined for any other injuries -- bullet exit and entrance wounds. He would be put on a gurney, strapped and taped in place, and transported to the ER as soon as they were sure he was stable. Time on scene would usually be 15 minutes or less.
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    Understood. Pyekett's Avatar
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    Quote Originally Posted by Plains Pen View Post
    The term "shock" is commonly used to describe the trauma of seeing something awful, but paramedics use "shock" to mean blood loss from an injury or some other reason that the heart stops pumping blood well.

    These are two different things. I think its fine to talk about either one, but don't have your paramedics call it "shock" if she hasn't been physically injured.
    Because the pedant in me is running high tonight (and howling at the moon), I'll expand on this.

    There are four three basic kinds of shock, medically speaking:
    1) Hypovolemic
    2) Cardiogenic
    3) Distributive
    3a) Neurogenic
    3b) Anaphylactic
    [3c) Septic]

    All "shock" means is that tissue broadly is being hypoperfused. That can happen because:

    1) there is not enough blood to get to the tissues (hypovolemic shock--fluid loss from burns, severe dehydration, major tissue damage, etc.), or

    2) there is enough blood, but the heart is doing a piss-poor job of getting it there (cardiogenic shock--heart attack weakens too much muscle, valve is failing, there is an arrhythmia incompatible with life, etc.), or

    3) there is enough blood and the heart is working well, but there is a severe problem with how the blood is distributed, such as:

    3a) a problem with neurovascular control has led to massive dilatation of the small blood vessels, suddenly greatly expanding the distribution area (neurogenic shock--anesthesia, spinal cord injury, even [but rarely] very severe pain or anxiety), or

    3b) a severe allergic reaction has led to widespread vasodilation (anaphylactic shock--from a severe allergic reaction to drugs, peanuts, what have you)

    So you can get medical shock through a variety of pathways. Certainly traumatic injury is the most common cause, but as a writer, you have a wealth of possibilities to choose from, if you can sell it.

    Added: Didn't mean to label this with a frowny face at the top. I'm actually feeling mellow, bordering on genial. Halfway to sleepy, also wondering what set the character the original poster off into shock, be it psychologically or physiologically.

    Also Added: But maybe that's another story. I went into shock once, being just special enough to cross-react to another antibiotic with my penicillin allergy.

    My friends, do not accept a shot in the bum to which you may be allergic and then go home. It is much better to go back to work and freak out an entire building of coworkers.

    And Added Again: And there is septic shock, another form of distributive shock in which bacterial products cause widespread vasodilation.
    Last edited by Pyekett; 02-05-2013 at 08:11 AM.
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  5. #5
    Mr. Boo is watching you. rosehips's Avatar
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    In my case, I've gone into "shock" twice. The first time it happened when I got knocked down. I think I was nine or so, and I don't really remember what happened very well. I know I got knocked down, and then I got all dizzy and had to put my head between my legs and wait for the whatever it was to pass, but I don't suppose that's the real shock people are talking about here. Then the second time I was already in the hospital with an infected pilonidal cyst. If you aren't familiar with this condition, I will be brief and say it is an absess located at the base of your spine, and it is excruciating. And actually, come to think of it, on two occasions during this period of time, I passed out. The first time they made me walk to the x-ray room, and I passed out in the hall, and the second time they wanted me to remove a long, packed drain after taking a shower, and I passed out. This was over twenty years ago, and I guess medical care has improved since then, because I've been to the hospital for other things, and I can't imagine any nurse or doctor being so idiotic anymore.

  6. #6
    Hi, I'm a paramedic.

    As has been said, what your MC has is not shock. In medicalese it's termed acute stress reaction, but it's physically harmless and doesn't need any particular medical treatment. A quick assessment and maybe telling somebody to stay with her and get her a blanket should be all EMS does for her. The shoulder guy is much more important.

    Plains Pen has already laid out the basics of what would happen to shoulder guy, but I'm a nitpicky type, too: Airway, breathing, circulation. First they check if he can breathe and if he does, then they take care of the shoulder (= put pressure on the bleeding and immobilize it). Blood pressure and pulse are only part of a rapid physical exam. It also includes an examination of the guy's level of consciousness and mental status as well as any pertinent medical information (= they're going to ask him a bunch of questions), pupil size and reaction, presence of any discharge in nose and ears (= look at them with a pen light), presence of any other injuries including spinal (= pat him down, check under his clothes, check pulse on hands and feet, have him squeeze a medic's fingers and push his toes up and down against a medic's hands). One will be talking to him for the entire time, asking if this and that hurts, if he can feel the medic touching him and so on.
    Assuming he's breathing okay on his own he'll be c-collared and strapped to the backboard, which then is strapped to the gurney. We generally don't use tape for that. He gets oxygen and one, possibly two, IVs. There's more stuff but that mainly goes on in the back of the ambulance.
    Since a gunshot wound to the shoulder can cause actual circulatory shock, time on scene would be significantly less than fifteen minutes. An experienced pair of medics should get this done in less than five.

    Something that hasn't been mentioned yet: If there is more than one (real) patient EMS should call for backup. Also, if it's a scene with an active shooter, the police need to be there. If the cops haven't been called yet, the medics will call them and they should not enter the scene until the cops have told them it is safe.

  7. #7
    Mr. Boo is watching you. rosehips's Avatar
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    Thank you, all of your responses are extremely helpful.

  8. #8
    practical experience, FTW Dandroid's Avatar
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    As a paramedic myself, I echo asroc's post.
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  9. #9
    practical experience, FTW Dandroid's Avatar
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    Here's an example of a rapid trauma assessment...

    http://www.youtube.com/watch?v=n2wRW...e_gdata_player
    Rule #1: do what you love, love what you do.
    Rule #2: learn everything else.

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  10. #10
    Allegedly Gullible StormChord's Avatar
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    From what I learned in CPR and First Aid, you're supposed to regulate their temperature - via blankets or sunshades - and refuse them water or food because they might need surgery. This is, of course, only true of the shock that can result in organ failure. Treatment for shock at nearly getting shot will probably be to give them a cookie and make sure they don't pass out.
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