Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
EMS personnel are well trained in the initial assessment of the patient in shock. The first course of action is to make certain that the
ABCs have been assessed. The so-called ABCs are:
Airway: assessment of whether the patient is awake enough to try to take their own breaths and/or if there is there anything blocking the mouth or nose.
Breathing: assessment of the adequacy of breathing and whether it may need to be assisted with mouth-to-mouth resuscitation or more aggressive interventions like a bag and mask or intubation with an endotracheal tube
and a ventilator.
Circulation: assessment of the adequacy of the blood pressure adequate and determination of whether intravenous lines are needed for delivery of fluid or medications to support the blood pressure.
If there is bleeding that is obvious, attempts to control it with direct pressure will be attempted.
A fingerstick blood sugar will be checked to make certain that hypoglycemia (low blood sugar)
does not exist.
In the emergency department, diagnosis and treatment will occur at the same time.
Patients will be treated with oxygen supplementation through nasal cannulae, a face mask, or endotracheal intubation. The method and amount of oxygen will be titrated to make certain enough oxygen is available for the body to use. Again, the goal will be to pack each hemoglobin molecule with oxygen.
Blood may be transfused if bleeding (hemorrhage) is the cause of the shock state. If bleeding is not the case, intravenous fluids will be given to bolster the volume of fluids within the blood vessels.
Intravenous drugs can be used to try to maintain blood pressure (vasopressors). They work by stimulating the heart to beat stronger and by squeezing blood vessels to increase the flow within them.