Shock

As is typical on nightshifts my brain has turned largely into mush. I work, I sleep, I eat and I wash. Beyond that very little penetrates the gray haze that surrounds everything.
Which is my way of trying to excuse any impenetrability of the following blogpost.

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I am trying to get away from writing about patients who are being a bit daft anymore. A lot of the time it's not really their fault that they just don't understand their body enough to realise what is an emergency and what isn't.

But.

Last night we found ourselves going to multiple calls with multiple patients all suffering from 'shock'.

For those of us in the medical field Shock means something rather definite, it means that the tissues of the body are lacking in oxygen, in most cases this is caused by people losing the red, sticky stuff that flows around the body and carries oxygen to those same tissues.

What 'shock' seems to mean for everyone else is 'a bit worried, a bit scared or a bit upset'.

This is not a medical emergency.

While I dearly love the police, they do seem to have a habit of sending us on calls to patients suffering from this second form of shock. So during the shift we found ourselves going to a woman who had been involved in a verbal argument with her son and two car crashes.

Take one of the car crashes as an example.

When I say that I could do more damage to their car with my size 12 boot than had been caused by this collision you understand that it was a minor bump rather than anything serious. But still we are sent to the woman who was hit who was complaining of… well… feeling a bit upset.

And, of course, she wanted to go to hospital in order to be 'checked out', and as she wanted to go we had no choice but to take her. After a ten minute drive with my crewmate chatting to her in the back she was feeling somewhat better, but still seemed surprised when the triage nurse (rightly) sat her out in the waiting room.

A later call had someone who had been mugged as, once more, 'shocked'. And once more it would be fair to say that they were actually just a bit shook up. Nothing that a fully equipped emergency ambulance and A&E department could do. Certainly nothing more technical than to make a cup of tea and have a good sit down and a natter. Important, yes, but not really something for a vehicle that has the word 'emergency' written on the side in big un-friendly letters.

My point about the use of terminology is not one of making sure the 'right' term is used out of some sort of grammar nazism – instead it's so that people think twice before calling an ambulance for someone a who is 'upset' rather than 'shocked'.

23 thoughts on “Shock”

  1. I've heard and seen numerous news reports where after some catastrophe/accident, “5 people were treated for shock and minor injuries at nearby XYZ Hospital.”Must be hard for the average punter feeling a bit dicky and panicked to know if and why the people they've heard about all the time to had to be admitted…?

    I don't know why, myself, in fact?

  2. If all they need is a cup of tea and someone to hold their hand, someone should do that without the necessity of nursing training.

  3. The problem I've seen is people who have done First Aid training who do not understand that what they are taught to deal with are life threatening situations – someone who is a little shaken up is offered a cup of tea by a friendly shop keeper and they come running in screaming “I'm a First Aider – NO FLUIDS!!”

  4. maybe the LAS should consider installing a tea urn in it's ambulances, and some fluffy cushions. it'd allow you to treat shock more effectively…

  5. It sounds, from a psychiatric view as if you could do with counsellors as responders, secondary that is.if u pass a person fit, and they are still psychologically traumatised a counsellor should be on hand and it would save a lot of your time.

  6. I was shouting that at the TV on Sunday while watching that Dancing on ice thingy. One of the “celebs” had a fall, and when she was talking about it she said “I went into shock”. I was yelling “that's not shock you ejit” at the TV! She had a shock, or was shaken up,but that was it.

  7. it's all the fault of you English I say. If your language wasn't so screwed up then this problem wouldn't exist 😛 maybe we should ask the police what type of shock it is before deciding to send in Reynolds or a social worker …

  8. If I remember my training correctly (and it was a LONG time ago), the definition of shock ran something like “any condition leading to inadequate tissue perfusion”.I suggest that call takers ask callers if patients' tissues are adequately perfused. That'll learn 'em.

  9. Installing tea urns sounds like an excellent plan. When it's not being used to deal with shock victims the crew could use it. After all, they'd need to, to get over the shock of having it there!

  10. Seriously. It's the fault of English, if not you English. It's the same problem the scientists have when talking about whether they're sure of something, for instance in court. Scientists are never sure of anything. Even the law of gravity is a probability statement. But a non-scientist, for instance on the jury, who hears the word “probability,” feels that the scientist has just said “uncertain.”Non-specialists are going to use words like “certainty” and “shock” colloquially. That's just all there is to it. I don't see the solution as expecting them to acquire a specialist's precision. Better for the scientist to say, “You're as likely to be hit by an asteroid right now as that these two blood samples match.” Or for the dispatcher to say, “Is the person cold and clammy to the touch?” . . . or whatever the symptoms of clinical shock are. I'm shocked — shocked! — to realize I don't know.

  11. What came first, the colloquial use or the medical usage? Something tells me that “shock” as a synonym for “jolt” or “impact” came first, so it's you lot who caused the confusion, not the rest of us.

  12. The man of street will always use words the way they mean them [see the mad hatter in Alice for his wise explanation of words], it is up to the specialist to find a word that has a precise meaning, for example “aorta”, to the layman its translation , heart , could refer to a nice lettuce.So I suggest “Ictus ” L shock.Cardiac Ictus, in Lieu,Clinical Ictus

  13. I just Googled “treated for shock and minor injuries” (the exact phrase with the quotes) and got 433 results – I didn't scan them all, but most on the first few pages were news reports.Since minor injuries don't appear able to cause the kind of clinical shock that's associated with large loss of blood, I'm posting this to support my earlier point that the media's presentation of “shock” (of the severely upset kind) as something absolutely requiring hospital treatment is far more to blame in this case than the (usual) patient error.

  14. stand corrected:The aorta is the main trunk of a series of vessels which convey the oxygenated blood to the tissues of the body for their nutrition.

    see wiki.

  15. Well, it's unlikely that any of those 5 people would have been admitted either, as they'd all have been suffering exactly the kind of thing Tom's talking about.I guess the media reports wouldn't be as snappy if they said “5 people are hugging a nice cup of tea and trying to calm themselves down a bit.”

    That said, in terms of inadequate tissue perfusion, I think that several times in my life upsetting/stressful things have sent me into shock. Of course, these episodes of shock presented mainly as a couple of seconds of whitening of the face and maybe hands before I came out of shock all on my own.

  16. Well, my feeling is that we aren't going to be able to get the general populace and even police officers to stop saying “shock” when they mean “shook up” or “upset”. Even when talking to medical people.I've always found it weird that some medical person latched onto the word and used it to describe hypoperfusion. and then we use acute stress reaction or other terms to describe what most people describe as shock. We did it to ourselves really.

  17. We did it to ourselves really.”That's my impression as well: this interested me, so I did a straw poll of friends, fam etc, and it turns out that a few of them did think a severely upsetting event alone, which came with minor injuries at most, may require hospital treatment, lest the person start to suffer from what were described as similar symptoms to the clinicl shock described.

    Interesting first aid suggestions for this kind of “shock” also included keeping the person warm and giving them sugary tea.

    Definitely a case for the media to step up as well, and stop using the same clichd term to describe being upset (albeit severely, and with good cause) as something always requiring immediate “treatment.”

  18. The day after this post, I got a call from the police which just said “patient is in shock”. I asked what injury the patient had and they said “no injury, she just walked in on her house being burgled”. So I replied with “'In shock' is a life threatening condition usually caused by severe blood loss. This patient has had a shock”. I bet they thought I was being a right smartarse but it annoys me too.

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