Episode 4: SHOCK!

Welcome to Episode Four of First Aid Unboxed

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Mark: Welcome to episode four of First Aid Unboxed with Louise Madeley from Madeley's First Aid Plus. Hi Louise, how are you doing?
Louise: Very well, thank you.
Mark: Can you believe we're at episode four already?
Louise: I know, where's the time gone?
Mark: Time flies when you're having fun, apparently.
Louise: Oh, it does, progressively.
Mark: When we started all these podcasts, I said to Louise, what order should we do this stuff in with first aid? And we came to the conclusion, when Louise worked in A&E, it's the order that people came in with. So we started off with cuts and bleeds, which is the most common thing in A&E.
Mark: The next most common thing then, please, what are we doing today?
Louise: We're doing shock.
Mark: Shock.
Louise: Yeah.

What is Shock?

Mark: Now, when you say shock, I was thinking shock.
Louise: Well, sort of, yes.
Mark: First of all, what is shock?
Louise: Okay, shock isn't when somebody goes boo, and suddenly you jump. That isn't what shock is, in a medical sense. Shock is actually a physical or physiological response that the body has to various situations or conditions, in a nutshell.
Louise: So, it's important to know there's lots of different types of it. We're not going to go into graphic detail about all the different types, because actually, you don't need to know it. When it comes to first aid, not necessary.
Louise: Some of it to a degree, but on the whole, you don't need to be an expert in the different types of shock, but it's worth noting them. The sort that we're talking about is, it's got a big posh word, hypovolemic shock. Sounds like a big posh word.

Understanding Hypovolemic Shock

Mark: It does.
Louise: It's actually not. It's Latin. And all it means is hypo, low, vol, volume, emic, blood.
Louise: So it's a low volume of blood in your system. Some people call it circulatory shock, is another word for it. But that's the sort of shock that we're talking about.
Mark: What would cause that type of shock?
Louise: Hypovolemic, in other words, hemorrhagic. So hemorrhagic, a hemorrhage, or you're leaking, basically. So shock can be triggered by a lot of different factors, but severe bleeding is the primary one.
Louise: It can also be caused by infection, heart problems, allergic reactions, traumatic injuries, many different things, but we're really talking about the severe bleeding. So your body is leaking.

Recognizing the Signs of Shock

Mark: So how do you know if someone is in shock?
Louise: Okay, if somebody is in shock, then you are looking at, for example, we're talking about somebody bleeding, and as a result, they have low blood pressure. Okay, so we're talking about the fact that they would look very pale, gray, blue, sort of look in their skin. Clammy, cold to touch, feeling sick, feeling thirsty.
Louise: Their breathing becomes really rapid and weak, as does their pulse. So they will be breathing very quickly. Chest will be going up and down very quickly.
Louise: But when you feel their pulse, it'll be going very fast and very weak. I call it thready. It's like a thready feel on their pulse.
Louise: But generally, they will look very ashen, very grey.

The Internal Effects of Shock

Mark: And what's actually happening to them inside? Is it a physical and a mental thing, or is it just a physical reaction?
Louise: This is a physical reaction, yeah. So what's actually happening is that the heart is pumping a lot quicker. So if we go back to the plumbing and the circulatory system, everything is being pushed around much quicker.
Louise: If you're bleeding and you've got a leak, then as a result, the pump is going to go twice as fast. It will do. But at the same time, it's coming out.
Louise: So yeah, the heart's having to work a lot harder. It's taking the blood from other places. Hence, you go very pale.
Louise: And everything is trying to be pushed around quicker in order to keep those organs going. Because if you're not getting the right nutrients and oxygen to the other organs, the important organs, then your body is going to die.
Mark: Your heart is going into emergency mode.
Louise: Trying to work.
Mark: Your whole body is.
Louise: Trying to deal with the, wherever the problem is, wherever the leak is, for the want of a better phrase.
What to Do If Someone Is in Shock
Mark: And what's the first thing you do? So we're getting to the first aid bit now.
Louise: So obviously someone's in shock. We know they're in shock because of the way they look and the way, from your description. So what's the first thing we do then when we realize that someone is in shock?
Louise: First thing you need to do is find out why they're in shock as much as anything. So if it is hypovolemic shock, which is when you're bleeding, find out where the injury is for starters, see if you can stop the bleeding. It may be that they're bleeding on the inside.
Louise: You may not be able to see it. It may be that they're bleeding into the abdomen, for example. So in which case, when you're doing a primary and secondary survey in first aid, you're having a look for that to see whether or not there are palpable areas of your body that are looking bigger than they should do.
Louise: Or if your abdomen is like a drum, and it's sticking out like a drum, and very tight, then it could well be that you're bleeding into your abdomen. In which case, you'll have exactly the same thing, namely shock, as you would if it was bleeding out from somewhere. However, as a first aid, there's nothing that you can do about that.
Louise: All you can do is keep them comfortable, lie them down, lift their feet up. I've got a phrase that, if the face is pale, raise the tail. If the face is red, raise the head.

