Emergency Medicine: This Is The One Thing You Haven’t Planned For

Emergency Medicine: This Is The One Thing You Haven’t Planned For
Jeremiah Johnson

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Good Day, guys and gals in Ready Nutrition land.  JJ here with another trauma medicine segment that it would be worth your while to file away with your first aid notes and prepping supplies.  We are all sure that someday we will need to use these supplies and reference materials.  Hopefully your prepping now will take some of the bite out when crunch time comes, whether that be a short-term or long-term emergency or disaster, or if society goes kaput as a whole when the SHTF.
Today’s article covers the parameters of shock, an ever-present and always-looming specter haunting every medical emergency and waiting in the wings to strike.  What is shock?  Well, it is a very broad category.  Taber’s Cyclopedic Medical Dictionary, 19^th Ed., pg. 1884, defines shock as “A clinical syndrome marked by inadequate perfusion and oxygenation of cells, tissues, and organs, usually as a result of marginal or markedly lowered blood pressure.”
Well, that’s certainly a mouthful!  But what does it mean?  Basically, as oxygen is carried to the tissues by the blood, it is almost akin to the entire body running out of air (oxygen, specifically), and being unable to supply the organs and systems.  That is an oversimplification, of course; however, it means that the homeostasis that your body maintains by regulating itself in terms of autonomic function (controlled by your body automatically) is out of alignment or not functioning at all.

Signs of Shock

Causes can be dehydration [from heat injuries], bleeding (i.e., hemorrhage), cardiac/heart problems, trauma, disease, poisoning, and so forth.  Common symptoms are confusion, agitation, restlessness, anxiety, difficulty breathing.  Remember: symptoms are what a patient feels.  Signs are those things that can be monitored, seen, and quantified:

• cool or clammy skin
  
• cyanosis (turning blue of the skin)
  
• racing/irregular heartbeat
  
• blood pressure failure
  

Readers, here’s the rule for you:  Shock is a life-threatening condition and a medical emergency that must be definitively treated after first aid is rendered to stabilize the patient!
Once you have stabilized the patient, you must take him or her to a doctor or a hospital.  Fluid resuscitation is vital, in most cases, and this involves oral replacement (as in hydration with water and/or electrolyte containing beverages such as Gatorade or Powerade) and/or IV therapy.  So what do you do?  When does this happen?  Let’s take a hypothetical patient: Johnny B. Goode, with whom you went camping.  Johnny was digging a fire pit and accidentally dug into a buried electrical cable, and he suffered a severe electrical shock and passed out.  You come upon him lying on his back with some burns on the hands and face and his clothes burnt in the front, his teeth chattering and babbling incoherently.  You assess the situation: Johnny is going into shock.  Time to act.

1. Check your patient for signs of shock: Look for sweaty but cool skin, pale skin, restlessness or nervousness, thirst, severe bleeding, confusion, rapid breathing, blotchy blue skin, nausea and/or vomiting.      [Johnny is nervous and confused with rapid breathing…you determine he is definitely going into shock]
   

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[*]Position your patient: Move him/her to cover if available, lay patient on back or in sitting position (whichever is easier to breathe for him/her), and elevate the patient’s feet higher than the heart using a stable/stationary object (such as a log or a rock)….Note: You elevate the feet only if there is no C-spine (cervical spine) injury, head wound abdominal wound, or unsplinted fractured or broken leg. 
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[*]Loosen clothing at the neck, waist, or anywhere it is tight or restrictive.
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[*]Prevent the patient from becoming chilled or overheated: Using a blanket, clothing, or improvised material (pine boughs, cardboard, etc.) cover your patient to prevent heat loss…and in cold weather, place material under the patient as well…preventing heat loss into the ground.  In hot weather: place the patient under either a permanent shelter (a cave/rock hollow), or improvise a shelter (using a blanket tied off at the four corners for a shade/awning) to protect from direct sunlight and overheating.
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[*]Calm and reassure your patient: Believe it or not, this is the most important one of all if your patient is conscious.  Take charge and show him/her that the situation is under control.  Give constant reassurance that the patient is being taken care of and you are going to keep the patient safe.  Do not leave your patient!  If you must leave to deal with something else (a runaway brush fire or a grizzly bear), first turn the patient’s head to one side (barring C-spine injury) to prevent inhalation if the patient vomits.
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[*]Watch the patient and monitor for life-threatening conditions that may develop…and SEEK MEDICAL AID!
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So there are your basic steps.  Other important considerations are for your first-aid kit and emergency gear.  I always travel with a large rucksack in my vehicle that has both a poncho liner and a space blanket.  In addition, I carry a U.S. Army issue foam pad for use under my sleeping bag.  You can find ones a little more “non-Neolithic” that actually inflate; however, these foam ones are cost-effective and replaceable.  They also work: they’ll insulate you from the ground (as mentioned earlier).
You are your own best monitor, and when you’re not monitoring yourself, you need to help monitor the others in your group.  Teach them to do the same.  You can all mutually support one another and prevent shock before it occurs in times of high physical exertion such as comes with a disaster or an emergency.  Remember, this article is for informational purposes and is not meant to diagnose, treat, or prescribe any condition or action outlined herein.  Consult with your licensed, certified, state-sanctioned-state controlled physician prior to taking any actions as outlined in this article.  Take care of yourselves and each other, have a great time in the outdoors, and be safe.
 
JJ

Jeremiah Johnson is the Nom de plume of a retired Green Beret of the United States Army Special Forces (Airborne). Mr. Johnson was a Special Forces Medic, EMT and ACLS-certified, with comprehensive training in wilderness survival, rescue, and patient-extraction. He is a Certified Master Herbalist and a graduate of the Global College of Natural Medicine of Santa Ana, CA. A graduate of the U.S. Army’s survival course of SERE school (Survival Evasion Resistance Escape), Mr. Johnson also successfully completed the Montana Master Food Preserver Course for home-canning, smoking, and dehydrating foods.
Mr. Johnson dries and tinctures a wide variety of medicinal herbs taken by wild crafting and cultivation, in addition to preserving and canning his own food. An expert in land navigation, survival, mountaineering, and parachuting as trained by the United States Army, Mr. Johnson is an ardent advocate for preparedness, self-sufficiency, and long-term disaster sustainability for families. He and his wife survived Hurricane Katrina and its aftermath. Cross-trained as a Special Forces Engineer, he is an expert in supply, logistics, transport, and long-term storage of perishable materials, having incorporated many of these techniques plus some unique innovations in his own homestead.
Mr. Johnson brings practical, tested experience firmly rooted in formal education to his writings and to our team. He and his wife live in a cabin in the mountains of Western Montana with their three cats.