If you’ve ever watched Grey’s Anatomy or a similar show, you’ve heard something like, “He’s going into shock!” probably a dozen times.  (You’ve also seen them erroneously shock asystole, but that’s another post for another day!)  But what exactly does it mean if someone is going in to shock?

To get a good understanding of what shock is and what causes it, think of the body like an engine.  If there is a problem with the pump, the fluid, or the lines, you could go into shock.  The pump in this scenario is your heart, blood is the fluid, and the lines are your blood vessels.  A problem with either of those is a problem for you.

Different Types of Shock
  • Pump problem (heart issue):       cardiogenic shock
  • Fluid problem (blood issue):        hypovolemic shock, hemorrhagic shock,
  • Line problem (blood vessels):     anaphylactic shock, psychogenic shock, septic shock

Even though there’s lots of different types of shock, at the simplest level we can slot them into one of the 3 categories of either a pump, fluid, or line problem.

How Shock Progresses: A story of hope, good intentions, and betrayal

If you want to know what shock looks like and how it can completely ruin your day, now we’re going to think of your body as a huge corporation.

The goal of your huge corporation is to survive, at all costs.  The CEO (the brain) is a pretty cutthroat.  Brain will sell out its own mother to make sure the corporation survives and if a recession occurs (like shock) Brain will take drastic steps to make sure the corporation can ride it out. (i.e. not die.)

The CEO of course has a board of directors, just like every corporation.  At the board table, you have Heart sitting right next to Brain.  Heart is a very big deal as well.

Also sitting on the board of directors are the Kidneys (they’re twins), Digestive System, Skin, Liver, and the Lungs (who are also twins.)

Obviously, these directors are in charge of their specific departments.  So Skin sits at the table to fight for his department’s best interests, as does Liver, and Lungs, etc.  They all think their department is the most important of course, so while they Board of Directors usually gets along because they all want the corporation to survive and thrive….during times of crisis they tend to fight a bit because everyone wants to be appreciated and important.

Let’s say that you’ve cut yourself very, very badly and you’re bleeding very very badly as a result.  You could go into shock (and you will in this scenario because it’s my blog and I said so) and all the different departments in your body are going to get a memo that something sub-optimal has occurred.

If the amount of blood loss is significant enough, your body will sound an alarm and a Board Meeting is called.  There’s a problem and hard decisions have to be made!  Sacrifices might have to be made to save the corporation!  (And the CEO.  That CEO Brain is selfish and greedy when it comes right down to it, but Brain gets away with that because it’s usually so good at running everything!)

So the Board assembles.  CEO Brain is there of course, along with Heart, Liver, Digestive System, Skin, and the two set of twins, Kidneys and Lungs.

CEO BRAIN:  Okay, folks.  We’ve got a problem.  We’re losing a bunch of revenue (blood) and our accounts are depleted.  I want solutions, people.  Solutions!  How do we deal with this and ride it out?

HEART: Seems to me there’s only so much money (blood) to go around, and since we lost a bunch of it, there isn’t enough to go around the whole corporation right now.  Someone needs to get on this, because if I run dry, we’re going to have big issues.

CEO Brain makes a call to the Blood Foreman, down in the production factory.  “We need more blood!  We need the blood replaced as fast as possible!”

The Blood Foreman takes off his little hardhat and wipes his little blood cell forehead and says, “Geez, Boss.  I hear ya.  My guys are doing what they can but it takes time, ya know?  We can’t get this done overnight, and it’s gonna take some overtime.”

CEO Brain: “Nobody goes home until our production problem is fixed!  I want that blood volume replenished ASAP!”

Blood Foreman: “I’m already down a bunch of workers.  Yup, just walked right off the job when that injury happened.  I’m understaffed as it is.  Plus, we’re union so….”

CEO Brain slams the phone down and glares around the table.  “We can’t count on the production team to save us.  It’s going to take some time to replenish our blood volume.  And I need a constant supply of blood and oxygen, damn it!  I need options.  What are we going to do?”

Heart says, “Layoffs.  We need to make cutbacks to make sure that we stay supplied with what we need.”

Brain glares around the table.  “You’re right.  Somebody’s got to go.  So who?”  Brain looks at Skin.

Skin starts to protest.  “Hey, whoa.  Whoa whoa whoa!  I’m important!  Way too important to be laid off!”

