Shock is a critical condition brought on by the sudden drop in blood flow through the body. Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes. When a person is in shock, his or her organs aren't getting enough blood or oxygen. If untreated, this can lead to permanent organ damage or even death. Signs and symptoms of shock vary depending on circumstances
and may include: - Cool, clammy skin
- Pale or ashen skin
- Bluish tinge to lips or fingernails (or gray in the case of dark complexions)
- Rapid pulse
- Rapid breathing
- Nausea or vomiting
- Enlarged pupils
- Weakness or fatigue
- Dizziness or fainting
- Changes in mental status or behavior, such as anxiousness or agitation
Seek emergency medical careIf you suspect a person is in shock, call 911 or your
local emergency number. Then immediately take the following steps: - Lay the person down and elevate the legs and feet slightly, unless you think this may cause pain or further injury.
- Keep the person still and don't move him or her unless necessary.
- Begin CPR if the person shows no signs of life, such as not breathing, coughing or moving.
- Loosen tight clothing and, if needed, cover the person with a blanket to prevent chilling.
- Don't let the
person eat or drink anything.
- If you suspect that the person is having an allergic reaction, and you have access to an epinephrine autoinjector, use it according to its instructions.
- If the person is bleeding, hold pressure over the bleeding area, using a towel or sheet.
- If the person vomits or begins bleeding from the mouth, and no spinal injury is suspected, turn him or her onto a side to prevent choking.
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April 29, 2021 - Shock. American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/shock. Accessed March 4, 2021.
- First aid. National Health Service. https://www.nhs.uk/conditions/first-aid/. Accessed March 4, 2021.
. Chapter 3. Safe Patient Handling, Positioning, and Transfers
Positioning a patient in bed is important for maintaining alignment and for preventing bed sores (pressure ulcers), foot drop, and contractures (Perry et al., 2014). Proper positioning is also vital for providing comfort for patients who are bedridden or have decreased mobility related to a medical condition or treatment. When positioning a patient in bed, supportive devices such as pillows, rolls, and blankets, along with repositioning, can aid in providing comfort and safety (Perry
et al., 2014). Patient Positions in BedPositioning a patient in bed is a common procedure in the hospital. There are various positions possible for patients in bed, which may be determined by their condition, preference, or treatment related to an illness. Table 3.6 lists patient positions in bed.
Table 3.6 Patient Positions in BedPosition
| Description
| | Supine position
| Patient lies flat on back. Additional supportive devices may be added for comfort. Supine position
| | Prone position
| Patient lies on stomach with head turned to the side. Prone position
| | Lateral position
| Patient lies on the side of the body with the top leg over the bottom leg. This position helps relieve pressure on the coccyx. Lateral position
| | Sims position
| Patient lies between supine and prone with legs flexed in front of the patient. Arms should be comfortably placed beside the patient, not underneath. Sims position
| | Fowler’s position
| Patient’s head of bed is placed at a 45-degree angle. Hips may or may not be flexed. This is a common position to provide patient comfort and care. Fowler’s position
| | Semi-Fowler’s position
| Patient’s head of bed is placed at a 30-degree angle. This position is used for patients who have cardiac or respiratory conditions, and for patients with a nasogastric tube. Semi-Fowler’s position
| | Orthopneic or tripod position
| Patient sits at the side of the bed with head resting on an over-bed table on top of several pillows. This position is used for patients with breathing difficulties.
| | Trendelenburg position
| Place the head of the bed lower than the feet. This position is used in situations such as hypotension and medical emergencies. It helps promote venous return to major organs such as the head and heart. Trendelenburg position
| | Data source: ATI, 2015a; Perry et al., 2014; Potter et al., 2011
|
Moving a Patient up in BedWhen moving a patient in bed, perform a patient risk assessment prior to the procedure to determine the level of assistance needed for optimal patient care. If a patient is unable to assist with repositioning in bed, follow agency policy regarding “no patient lifts” and the use of mechanical lifts for complex and bariatric patients. See Checklist 25 for the steps to move a patient up in bed.
