Recognition of shock
The priority for effective first aid is to recognise a seriously ill person (or a person who may deteriorate and become seriously ill), act early, and escalate care quickly, rather than expecting first aiders to identify an exact clinical diagnosis. This matters especially with shock, because even experienced clinicians can find it difficult to make a precise diagnosis in the early stages, and spending time trying to label the condition can delay the simple first aid actions the deteriorating patient urgently needs.
The signs and symptoms of shock are common to many conditions, but it is the combination of findings that may indicate serious illness. The more of these red flags that are present together, the greater the concern. As with many conditions, the absence of signs and symptoms does not necessarily mean that the patient is not in shock.
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For adults, common signs and symptoms of serious illness include:
- rapid breathing
- breathlessness or difficulty breathing
- rapid or abnormal pulse
- cool, sweaty, pale, blotchy, or discoloured (often described as mottled) skin
- agitation, anxiety, dizziness, or confusion
- reduced level of consciousness
- shivering, fever, or feeling very cold
- nausea or vomiting
- passing little or no urine
- loss of consciousness
The ANZCOR guideline also highlights something that should not be overlooked: a patient’s own words. Statements such as “I don’t feel right” or “I think I’m going to die” should be taken seriously, especially when paired with visible deterioration or concern from family, co-workers, or bystanders.
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For children and infants, common signs and symptoms of serious illness include:
- breathing difficulty
- altered responsiveness
- seizures
- abnormal skin colour
- fever or feeling cold
- poor feeding
- reduced urine output
- vomiting
- unusual or persistent distress
For infants and children, deterioration can happen very quickly, so treatment must not be delayed. This urgency is even greater than in most adults.
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– The priority in first aid is to recognise a seriously ill person, act early, and get help – not to make a precise diagnosis. Even experienced clinicians can struggle to diagnose shock early, so don’t delay care by trying to label the condition.
– Look for patterns, not single signs – the more red flags present together, the greater the concern, but remember someone can still be seriously ill even if signs are subtle or absent.
– Common adult red flags include breathing problems, abnormal pulse, pale cool sweaty or mottled skin, confusion or reduced consciousness, fever or feeling very cold, nausea or vomiting, and reduced urine output.
– Take what the person says seriously – statements like “I don’t feel right” or “I think I’m going to die” can be important warning signs.
– In children and infants, look for breathing difficulty, changes in responsiveness, seizures, abnormal skin colour, fever or cold, poor feeding, vomiting, reduced urine, or unusual distress.
– Children can deteriorate very quickly – act early and don’t delay treatment.
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