Liver says, “I don’t know if I agree with that.  You have a big blood supply and if we shut you down, we can take your budget (blood) and redirect it to more important areas.”

Skin says, “No way!  My budget ensures that the body looks healthy, pink and dry.  I’m why we stay warm to the touch!  And, my skin keeps the body from leaving a slimy trail everywhere we go!”

CEO Brain thinks this over, then says, “Sorry, Skin.  You’re nice and all, and the lack of slimy trail thing is good, but this is a survival issue.  Laying you off until things get better is the best thing for the company.”

Skin huffs and puffs and throws a few things, but it packs up and leaves, slamming the door behind it.  The skin of someone in shock turns pale, cool, and clammy because blood flow is being redirected to where it’s needed most: the Board of Directors, aka the internal organs.

The Board will see if shutting down the skin fixes the situation but let’s say the bleeding continues.  More loss means even less blood to go around so there’ll have to be another round of layoffs.  (If the bleeding is stopped quickly enough, it doesn’t take long for the CEO to call up the skin and apologize before offering its job back.  Skin always comes back, it’s very loyal.)

CEO Brain: “Okay, we’re still experiencing losses and we don’t have enough funding (blood) to go around. Someone else has to go.  Who’s it going to be?”

A chorus of panicked, angry organ voices explode from the table.  Nobody wants to be laid off and everyone thinks they’re extremely important to the survival of the company.  Brain raises its hands and yells for everyone to be quiet.  Then Brain looks at Digestive System, whose mouth falls open and it clutches its pearls.

Digestive System: “No, Brain.  Surely you don’t think….you can’t get rid of me!”

Kidneys say, “Oh please.  We’re constantly filtering and purifying the blood and getting rid of toxins.  What’s your department doing all day?”

Digestive System pleads with Brain.  “Come on, Brain.  You know we’re constantly working.”

Brain says, “I know, but that requires a large blood supply and we just don’t have enough to go around anymore.  If we can take your blood supply because you aren’t using it for anything, we can make sure the rest of the Board stays supplied.”

Digestive System yells, “I have big projects on the go!  I’m in the middle of digesting and processing a giant beef burrito right now as we speak!  I’m in talks with Gall Bladder!  I have an order in with Pancreas!”

Brain shakes its head.  “Sorry, DS.  These are hard times.  What we need is blood.  We don’t need the burrito broken down right now.  Your department just isn’t a priority in this crisis, so you need to leave.  We all have to make sacrifices for the greater good.”

Digestive System is a little sensitive and prone to temper tantrums so with tears in its eyes, it sweeps from the boardroom whispering, “You’ll miss me.”  Then it pauses dramatically at the door and yells, “And I’m taking my project with me!!  Come on, Burrito.  We’re out of here!”  People in shock will frequently complain of nausea and sometimes will even vomit because the easiest way to be able to shut down digestion, is to get rid of everything in the system!

CEO Brain looks around the table.  Brain is still there, along with Heart, Lungs, Liver, and Kidneys.  Brain notices Heart is dabbing its forehead with a silk handkerchief.  “Are you okay, Heart?  What’s the problem?”

Heart is panting a little bit.  “It’s just….I’m doing my best to keep as much of the body supplied with blood as I can.  I know we don’t have enough, so I’m trying to take what we do have and pump it around the body faster.  I’m feeling a little stressed out, but I can handle it for now.”  The pulse rate often increases in the early stages of shock, but it will feel weaker at the wrists because of the layoffs occurring. Arms and legs aren’t that important to the Board at times like this, so blood will also be shunted from the extremities towards the core where the organs are.

The Lungs are also looking a little anxious, breathing faster than normal.  “We’re here for you, Heart.  We’re down blood, which means we’re down oxygen.  There’s no point in shipping the blood faster if there’s not enough oxygen in it.  We’re trying to bring in as much as we can to keep the supply up.”  Another sign of shock is a faster breathing rate.  This can be in part due to anxiety (the brain is very unimpressed with this turn of events) and because the body’s natural response to low oxygen levels (and blood delivers oxygen to the body) is to breathe faster to bring in more oxygen.

Heart gets a little teary and gives an odd little jump in its chair.  “Thanks, guys.  That’s so nice, it made me feel a little funny for a second.”

Liver rolls its eyes.  “You feel everything a little funny.  Less feelings, more function.”