When to Call for Emergency Help

Louise: The one time this doesn't count is when somebody's having a heart attack. But if the face is pale, raise the tail. So lift the feet up and put them onto a chair, onto a box or something, lying on the floor, head down, but get the feet up.
Louise: If the face is red, it could be that they're in anaphylactic shock, in which case, you need to raise the head. So you need them sitting upright. So that's always a good one.
Louise: Making them comfortable, lying them down, raising their legs, keeping them warm as best you can. It is always an ambulance situation, always. It's a 999.

Treating Other Causes of Shock

Louise: All shock is life-threatening, full stop. I'm saying before that there's lots of different types, and that does make a difference to how you treat somebody in shock. For example, if it's a hemorrhage that's causing it, if it's septic shock, which is caused by an infection, again, there's nothing that you can do as a first aider, except lie them down, raise their feet, keep them warm.
Louise: The important thing is getting the ambulance there as quickly as possible. They're going to need antibiotics and other treatment, and fluids and so on. Heart problems, allergic reactions, as I was saying before, if it's an allergy, anaphylactic shock, if they have an EpiPen on them, or an AAI, as they're called, and we'll do anaphylaxis another time, but effectively adrenaline that they need injecting, or if it's traumatic injuries that you can stabilize in some way, reducing the blood flow.

Addressing Emotional and Psychological Shock

Mark: Well, let's just quickly look at these other potential shock situations, because I often think about people who go into shock because they've seen something horrific, so they've been involved in a car accident or something like that. Is that shock or is that something else?
Louise: It is a form of shock, yeah, of course it is. But in these situations, it's a question of if somebody sees something particularly traumatic, then you need to keep them calm, you need to keep them warm and have them treated at the hospital exactly the same as the others, as anybody else that's in an accident. Because again, you don't always know, if somebody goes very quiet, for example, it may be that they're in shock, but you don't know if something else has happened as well.
Louise: A quiet person always concerns me in first aid. I want to make sure that there's nothing going on, whether they've had a head injury, for example, or some other traumatic injury that you can't necessarily see. It's not always the person that's shouting the loudest that is necessarily the one that's in the worst condition.

Shock is Always an Emergency

Mark: So regardless, then they're going in an ambulance and they're going to A&E to be treated.
Louise: Absolutely. Anybody in shock, whatever type of shock, it's always an ambulance, it's always to A&E department, full stop. It's always life-threatening or it can be if intervention isn't early.

Long-term Implications of Shock

Mark: So what are the long-term implications of this?
Louise: Well, unfortunately, it can be that somebody will lose their life when it comes to shock. It's an emergency. It's a question of getting them to A&E as quickly as possible.
Louise: It depends on what's caused it in the first place, in a nutshell. So, for example, somebody who has septic shock, sepsis is life-threatening. I have had sepsis four times in total.
Louise: The first time I had it, it was extremely life-threatening. I went from very fit, very well, and very healthy. In fact, it happened at four o'clock in the morning when I went into something called Rygors, which is when you start shaking from your temperature going up to 40 degrees.
Louise: When I got there, it was 42, and I became very sick very quickly. All your blood vessels open from infection. That's just a natural response.
Louise: Blood pressure drops, and I became very poorly very quickly. I was heading to the HDU in a matter of two or three hours. And before that, I was fit and healthy and went to bed expecting to get up and do a normal day's work the next day.
Louise: And instead, I woke up in HDU instead. So it can be potentially life-threatening. So it's about recognizing it early, especially the ashen and gray look, the fact that their heart rate's going really quickly, the fact that they are looking very poorly very quickly, and the speed of onset as well.
Louise: It can happen so fast. So it's about getting them to emergency services as quickly as possible.

