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    of 2

    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 perfusion to the cells and organs.


    with injury. Some con- But during the later stages the
    ditions such as extreme body has difficulty compensating
    fatigue, dehydration, or for the loss of tissue perfusion.
    illness predispose an athlete to The terms "compensated" and
    shock (Bledsoeet al., 1998;Crosby "decompensated" shock, respec-
    & Lewallen, 1995; O'Keefe et al., tively, are used to describe these
    1998).Shock may be compounded conditions of shock.
    by the athlete's initial reaction The term "irreversible" shock
    once he or she realizes a serious means the body has lost the battle
    injury has occurred. to maintain tissue perfusion to its
    Since shock may be serious organs and irreparable damage
    and possibly life-threatening, it is may occur, especially to the liver,
    the duty of the athletic trainer or kidneys, brain, and heart.
    therapist to recognize the initial Since shock can progress
    signs and symptoms and take rapidly from compensated to de- .
    appropriate action to prevent compensated to irreversible, it is
    shock from escalating. important for the athletic trainer
    This article discusses three or therapist to recognize the ini-
    stages of shock and introduces a the cells. This results in impaired tial signs and symptoms of shock
    "container" analogy to enable the cellular function and lactic acid (see Table 1) in order to prevent
    athletic trainer to better under- production. The eventual out- the athlete's condition from dete-
    stand shock. It describes the clas- come is cell death or acidosis and riorating.
    sifications of shock and discusses cardiac arrest (Bledsoeet al., 1998;
    appropriate treatment for the Crosby & Lewallen, 1995;Everett, Compensated Shock
    athlete in shock so that his or her 1997; O'Keefe et al., 1998). Compensated shock describes
    condition does not worsen. the body's attempt to compensate
    Shock occurs when the cardio- Conditions of Shock for decreased tissue perfusion at
    vascular system fails to supply the cellular level (Bledsoe et al.,
    enough oxygen-rich blood to the During physical activity, dehy- 1998; Crosby & Lewallen, 1995;
    organs of the body. It is best de- dration decreases the volume of Everett, 1997; Michigan Dept.,
    scribed +astissue.hypoperfusion . _ blood. An injury, may further 1995; OlKeefe et al., 1998). ---+

    which occurs when (a) the heart complicate the situation and Signs and symptoms of com-
    pumps blood inadequately, (b)the predispose the athlete to shock. In pensated shock include agitation,
    vessels dilate, and/or (c) oxygen the early stages, the body can anxiety, or restlessness. The ath-
    and glucose are not delivered to compensate for the lack of oxygen lete may also present a weak and
    O 1998 Human Kinetics

    48 Athletic Therapy Today November 1998


    rapid (thready) pulse. The skin tissue perfusion (Bledsoe et al., shock. Eventually the body's or-
    appears pale and ashen and feels 1998; Crosby & Lewallen, 1995; gans will fail since their cells are
    cool or clammy; the lips will ap- Everett, 1997; Michigan Dept., not receiving the oxygen supply
    pear blue. The athlete may be dia- 1995; O'Keefe et al., 1998). Signs they need to survive. This may
    phoretic, sweatingprofusely with and symptoms include gradual result in myocardial infarction.
    respirations that are often labored, and steadily falling systolic blood Even if the athletic trainer or
    shallow, and irregular. Nausea, pressure, poor urinary output, therapist is able to maintain or re-
    vomiting, thirst, and delayed cap- dull eyes with dilated pupils, and store adequate vital signs, the ath-
    illary refill of longer than 2 seconds weak or absent peripheral pulses. lete may die due to organ failure.
    are also symptomatic of shock. Since the body has several
    To determine delayed capil- mechanisms to compensate for
    lary refill, the athletic trainer or hypoperfusion, detection of a A Container Analogy
    therapist can squeeze the nail bed gradual and steadily falling sys- The physiological basis for the
    of the fingers or toes until they tolic BP is often one of the last signs and symptoms of shock are
    blanch, then release the pressure. signs or symptoms observed. Yet more easily understood by using
    The normal pink color under the this gradual and steadily falling a container analogy to examine
    nail bed should return within 2 systolic BP is also one of the most how blood is shunted throughout
    seconds after gentle compression significant signs of decompen- the body (Everett, 1997).The first
    is released. The return of the pink sated shock. container consists of the skin and
    color under the nail bed indicates extremities. The second consists of
    that the circulatory system is Irreversible Shock the liver, kidneys, and brain. The
    adequately restoring blood to the Irreversible shock is a definite third consists of the heart and
    capillaries. medical emergency (Bledsoeet al., lungs. Using this container analogy,
    1998; Crosby & Lewallen, 1995; the signs of shock can be observed
    Decompensated Shock Everett, 1997; Michigan Dept., as the athlete regresses through
    Decompensated shock is a life- 1995; O'Keefe et al., 1998).Obvi- the three stages.
    threatening situation because it ously low-and falling-systolic When an athlete enters com-
    means the body is having diffi- BP and altering levels of conscious- pensated shock, blood is shunted
    culty compensating for the loss of ness are symptoms of irreversible from the nonvital organs to the

    Rapid ir, & shal


    - -0-
    BP; a
    d capillary Pale
    m cool, d a r
    0-n. AW.7 ..A$:ll

    ossible tl m y reter Urina ion; extn


    ;t thirst

    November 1998 The Professional Journal for Athletic Trainers and Therapists 49

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