Shock & Unconsciousness

Shock is not simply "being shocked" by bad news. In medical terms, shock is a life-threatening condition in which the body's tissues are not receiving enough oxygen — either because the heart is not pumping effectively, blood volume is too low, blood vessels have abnormally dilated, or a combination of these. Without treatment, shock causes organ failure and death. Recognising shock early and responding correctly can buy critical time before emergency medical care arrives.

Unconsciousness presents a separate but related challenge: an unconscious person cannot protect their own airway. The tongue can fall back to block the throat; vomiting can obstruct breathing. The recovery position solves both problems with a single technique that can be learned in minutes.

Types of Shock

Understanding the type of shock helps explain both the cause and the treatment direction.

Hypovolemic Shock

Caused by loss of blood or fluid volume. The most common type in trauma.

Causes: Severe bleeding (internal or external), severe burns, severe vomiting/diarrhoea, dehydration

Signs: Pale, cold, clammy skin; rapid weak pulse; low blood pressure; rapid breathing; confusion; thirst; reduced urine output; collapsed veins in limbs

Cardiogenic Shock

Caused by the heart failing to pump effectively.

Causes: Heart attack (myocardial infarction), severe heart arrhythmia, heart failure

Signs: Similar to hypovolemic shock but may have congested neck veins and lung crackles (fluid backing up); often preceded by chest pain or cardiac history

Distributive Shock (Anaphylactic, Septic, Neurogenic)

Caused by abnormal dilation of blood vessels, so blood pressure falls even with normal volume.

Anaphylactic shock: Severe allergic reaction; may also have airway swelling, hives, vomiting Septic shock: Overwhelming infection; often accompanied by fever, confusion, known infection source Neurogenic shock: Spinal cord injury disrupts blood vessel tone; often accompanies spinal trauma; skin may be warm and dry (unusual for shock)

Obstructive Shock

Caused by physical blockage of blood flow: tension pneumothorax (collapsed lung causing pressure on heart), cardiac tamponade (blood around the heart), or massive pulmonary embolism.

These require specific medical interventions and are typically beyond lay first-aid capability — the primary action is emergency services as rapidly as possible.

Recognising Shock

Regardless of cause, the common signs of developing shock are:

Sign	Early Shock	Late Shock
Skin colour	Pale	Grey, mottled
Skin temperature	Cool	Cold
Skin moisture	Dry to clammy	Clammy
Pulse	Rapid, may be weak	Very rapid and weak or absent
Breathing	Fast	Very fast, shallow
Consciousness	Anxious, restless, confused	Reduced consciousness, unresponsive
Thirst	Present	Intense

⚠️ In early shock, the person may appear anxious or irritable and report feeling very thirsty. Do not dismiss these signs — anxiety and thirst are early indicators that the body is compensating for falling blood pressure.

General Shock Response

While specific treatment varies by type, the initial response is consistent:

1. Call emergency services immediately — shock requires hospital-level treatment
2. Treat the cause if possible: control bleeding, remove allergen, cool a heat casualty
3. Lay the person down — flat on their back, unless breathing is more difficult lying flat or injury prevents it
4. Raise the legs 20–30 cm above the level of the heart — this shifts blood from the extremities toward the vital organs. Do not raise the legs if there is a suspected lower limb fracture, spinal injury, or breathing difficulty
5. Keep the person warm — cover with a blanket; hypovolemic shock is worsened by cold (clotting is impaired)
6. Do not give anything to eat or drink — the person may need surgery; a full stomach under general anaesthetic is dangerous
7. Reassure and keep the person calm — anxiety increases oxygen consumption and worsens shock
8. Monitor continuously — pulse, breathing, consciousness level, skin condition

Specific Variations

Type	Additional Actions
Hypovolemic	Control bleeding; keep warm; maintain position
Anaphylactic	Epinephrine auto-injector if available; position as tolerated; airway priority
Cardiogenic	Semi-reclined if breathing difficulty; do not raise legs; prepare for CPR
Septic	Keep warm; emergency services; give any known antibiotics they carry
Neurogenic	Do not raise legs (risk of worsening spinal injury); keep warm; maintain inline cervical stabilisation

Unconsciousness

An unconscious person is at immediate risk of airway obstruction from the tongue falling back, and from aspiration if they vomit. The recovery position protects the airway when CPR is not required (i.e., the person is breathing).

Assessing Unconsciousness

1. Check for response: Shout and tap the shoulders. No response = unresponsive.
2. Check for normal breathing: Look for chest rise, listen for breath sounds (up to 10 seconds). Occasional gasping is not normal breathing.
3. If breathing normally: Place in the recovery position (see below)
4. If not breathing normally: Begin CPR immediately

⚠️ Always check breathing before placing in the recovery position. An unconscious person who is not breathing needs CPR — not the recovery position.

The Recovery Position

The recovery position keeps the airway open and allows fluid (vomit, blood) to drain from the mouth rather than being inhaled.

Steps — Standard Recovery Position

1. Kneel beside the person on their side
2. Place the near arm out at right angles to the body, elbow bent, palm facing up
3. Bring the far arm across the chest and hold the back of the hand against the near cheek
4. Raise the far knee so the foot is flat on the floor
5. Pull the raised knee toward you to roll the person onto their side, keeping the hand against the cheek
6. Adjust the upper knee to approximately 90 degrees to prevent rolling forward
7. Tilt the head back gently to open the airway and make sure the mouth is pointed downward
8. Monitor breathing continuously — check every minute

If the person shows signs of possible spinal injury (fall from height, high-speed collision), rolling them should be done with inline cervical stabilisation (one person holding the head in line with the body while another manages the roll).

If You Must Leave to Call for Help

Place the person in the recovery position before leaving. Return as quickly as possible.

Monitoring an Unconscious Person

While waiting for emergency services, monitor every minute:

• Breathing: Is it present and regular?
• Colour: Pink is normal; pale, grey, or blue (cyanosis) are warning signs
• Pulse: Check at the carotid (neck) — rate and strength
• Pupil response: Shine a light — pupils should constrict (get smaller). Fixed dilated pupils are a serious sign.
• Level of response: Does the person respond to calling their name? To pain? Not at all?

Report all findings to emergency services on arrival.

When an Unconscious Person Stops Breathing

If a person in the recovery position stops breathing normally, remove them from the recovery position, lay them flat on their back, and begin CPR immediately.

Quick Reference

Situation	Action
Signs of shock present	Lay flat; raise legs; keep warm; call emergency services
Anaphylactic shock	Epinephrine if available; emergency services; airway priority
Cardiogenic shock	Semi-recline; do not raise legs; prepare for CPR
Unconscious + breathing	Recovery position; monitor breathing every minute
Unconscious + not breathing	CPR immediately
Vomiting while unconscious	Roll to side; clear mouth; recovery position
Possible spinal injury	Inline stabilisation during any roll
Monitoring	Every minute: breathing, colour, pulse, consciousness

This guide provides general information on shock recognition and management. Shock is a medical emergency requiring definitive hospital care. These actions are designed to support life until emergency services arrive. Always call emergency services first.