Heart takes this personally.  “You’re just jealous that no one ever talks about having their liver broken.  I’m very significant!”

Liver snorts.  “If they break their liver, they die soooo I’d say that’s pretty significant.”

Brain rubs its head.  “Enough, you two.  I’ve just had an update.  We’ve lost even more blood.  Things are getting dire.  Things are about to get really painful.  There will be losses.”  Brain looks around the table.  It’s not going anywhere.  No way.  Brain must survive at all costs, otherwise all is lost.  Heart is left, Lungs are left, Liver still sits at the table, and so do the Kidney twins.

Brain sighs.  “I have to be honest with you, guys.  Liver, you have a huge budget.  And so do the Kidneys.  You guys do great work, but you also demand a lot.  I mean, come on Liver.  You need 10% of our blood volume circulating in your department at any given time?  And Kidneys, 20% of our cardiac output, really?  Only thinking of yourselves.  Did you ever stop to think about how much blood flow I need at every moment?”

The Kidneys say, “Liver should go, not us.  There’s one of Liver, and there’s two of us!”

Liver yells, “Exactly!  There’s two of them!  There’s only one of me so I should stay!”

Brain sighs.  “This is a tough one.  Liver, we’re going to have to slow production.  Reduce your department hours.  We’ll redirect as much of your blood supply as we can to try and get through this.”

Liver: “You know if you do that, it’s going to cause more problems.  Toxins are going to build up, nasty things are going to start circulating, things are going to get out of balance.”

The Kidneys are smugly grinning at Liver right now, until Brain looks at them and says, “It’s not fair to Liver, since your departments work pretty closely with each other.  You know, all the purifying and toxin removal.  I think you guys should go too.”

The Kidney twins mutter something and Brain tells them that kind of language is unnecessary.

Liver and Kidneys stomp out of the Board Room.  As shock progresses, the liver and kidneys become dysfunctional and the person in shock can experience multiple organ failure, including the liver and kidneys.  This compounds the problem, as these are the main organs of detoxification.  As shock progresses, there are substances released into the blood that essentially poison the body as they build up and without the liver and kidneys to filter them out…the good intentions of the body start contributing to the problem.

Brain looks at Heart and the Lungs.  “The ship is going down, my friends.  Maybe if one of you resigns, we have a chance.”

Heart is still panting and worked up, wiping its sweaty forehead like it’s been running a marathon.  Which it has!  “I don’t know, Brain.  I have to tell you, I don’t think I can keep this up much longer.  I’m tired!”  The pulse rate of someone deeply in shock may become irregular, or even become slower than normal.

The Lungs agree.  “This is hard work without everyone else to help.  Maybe we need to slow things down a little, just so we can rest a little.”  The situation is critical.  A person deeply in shock may start struggling to breathe, or breathe too slowly.  They might breathe in a very irregular way.

Brain sighs and hangs his head.  “How did this go so wrong?”

Heart gasps out, “Chopping wood with an axe in the dark after 6 beer.  That’s how.  And frankly, Brain, I blame you for not preventing that in the first place.  What were you thinking?”

Brain shrugs, looking miserable.  “Beer goes right to me and after the body has 6, I don’t make the best decisions.  I thought it would be fine.  Beer, dark, axe…what could go wrong?”

The Heart and Lungs just look at Brain in disgust.  Soon, the Corporation is completely bankrupt.  There isn’t enough money to keep the lights on and the whole Corporation goes dark.  The End.

Okay, that was worst case scenario.  A large enough blood loss is difficult to come back from.  But with a proper first response from bystanders, response from emergency personnel and definitive medical care in hospital, people can survive because the body is extremely resilient.

If you’re a bystander or first aider and you see:

  • pale or clammy skin
  • increased breathing
  • fast, slow, or irregular pulse
  • anxiety and/or confusion, altered mental status of some kind

you should suspect shock and act quickly.

 How Bystanders Can Help Someone In Shock

  • Get help on the way.  Activate onsite medical or call 911.
  • Stop the cause of the shock if you can, i.e stop any bleeding.
  • Reassure the person that help is on the way.
  • Keep them calm and at rest (without restraining them)
  • Keep them warm.
  • Be prepared to assist their breathing if necessary.
  • Stay with them until help arrives.

If you have any questions or would like to know more about shock, feel free to leave a comment below!