Understanding Shock: Introduction

Ladies and gentlemen, it is time to crack the door to a vast and terrible realm.

It won’t be a short journey, and it won’t be an easy one. But it is our destiny.

What am I talking about? I’m talking about shock, of course.

Prehospital providers don’t understand shock. That’s understandable — because shock is complicated. It’s as complicated as disease processes get.

But we need to understand it. Shock is quite literally in our blood. Since the very birth of EMS, reducing the harm associated with shock states has been one of our main reasons for existing. It kills many, it debilitates many more, it spares no age, race, or gender, and its physical effects are exhaustively widespread. Yet when properly managed, many of those patients can be saved.

We should all be experts. To work in EMS is to be, among other things, a shock technician. This is our wheelhouse.

So, although it will take more than a few posts to walk through the different facets of this Very Big Topic, let’s talk about shock.

Sharpen your pencils, gird your loins, and stand by for further.

Understanding Shock II: What the What?

Understanding Shock III: Pathophysiology

Understanding Shock IV: Bleeding Control

Understanding Shock V: Blood Transfusion

Understanding Shock VI: Fluid Resuscitation

Understanding Shock VII: Negatives of Fluid Resuscitation

Understanding Shock VIII: Prehospital Course of Care

Understanding Shock IX: Assessment and Recognition

Understanding Shock X (supplement): Fluid Choices


  1. Pre-hospital providers don’t understand shock because, let’s face it. We’re taught to treat shock the same every single time. Keep patient warm, apply O2, and punch it to the ED.

    Shock is a complicated beast of a medical condition (that needs to be treated rapidly). I look forward to reading this series.

  2. I disagree with Fern. We treat cardiogenic shock differently from anaphylactic shock differently from hypovolemic shock differently from hypovolemic shock differently from neurogenic shock, etc…

    When I was first in EMT school, I was taught that shock was “inadequate tissue perfusion.” In reality, it is much, much more than that.

    We have to be able to recognize the differences between the types of shock, then know which treatments to apply. I am looking forward to reading more as well.

    I love sick people. Give my a good heart failure over a multiple gunshot wound any day!

  3. CCC, I may be wrong, but here’s what my protocols say:

    “Shock (Hypoperfusion) of unknown etiology.”

    Page 78 on this PDF: http://www.mass.gov/eohhs/docs/dph/emergency-services/treatment-protocols-902.pdf

    Now, yes, there’s different problems behind different types of shock. For example anaphyalaxtic shock you’ve got to worry about airway vs. hypovolemic shock from burns (need lots of fluid to keep those RBCs moving).

    CCC, I’m not disagreeing with you, but I have found that many of my fellow young EMTs that are at the same college as I am, simply go to the minimum bar and then make that bar stupidly simple. That’s been my experience.

    • Fern, by all means, disagree with me. It’s okay, and I promise I won’t get my feelings hurt. This is a dynamic field we are in, and the best way to learn is to study and discuss with others.

      It’s not just your fellow EMT students (I’m kinda confused, are you an EMT in Paramedic school, or in EMT school? Not that it matters…) that “go to the minimum bar and make that bar simply stupid.” It’s an overwhelming majority of providers in EMS. “Why would I want to be a critical care paramedic? That means I will have to run more nonemergency calls?” is a comment I hear frequently.

      Regretfully, most students attend school with the goal of passing a test. They don’t want to put forth the effort to be more than that. The fact that you read blogs, and are interested in learning more, puts you light years ahead of other students. The fact that you comment (coherently, too) on blogs puts you ahead of others who may peruse blogs for fun late at night.

      I don’t think your protocols are agressive enough, but then, protocols have the same problem you previously mentioned. Protocols are written for the lowest common denominator. For example, your protocol states to “administer a 250mL bolus of IV Normal Saline…” For the septic patient, that is simply not enough. For a patient in septic shock, treatment recommendations are 20ml/kg, and may be as much as 60ml/kg. That would be at least 2 liters of fluid for a 220 pound patient.

      Knowing protocols is important, but not as important as how to properly assess your patients.

  4. “Knowing protocols is important, but not as important as how to properly assess your patients.”


    I am a full-time college student as well as being a Mass. EMT, although I am considering going for an intermediate later on in life (don’t really want to do all the drug calculation stuff. I just don’t trust myself with it.) I am an advocate for the best provider that we can be.

    You just gave me an excellent idea for a blog post. While I have covered some of these topics previously on my blog (here: http://fire-rescue-newbie.blogspot.com/2011/12/rebuttal-to-medic-sbks-thoughts.html as well as here: http://fire-rescue-newbie.blogspot.com/2011/09/what-should-we-be-called.html

    Your words lit the lightbulb in my brain. I’ll get right on that later today and we can delve into this further. (Not trying to take away from Brandon’s topic of shock at all, but this conversion is probably going to quickly evolve into EMS as a whole. If you are wondering why this is making 0 sense I am running on fumes and need some sleep right now.)

  5. Count me as excited! Sorry for the late comment, I’m about 2 weeks (and 300+posts) behind on my blogroll. Ugh.


  1. […] we like to talk around here about exciting topics like shock and airway management, the reality is that for many EMS providers — particularly at the BLS […]

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