Introduction: What is shock management?

Shock is an acute, life-threatening circulatory failure resulting in insufficient oxygen supply to vital organs. In emergency medicine, rapid and structured action is one of the key factors for the survival of the affected persons. So-called shock management comprises all measures for recognizing, treating and stabilizing a state of shock.

Professional shock management in the healthcare setting is of great importance for medical staff, caregivers and first aiders in the D/A/CH region, as well as for professionals abroad – for example, in Marbella or on the Costa del Sol. Every first aider must be able to recognize shock, initiate immediate measures and communicate correctly.

What happens during shock? Causes and symptoms

Physiological fundamentals

Shock is characterized by critically reduced tissue perfusion. It is often due to a failure of the cardiovascular system, in which the blood volume is no longer sufficient to provide adequate oxygen to the organs. Consequence: cell death, multi-organ failure and, without intervention, death.

Early symptoms of a state of shock

The symptoms of shock vary according to the cause, but show typical characteristics that should be recognized early:

• Pale, cold or mottled skin
• Cold sweats
• Rapid heart rate (tachycardia)
• Shallow and rapid breathing
• Lowering of blood pressure
• Alterations of consciousness, restlessness to apathy

The faster the signs are identified, the greater the chance of survival – especially for non-professional helpers the following applies: it is better to act once too late than too late.

Recognize and treat the most important types of shock.

For the management of shock, differentiation of the underlying type of shock is decisive. In clinical and preclinical practice, the following forms are particularly frequent:

Hypovolemic shock

Cause: Significant fluid or blood loss (e.g., from severe bleeding, burns, dehydration). Treatment: Volume administration, hemorrhage control, monitoring.

Cardiogenic shock

Cause: Heart failure, e.g., during myocardial infarction or heart muscle weakness. Treatment: Circulatory support medication (vasopressors, inotropics), oxygen supply, invasive measures depending on the cause.

Anaphylactic shock

Cause: Allergic reaction (e.g., to insect bites, food, medications). Treatment: Administration of adrenaline, antihistamines, volume replacement therapy, airway securing.

Septic shock

Cause: Severe infection with systemic inflammatory response, often caused by bacteria. Treatment: Rapid administration of antibiotics, fluid replacement, if necessary intensive care unit care.

Neurogenic shock

Cause: Central nervous system injury (e.g., due to head injury or spinal cord injury). Treatment: Volume replacement, stabilization of the nervous system, surgical intervention if necessary.

Psychological shock

This term does not refer to a medical circulatory disturbance in the strict sense, but to an acute reaction to stress. Symptoms may include palpitations, shortness of breath or circulatory weakness. First aid includes emotional support, avoidance of sensory overstimulation and, if necessary, psychological or medical care.

First aid in case of shock – what to do until the emergency team arrives?

When shock is recognized, every minute counts. Even simple first aid measures can save lives:

5 quick measures in case of suspected shock

• Calling 112 – clear information about the condition
• Check for vital signs: consciousness, respiration, pulse.
• Anti-shock position: lift the legs (if there are no injuries that prevent it).
• Maintaining body heat: covering the person without overheating him or her
• Reassure and accompany, never leave the person alone.

Anti-shock position vs. Trendelenburg position

The classic anti-shock position is performed by lying the patient with the legs slightly elevated. The Trendelenburg position (head down, legs elevated) is used less frequently nowadays and is contraindicated in case of suspected cardiogenic shock or respiratory distress.

The correct positioning technique for shock should always be adapted to the patient’s condition and coordinated with the emergency services.

Shock management in medical practice (clinic and emergency services)

Professional emergency management of shock is based on structured procedures, coordinated teamwork and targeted medication. In the clinic and emergency departments, shock management is performed in several phases:

Emergency protocols and distribution of functions

Depending on the institution, there are standardized action plans for shock management. Clear responsibilities – e.g., for securing the airway, venous access, medication administration – ensure a smooth course of the intervention.

Pharmacological treatment

For the treatment of shock states, the following drugs are used, depending on the type:

• Volume replacement therapy (e.g. crystalline solutions)
• Vasopressors for circulatory stabilization
• Specific medications such as adrenaline in case of anaphylactic shock
• Antibiotics in case of septic shock

Monitoring and aftercare

Continuous monitoring of vital parameters such as blood pressure, pulse and oxygen saturation is essential. After stabilization, intensive aftercare follows, ideally coordinated in an interdisciplinary manner.

Shock management education and training – D/A/CH and International

For nurses, emergency services and physicians, it is essential to participate in regular training courses on shock management. Especially abroad, such as on the Costa del Sol, the demand for training in German is increasing.

Shock management training in Marbella and Costa del Sol

Numerous educational institutions offer certificate courses in the German language – both for professionals and for interested parties without medical training. The main topics include:

• Introduction to shock management according to D/A/CH standard
• Intensive course on shock management on the Costa del Sol
• Simulation of critical situations (e.g. anaphylactic shock in daily life)
• Emergency medicine courses for expatriates, nurses and aid organizations

A good training program not only improves individual safety, but also the quality of care at the entire intervention site.

Common mistakes in shock management – and how to avoid them