Shock in Athletics DOUGLBS 0. BLBLCBUPRB, I S , Am, GSCS, EMT WILLIAM R EBBEW, I S , BMSSW, CSCS

U.S. Olympic Education Center Department of Athletics Northern Michigan University Marquette University

HOCK IS a possibility with injury. Some con- ditions such as extreme fatigue, dehydration, or

illness predispose an athlete to shock (Bledsoe et al., 1998; Crosby & Lewallen, 1995; O'Keefe et al., 1998). Shock may be compounded by the athlete's initial reaction once he or she realizes a serious injury has occurred.

Since shock may be serious and possibly life-threatening, it is the duty of the athletic trainer or therapist to recognize the initial signs and symptoms and take appropriate action to prevent shock from escalating.

This article discusses three stages of shock and introduces a "container" analogy to enable the athletic trainer to better under- stand shock. It describes the clas- sifications of shock and discusses appropriate treatment for the athlete in shock so that his or her condition does not worsen.

Shock occurs when the cardio- vascular system fails to supply enough oxygen-rich blood to the organs of the body. It is best de- scribed +as tissue.hypoperfusion . _ which occurs when (a) the heart pumps blood inadequately, (b) the vessels dilate, and/or (c) oxygen and glucose are not delivered to

the cells. This results in impaired cellular function and lactic acid production. The eventual out- come is cell death or acidosis and cardiac arrest (Bledsoe et al., 1998; Crosby & Lewallen, 1995; Everett, 1997; O'Keefe et al., 1998).

Conditions of Shock

During physical activity, dehy- dration decreases the volume of blood. An injury, may further complicate the situation and predispose the athlete to shock. In the early stages, the body can compensate for the lack of oxygen

perfusion to the cells and organs. But during the later stages the body has difficulty compensating for the loss of tissue perfusion. The terms "compensated" and "decompensated" shock, respec- tively, are used to describe these conditions of shock.

The term "irreversible" shock means the body has lost the battle to maintain tissue perfusion to its organs and irreparable damage may occur, especially to the liver, kidneys, brain, and heart.

Since shock can progress rapidly from compensated to de- . compensated to irreversible, it is important for the athletic trainer or therapist to recognize the ini- tial signs and symptoms of shock (see Table 1) in order to prevent the athlete's condition from dete- riorating.

Compensated Shock

Compensated shock describes the body's attempt to compensate for decreased tissue perfusion at the cellular level (Bledsoe et al., 1998; Crosby & Lewallen, 1995; Everett, 1997; Michigan Dept., 1995; OlKeefe et al., 1998).

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Signs and symptoms of com- pensated shock include agitation, anxiety, or restlessness. The ath- lete may also present a weak and

O 1998 Human Kinetics

48 Athletic Therapy Today November 1998

rapid (thready) pulse. The skin appears pale and ashen and feels cool or clammy; the lips will ap- pear blue. The athlete may be dia- phoretic, sweating profusely with respirations that are often labored, shallow, and irregular. Nausea, vomiting, thirst, and delayed cap- illary refill of longer than 2 seconds are also symptomatic of shock.

To determine delayed capil- lary refill, the athletic trainer or therapist can squeeze the nail bed of the fingers or toes until they blanch, then release the pressure. The normal pink color under the nail bed should return within 2 seconds after gentle compression is released. The return of the pink color under the nail bed indicates that the circulatory system is adequately restoring blood to the capillaries.

Decompensated Shock

Decompensated shock is a life- threatening situation because it means the body is having diffi- culty compensating for the loss of

tissue perfusion (Bledsoe et al., 1998; Crosby & Lewallen, 1995; Everett, 1997; Michigan Dept., 1995; O'Keefe et al., 1998). Signs and symptoms include gradual and steadily falling systolic blood pressure, poor urinary output, dull eyes with dilated pupils, and weak or absent peripheral pulses.

Since the body has several mechanisms to compensate for hypoperfusion, detection of a gradual and steadily falling sys- tolic BP is often one of the last signs or symptoms observed. Yet this gradual and steadily falling systolic BP is also one of the most significant signs of decompen- sated shock.

Irreversible Shock

Irreversible shock is a definite medical emergency (Bledsoe et al., 1998; Crosby & Lewallen, 1995; Everett, 1997; Michigan Dept., 1995; O'Keefe et al., 1998). Obvi- ously low-and falling-systolic BP and altering levels of conscious- ness are symptoms of irreversible

shock. Eventually the body's or- gans will fail since their cells are not receiving the oxygen supply they need to survive. This may result in myocardial infarction.

Even if the athletic trainer or therapist is able to maintain or re- store adequate vital signs, the ath- lete may die due to organ failure.

A Container Analogy

The physiological basis for the signs and symptoms of shock are more easily understood by using a container analogy to examine how blood is shunted throughout the body (Everett, 1997). The first container consists of the skin and extremities. The second consists of the liver, kidneys, and brain. The third consists of the heart and lungs. Using this container analogy, the signs of shock can be observed as the athlete regresses through the three stages.

When an athlete enters com- pensated shock, blood is shunted from the nonvital organs to the

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November 1998 The Professional Journal for Athletic Trainers and Therapists 49