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Old 8th April 2009, 09:06 AM   #1
Eddie Dane
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Why does one go into shock?

Why does physical or psychological trauma cause a person to go into shock?

Someone told me that is nature's anaesthetic, making the process of dying much less painful.

But I try not to think in terms of "nature designed this for that purpose".

There had to be an advantage to shock for it to evolve did it not?

Any ideas?
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Old 8th April 2009, 09:27 AM   #2
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I've seen many animals being killed by other animals apparently going into a shock-type state, where they just give up fighting.
That's not a survivable trait, difficult to pass that on to the descendants you won't have.
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Old 8th April 2009, 09:30 AM   #3
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Two different types of shock being described here.

Psychological shock, I think, is connected to a sudden rush of the "fight-or-flight" hormones. This may prime the body to take some extreme action, but it can be so strong that it overwhelms the senses for a time.

Physical "shock", that is cardiovascular shock, is the process of the peripheral circulation shutting down following severe trauma.

I once read an article comparing military casualty survival in Vietnam and the Falklands. In Vietnam the medics jumped on the casualties and set up i/v fluids and warmed them and did everything they could to get the circulation going and bring them out of shock. In the Falklands the climate was cold and the terrain was isolated, and many casualties were left on cold battlefields in shock for quite some time before they were airlifted back to the medical facilities.

The Falklands survival rate was better.

This led trauma surgeons to consider whether the whole shock thing was beneficial, helping stem bleeding, and putting the body into a sort of suspended animation state while the immediate injuries stabilised. I'm not sure where the article was, or how much of this has found its way into modern practice, but it was an interesting observation.

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Last edited by Rolfe; 8th April 2009 at 09:31 AM.
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Old 8th April 2009, 10:54 AM   #4
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Having experiencing physiological shock on several occasions, from different severities of injury, I speculate that there's a balance between two mechanisms, both of which can improve survival chances under certain circumstances, but whose effects tend to be opposed to one another.

One mechanism is that the immediate pain of the injury seems to be suppressed. So, if you really need to keep fighting or running or whatever to survive, and it's physically possible to do so, you have a chance to do so without being debilitated by the pain.

The other, shock, counterbalances that. In cases where I've suffered an injury that's more severe than I immediately realized (due to the short-term suppression of pain), the shock reaction made me less likely to continue unnecessary activity that could have worsened the injury. Of course, these were in circumstances where I was able to stop what I was doing and tend the injury, rather than e.g. continue fighting off the bear.

In both cases I'm talking about relatively minor (that is, survivable without modern medicine) injuries such as strained joints and broken bones. Whether or not shock occurs as a result of injuries that our distant ancestors couldn't survive in any case would be irrelevant as far as the evolution of those physiological mechanisms is concerned.

This conjecture would only make sense if vigorous physical activity following the injury temporarily wards off the shock reaction. Anecdotal evidence suggests that it does, but I don't know for sure, though I suspect this is something experts in the area do know.

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Old 8th April 2009, 11:30 AM   #5
JoeTheJuggler
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Originally Posted by Rolfe View Post
Physical "shock", that is cardiovascular shock, is the process of the peripheral circulation shutting down following severe trauma.
Just to tie this into the "why" part of the question: a greater supply of blood and oxygen is sent to the vital organs, which enhances survival.
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Old 8th April 2009, 11:38 AM   #6
roger
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Originally Posted by Myriad View Post
In both cases I'm talking about relatively minor (that is, survivable without modern medicine) injuries such as strained joints and broken bones.
That's not shock, sorry. Shock is major loss of blood pressure, due to blood loss, a major infarction, and the like, and is nearly always fatal without immediate treatment.

http://www.medterms.com/script/main/...rticlekey=5477
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Old 8th April 2009, 11:52 AM   #7
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Agree with Roger there. It is failure of the circulatory system to deliver oxygen and sugars to the cells that require them. It is usually the result of bleeding injury, external or (worse) internal, and also sometimes the result of certain diseases or disease toxins which change the permeability of blood vessels, allowing the pressure to drop. The blood vessel have to be pressurized in order for a beating heart to force blood through the capillaries; if they're empty, or even only empty to the point of being flaccid, then the beating doesn't produce the desired result. The best cure for shock is to patch the leak(s) and intravenous whole blood or plasma; anything to get the pressure up. First aid is to raise the feet and legs so there is more blood pressure around the heart, and particularly to the brain.