Checklist 25: Moving a Patient Up in BedDisclaimer: Always review and follow your hospital policy regarding this specific skill.
| Safety considerations: - Perform hand hygiene.
- Check room for contact precautions.
- Introduce yourself to patient.
- Confirm patient ID using two patient identifiers (e.g., name and date of
birth).
- Listen and attend to patient cues.
- Ensure patient’s privacy and dignity.
- Assess ABCCS/suction/oxygen/safety.
- Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.
- Ensure patient has a draw sheet or a friction-reducing sheet on the bed prior
to repositioning.
| Steps
| Additional Information
| 1. Make sure an additional health care provider is available to help with the move.
| This procedure requires two health care providers.
| 2. Explain to the patient what will happen and how the patient can help.
| Doing this provides the patient with an opportunity to ask questions and help with the positioning.
| 3. Complete risk assessment (Checklist 24) of patient’s ability to help with the positioning.
| This step prevents injury to patient and health care provider.
| 4. Raise bed to safe working height and ensure that brakes are applied. Health care providers stand on each side of the bed.
| Principles of proper body mechanics help prevent MSI. Safe working height is at waist level for the shortest health care provider. Bed at waist level
| 5. Lay patient supine; place pillow at the head of the bed and against the headboard.
| This step protects the head from accidentally hitting the headboard during repositioning.
| 6. Stand between shoulders and hips of patient, feet shoulder width apart. Weight will be shifted from back foot to front foot.
| This keeps the heaviest part of the patient closest to the centre of gravity of the health care providers. Feet
shoulder width apart
| 7. Fan-fold the draw sheet toward the patient with palms facing up.
| This provides a strong grip to move the patient up using the draw sheet. Fold
sheet with fingers facing upward
| 8. Ask patient to tilt head toward chest, fold arms across chest, and bend knees to assist with the movement. Let the patient know when the move will happen.
| This step prevents injury from patient and prepares patient for the move. Chin
tucked in and arms across chest
| 9. Tighten your gluteal and abdominal muscles, bend your knees, and keep back straight and neutral.
| The principles of proper body mechanics help prevent injury.
| 10. On the count of three by the lead person, gently slide (not lift) the patient up the bed, shifting your weight from the back foot to the front, keeping back straight with knees slightly bent.
| The principles of proper body mechanics help prevent injury. Facing
direction of movement
| 11. Replace pillow under head, position patient in bed, and cover with sheets.
| This step promotes comfort and prevents harm to patient.
| 12. Lower bed, raise side rails as required, and ensure call bell is within reach. Perform hand hygiene.
| Placing bed and side rails in safe positions reduces the likelihood of injury to patient. Proper placement of call bell facilitates patient’s ability to ask for assistance. Bed in lowest position, side rail up, call bell within reach Hand hygiene reduces the spread of microorganisms.
| | Data source: Perry et al., 2014; PHSA, 2010
|
Watch these three videos for more information about how to move a patient up in bed. Take this Repositioning a Patient in Bed, Caregivers at Head course to learn how to move a patient up in bed, with caregivers at the head of the bed. Take this Repositioning a Patient in Bed, Caregivers Facing Each Other course to learn how to move a patient up in bed, with the caregivers facing each other. Take this Repositioning a Patient in Bed, Diagonal Technique course to learn how to move a patient up in bed, with the caregivers standing positioned diagonally. Positioning a Patient to the Side of the BedPrior to ambulating, repositioning, or transferring a patient from one surface to another (e.g.,
a stretcher to a bed), it may be necessary to move the patient to the side of the bed to avoid straining or excessive reaching by the health care provider. Positioning the patient to the side of the bed also allows the health care provider to have the patient as close as possible to the health care provider’s centre of gravity for optimal balance during patient handling. Checklist 26 describes how to safely move a patient to the side of the bed.
Checklist 26: Positioning a Patient to the Side of the BedDisclaimer: Always review and follow your hospital policy regarding this specific skill.
| Safety considerations: - Perform hand hygiene.
- Check room for contact precautions.