Preventing Shock from Escalating

Mark: So there's no sort of lead up to this, this just happens.
Louise: It depends on the cause again. If it's sepsis, then no, it can just happen. It's an infection, or rather, it's a massive response to an infection.
Louise: The infection itself might not be particularly life-threatening, and it wasn't in my case. But the reaction of the body was life-threatening, which is what sepsis is. It's an overreaction of your immune system, sepsis, basically.
Louise: Hypovolemic shock caused by bleeding, for example, then the fact that they are bleeding out, you need to stop that bleeding. And if you don't stop that bleeding, they're going to die.

Key Takeaways for Managing Shock

Mark: I mean, we talked about this in the last episode regarding bleeding and cuts. And obviously, there's a whole process you can go through there before, hopefully before you get to the shock situation to try and avoid that.
Louise: Shock is a very extended problem following on from bleeding, yeah.
Mark: So with shock, what's your takeaway? What order do we need to do things in?
Louise: Takeaway probably is that you need to remember that shock is a critical condition. So it's your body's circulatory system, and it will fail to deliver enough oxygen and nutrients to your organs and your tissues. Because of that, the chances are that you could die if you don't get treated, which is why it's a 999, and it's an emergency, okay?
Louise: The only thing that you can do as a first aider is to lie them down, make them comfortable. Don't try and give them anything to eat and drink. Tempting as it is because they've got low blood pressure, still do not give them fluids.
Louise: The minute the ambulance arrives, they will be putting fluids up and giving it intravenously. So you don't need to worry about that. It is tempting, though, to give them something.
Louise: Don't. And again, it's really about keeping them comfortable, keeping them reassured, and getting help to them as quickly as possible.

The Role of Intravenous Fluids in Emergencies

Mark: When the ambulance is putting fluids in, are they fluids to replace the blood that you've lost? Or is it other things? Are they putting in drugs of some sort?
Louise: Depends on the situation. Generally it is fluids that is basically just to lift your blood pressure back up. It's not generally antibiotics and so on, and medication unless you're in pain or something else going on.
Louise: But no, it's fluids to bring your blood pressure back up, so that your heart has got something to pump around.

Emphasizing the Importance of Dialing 999

Mark: So I think the takeaway is, call 999.
Louise: Absolutely.

Exciting Updates from Madeley's First Aid Plus

Mark: I totally get that. Right, let's talk a little bit about Madeley's First Aid Plus, because you've got something quite exciting going on, haven't you? Hopefully, the new website will be up and running next week, were you telling me?
Louise: Yeah, Thursday, fingers crossed.
Mark: Yes, and what's the new website going to be, what's it going to be offering people?
Louise: It's going to have the podcast on it, for starters. It's also going to have the blog on it. It will be significantly easier to book on courses as well.
Louise: It's got a much better booking app on it for booking on to different courses. It also explains the courses a lot better, what's in them, the content and the delivery, goes into much more detail about that.

Customised First Aid Training for Companies and Individuals

Mark: So that's a complete overhaul basically, of your booking and your...
Louise: It is. It looks at the different industries as well, goes through different industries as to what courses I deliver, depending on, because I do it differently, if you like, in that I do it bespoke. So if I go into a company or go into an organization, it will depend on their first aid risk assessments and their policies that will determine what sort of course I deliver.
Louise: So some places may have heavy plant machinery, therefore they need the catastrophic bleed element, this sort of thing. So every course that I do or that's delivered is bespoke to the company and depending on what they have and what hazards they have in there.
Mark: So there's not a one size fits all for a first aid course then?
Louise: There never is, no.