A heart attack can be considered shock, but the attack itself is the more immediate worry, and treatment is of a toally different class.
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Old 8th April 2009, 11:55 AM   #8
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Originally Posted by Eddie Dane View Post
Why does physical or psychological trauma cause a person to go into shock?

Someone told me that is nature's anaesthetic, making the process of dying much less painful.

But I try not to think in terms of "nature designed this for that purpose".

There had to be an advantage to shock for it to evolve did it not?

Any ideas?
Damn, this is a serious thread... and I was going to make a joke about opening up my credit card bills.

Anyway, Roger's link describes it best:

Originally Posted by Medicine.net "Definition of Shock"
There is failure of the circulatory system to maintain adequate blood flow. This sharply curtails the delivery of oxygen and nutrients to vital organs. It also compromises the kidney and so curtails the removal of wastes from the body.
Basically, the body slides into this state of dysfunction when the injury is so severe, the circulatory system fails to do even it's basic job. That's the way I read that link. One system gets messed up, that leads to another system failing... things start to domino.

Rolfe: If you ever find that Falkland's study, I'll be damn interested in reading it. My college education may be a distant memory , but I'd still love to see what it has to say.
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Old 8th April 2009, 03:39 PM   #9
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I've always figured psychological shock is seeing the wild pitch come towards your head, and the next thing you know you are in the dug out. But it didn't hurt me none....But it didn't hurt me none....But it didn't hurt me none....

And waking up underneath your dirt bike, feeling very comfortable in spite of the burns happening against the exhaust pipe. The feeling is like the relaxation of hypnosis. But it didn't hurt me none....But it didn't hurt me none....

Or in a totaled car. Or getting hit in the head when a blank flies off of the lathe. I never felt any impacts, but did black out. Or at least my knees turned to rubber. I've read that that is what a 'glass jaw' is- you black out because you know what is coming.

My guess is that it's a way of inducing 'playing possum', you drop like a rock, in hopes that the predator will go find something more exciting to play with?
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Old 8th April 2009, 03:51 PM   #10
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When I found myself on the road under my motorbike, with the hot exhaust on top of my thigh, I got out from under there faster than you would believe. Normally, I had trouble lifting that bike. This time, even though I was under it and not in a good leverage position, I practically levitated it. I still maintain most of the muscle soreness I had the next day was due to doing that, rather than the actual fall.

Rolfe.
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Old 9th April 2009, 12:32 AM   #11
Eddie Dane
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Lots of good answers so far.

So real shock is not a function, but just a side effect of loss of circulation.

And there is something else that people call "shock", causing some kind of hypnotic state that helps you ignore pain.

This is probably a whole different phenomena.
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Old 9th April 2009, 03:08 AM   #12
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I imagine it's a whole different phenomenon.

Rolfe the pedant.
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Old 9th April 2009, 04:03 AM   #13
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Originally Posted by Rolfe View Post
I imagine it's a whole different phenomenon.

Rolfe the pedant.
Rolfe, a pendant?

I'm shocked.
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Old 9th April 2009, 08:35 AM   #14
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Originally Posted by Mashuna View Post
Rolfe, a pendant?

I'm shocked.
A Rolfe pendant? I want one!
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Old 9th April 2009, 08:54 AM   #15
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Search on "Golden Hour" and shock to see a lot of info.

http://en.wikipedia.org/wiki/Golden_hour_(medicine)

It must be very frustrating for medical persons to see someone slip away that could have been saved with just a few minutes extra.