- Introduce yourself to patient.
- Confirm patient ID using two patient identifiers (e.g., name and
date of birth).
- Listen and attend to patient cues.
- Ensure patient’s privacy and dignity.
- Assess ABCCS/suction/oxygen/safety.
- Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.
- Ensure patient has a draw sheet or a friction-reducing sheet on the bed
prior to repositioning.
| Steps
| Additional Information
| 1. Make sure you have as many additional health care providers as needed to help with the move.
| The procedure works best with two or more health care providers, depending on the size of the patient and the size of the health care professional.
| 2. Explain to the patient what will happen and how the patient can help.
| This provides the patient with an opportunity to ask questions and help with the positioning.
| 3. Raise bed to safe working height and ensure that brakes are applied. Lay patient supine.
| Principles of proper body mechanics help prevent MSI. Safe working height is at waist level for the shortest health care provider.
| 4. Stand on the side of the bed the patient is moving toward. One person stands at the shoulder area and the other person stands near the hip area, with feet shoulder width apart.
| This step keeps the heaviest part of the patient closest to the centre of gravity of the health care providers. Keep heaviest part of the patient closest to your center of gravity
| 5. Fan-fold the draw sheet toward the patient with palms facing up.
| Fold
sheet with fingers facing upward
| 6. Have the health care provider at the head of the bed grasp the pillow with one hand and the draw sheet with the other hand.
| This prevents injury to patient. Grasp the pillow with one hand and
the draw sheet with the other
| 7. Have patient place arms across chest.
| This step prevents injury to patient. Chin
tucked in and arms across chest
| 8. Tighten your gluteal and abdominal muscles, bend your knees, and keep back straight and neutral. Place one foot in front of the other. The weight will shift from the front foot to the back during the move.
| Use of proper body mechanics helps prevent injury when handling patients.
| 9. On the count of three by the lead person, with arms tight and shoulders down, shift your weight from the front foot to the back foot. Use your large leg muscles to move the patient. Do not lift, but gently slide the patient.
| Start move with weight on front footShift weight to back foot If the patient is bariatric, the move should be repeated to correctly position the patient, or use a mechanical lift.
| 10. Once patient is positioned toward the side of the bed, ensure pillow is comfortable under the head, and straighten sheets. Complete all other procedures related to safe patient handling.
| This step promotes comfort and prevents harm to patient. Raise side rails
| 11. Lower bed, raise side rails as required, and ensure call bell is within reach. Perform hand hygiene.
| Placing bed and side rails in safe positions reduces the likelihood of injury to patient. Proper placement of call bell facilitates patient’s ability to ask for assistance. Bed in lowest position, side rail up, call bell within reach Hand hygiene reduces the spread of microorganisms.
| | Data source: Perry et al., 2014; PHSA, 2010
|
- Name five body mechanic principles that should be used when moving a patient up in bed.
- A health care provider completes a risk assessment for a patient and determines the patient is unable to assist with repositioning. What should the health care provider do next?
- Your patient is experiencing shortness of breath related to heart failure. Which position in bed is best for this condition?
What position would you put someone with shock?
Shock:. Treat the cause of shock.. Lie them down with raised legs.. Call 999.. Loosen tight clothing.. Keep them calm and warm.. What is Fowler's position used for?
Standard Fowler's position, also known as sitting position, is typically used for neurosurgery and shoulder surgeries. The bed angle is between 45 degrees and 60 degrees. The legs of the patient may be straight or slightly bent. This position is often used for head, chest, and shoulder surgeries.
What is lateral position used for?
The lateral position is used for surgical access to the thorax, kidney, retroperitoneal space, and hip. Depending on the side of the body on which the patient is being operated, the patient will lie on their left or right side. Before being placed in the lateral position, the patient is induced in the supine position.
What is the most important element of the shock position?
The shock position, also known as passive leg raise, is a position where an individual lies flat on their back while their legs are passively raised to a 45 degree angle. The purpose of this position is to elevate the legs so that blood can flow from the lower body to the heart.
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