Accessible First Aid Courses for Individuals

Mark: And you will look at the company, look at their risk assessment and say, right, these are the things that we need to be looking at. And obviously, you do courses for companies. Do you also do courses for individuals as well?
Louise: Yes, I do. I do open courses. So you can go onto the website and book on to an individual course.
Louise: And I do those throughout the year. So yeah, between one and 12 people. 12 is the maximum I can do for a first aid course because it's a qualification, it's an RQF.
Louise: So it's Ofqual regulated, which means it can't have more than 12 people on it. But yeah, you can book on as an individual. It's extremely good for people who say there's just them in the company.
Louise: But for example, a holistic practitioner, they may have somebody who could pass out, who could, if you're a yoga teacher, for example, somebody may injure themselves in some way, you really need a first aid course. But there's only you, it doesn't matter, you can just book on.
Mark: And even if you're just a member of the general public who wants to have more knowledge about this sort of thing.
Louise: Absolutely, yes.

Innovating with Sustainable First Aid Kits

Mark: And the other thing you were talking about the other day, when we were talking, was first aid kits.
Louise: Yeah.
Mark: And you're putting together Madeley's First Aid Plus kits.
Louise: I am, yeah.
Mark: Yes, tell me a bit more about that as well. I'm intrigued by this.
Louise: Well, I'm working with Innovate UK to develop new first aid kits, which I know there are millions out there in the market. Mine are gonna be slightly different. I can't go into too much detail about them, but they, for starters, will be far more sustainable.
Louise: At the moment, even those that are sustainable aren't as sustainable as you might think. They're using it as much as they can that's sustainable, but there's still a long way to go. Even the sustainable ones, the biggest risk, if you like, is trying to find a way of making it sustainable, but it can still go in CSSD, which is how we sterilize everything, and finding the right material to be able to sterilize.
Louise: So even the sustainable ones at the moment tend to be wrapped in plastic, for example, the different bandages and so on. So it's finding a material that's good, that will tolerate the high enough standard for it to be used. So yeah, it's all in the pipeline at the moment.

Bespoke Kits for Specific Environments

Mark: And will the kits be bespoke as well to what the environment they're being used in or put into?
Louise: Yes, absolutely. They will be bespoke to anything that's required. It'll depend on the risk assessment that's made in the first place as to what's needed in the first aid box.
Louise: And that's what tends to get missed in a way. People will get a one to ten HSE first aid box, pop it in their establishment, and it might not be compliant for the environment it's in. It's about knowing your environment, knowing what you have that may be a hazard, and making sure that you've got the right stuff in there to treat whatever may come your way.
Mark: So you'll do the servicing of the boxes as well as actually selling the boxes in the first place?
Louise: Indeed.

How to Get in Touch with Madeley's First Aid Plus

Mark: And if people want to get in touch with you, what's the best way to do that? About anything to do with first aid, what's the website address?
Louise: It's madeleysfirstaidplus.co.uk.
Mark: Okay, and if people want to get in contact with you?
Louise: You can email me on inquiries at madeleysfirstaidplus.co.uk.

Looking Ahead to Future Topics

Mark: So all the information there is on the website. All you need to do is go to madeleysfirstaidplus.co.uk and have a little look on there. So we'll have another podcast in a couple of weeks' time.
Mark: What do you think we'll be talking about then?
Louise: Should we go with heart attacks?
Mark: I think heart attacks would be a very good one.
Louise: Sounds like a good one. Stick with the plumbing.
Mark: Absolutely. So we'll be talking about heart attacks and things like that. Are heart attacks and cardiac arrests the same thing?
Louise: No, they're not.
Mark: Different treatments, different?
Louise: Absolutely, yes. No, they are not the same thing. One's the plumbing, the other's the electrics.
Mark: Well, I'll tell you what we'll do. We'll save that for the next episode and people can find out. Thank you very much, Louise.
Louise: Always a pleasure talking to you.
Mark: Likewise.
Mark: Looking forward to the next one, which will be out in a couple of weeks' time. Keep your eye on it or subscribe or follow. We'd love to hear any reviews, love to hear any comments you've got.
Mark: If you want to get in touch, just go to the Madeley's First Aid site or the 1386 Audio site, 1386audio.com, and you can leave comments and messages there as well. Thank you very much, and we will see you in a couple of weeks' time.
Louise: Thank you.
Mark: This is a 1386 Audio production.
Louise: Thank you.

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