Next time you see that Ambulance with flashing lights- keep it in mind and hustle out of the way.
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Old 9th April 2009, 09:43 AM   #16
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It'd have saved a whole lot of confusion if the medics had called it something
other than "shock". "Hypovolemia" or something. I used to get irritated
whenever a sloppy reporter would talk of someone "suffering from shock"
when they'd only had a fright.
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Old 9th April 2009, 09:49 AM   #17
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Speaking of physiological reactions that I can't quite explain, what about itches? We all know that the more you scratch an itch, the more you increase the irritation. So why do our brains send the signal, "scratch me!", when it clearly shouldn't? I see no evolutionary advantage but like shock this may be a side-effect of something else.
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Old 9th April 2009, 10:06 AM   #18
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Originally Posted by Morrigan View Post
Speaking of physiological reactions that I can't quite explain, what about itches? We all know that the more you scratch an itch, the more you increase the irritation. So why do our brains send the signal, "scratch me!", when it clearly shouldn't? I see no evolutionary advantage but like shock this may be a side-effect of something else.
I suspect the scratching motion evolved to remove insects, which are a likely cause of an itch.
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Old 9th April 2009, 11:16 AM   #19
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Originally Posted by TX50 View Post
It'd have saved a whole lot of confusion if the medics had called it something
other than "shock". "Hypovolemia" or something. I used to get irritated
whenever a sloppy reporter would talk of someone "suffering from shock"
when they'd only had a fright.

Gets better. In Scotland when they speak of someone "having a shock", oldtimers sometimes mean a stroke.

Rolfe.
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Old 9th April 2009, 12:09 PM   #20
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To confuse things even further, besides hypovolemic (not enough volume) and cardiogenic (not pumping right) and neurogenic/psychogenic shock, there's also anaphylactic shock, caused by an allergic reaction which dilates the blood vessels & renders the pumping action of the heart less effective - and similar shock type from poisoning, which I forget the name of...
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Old 9th April 2009, 12:15 PM   #21
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When I were in the business we were actually told never to use the term "shock", as it covers so many different sitiuations.. Not helpful, but perhaps interesting...

cj x
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Old 9th April 2009, 04:02 PM   #22
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Originally Posted by Tiktaalik View Post
To confuse things even further, besides hypovolemic (not enough volume) and cardiogenic (not pumping right) and neurogenic/psychogenic shock, there's also anaphylactic shock, caused by an allergic reaction which dilates the blood vessels & renders the pumping action of the heart less effective - and similar shock type from poisoning, which I forget the name of...
Note that the consistent item across the board here is insufficient perfusion of vital organs (that is, not enough oxygen to the things what need oxygen). Whether shock comes from blood loss (hypovolemia due to having spilled most of said volume) or from your circulatory system blowing wide open (anaphylaxis), the net effect is not enough blood (and thus oxygen) where you need it.

Of course, in the case of anaphylaxis, you're quite likely to suffocate to death well before the shock gets you, due to the whole closed airway issue. The shock component can be pretty dramatic, though -- I've treated one case of anaphylaxis that occurred at a party, where the person involved unknowingly ate something they were allergic to, then passed out and did a faceplant on their wine glass.

(Psychogenic shock, of the "eek!" variety, is also just about lack of perfusion as your response to some situation makes your blood vessels open up more than is useful. I've seen that one once, too. Surprising.)
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Old 9th April 2009, 09:22 PM   #23
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Originally Posted by IXP View Post
I suspect the scratching motion evolved to remove insects, which are a likely cause of an itch.
Interesting theory... hadn't thought of that.

Sorry for the derail.
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Old 10th April 2009, 01:43 PM   #24
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Originally Posted by casebro View Post
I've always figured psychological shock is seeing the wild pitch come towards your head, and the next thing you know you are in the dug out. But it didn't hurt me none....But it didn't hurt me none....But it didn't hurt me none....

Or in a totaled car. Or getting hit in the head when a blank flies off of the lathe. I never felt any impacts, but did black out. Or at least my knees turned to rubber. I've read that that is what a 'glass jaw' is- you black out because you know what is coming.

My guess is that it's a way of inducing 'playing possum', you drop like a rock, in hopes that the predator will go find something more exciting to play with?
I would get your brain exaimed if you are in serious by getting hit in the head to the point where you black out. What you are describing are the pysiological effects to a concussion not shock. And your guess is horribly off. It's a response to the fact that your brain just rammed itself into the side of your skull.
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