"She's going into shock!"

This phrase seems to be turn up a lot in movies and television shows, especially of the scifi variety. "Shock" in this sense usually coincides with a character suffering some injury or sudden insult and then wildly convulsing or acting delirious or any combination of the two. I was just watching the pilot of Firefly earlier and there's a scene about half-way through where Kaylee gets shot by an Alliance agent:

She gets shot in the abdomen and, understandably, collapses, after which all the other characters hover over her. She starts to seem delirious at which point Simon declares that she's going into shock and a few seconds later says she's doing to die. Now, while it's true that altered mentation (delirium to loss of consciousness) is one of the first signs of shock, Simon curiously doesn't seem to take any vitals or make any efforts toward fluid resuscitation. Later he extracts the bullet* which doesn't treat the "shock" either... so, if Kaylee's delirium is indeed a sign of shock, just what else comprises it? Well, here's definition of shock:

• Inadequate supply of oxygen and nutrients for basic homeostasis at a cellular level
• Reduction of effective tissue perfusion leads first to reversible and then if prolonged irreversible cellular injury
• Not "low blood pressure"

And these are the defining features of shock:

1. Mentation: depressed
2. Respiratory Rate: increased
3. Blood pressure: decreased
4. Heart Rate: increased
5. Arterial pH: decreased
6. Urine output: decreased

In other words, shock means that there's inadequate flow of oxygenated blood to vital organs. This can happen for any number of reasons, but Kaylee's case is simple enough - blood loss from the gunshot wound. Simon and Mal both recognize the seriousness of a "stomach wound", though I wonder if this was more an example of the writers' superficial understanding that getting shot in the belly is a Bad Thing than anything deeper. Having said that, Simon doesn't actually treat the "shock"; he administers no fluids at all and there is no talk of transfusions or even surgery to stop any bleeding. And if they do not have saline or whatever the Alliance equivalent is on Serenity, one wonders why. These guys are constantly getting shot at - you'd think basic resuscitation supplies would be a must.

Fortunately Kaylee survives (she even lives through the movie where Simon sustains his own inadequately treated GSW vs. abdo), somehow, and this being TV, the writers weren't inclined to kill off one of the attractive female characters in the pilot. Not that Joss Whedon would ever kill off a major character...

Anyway, it's all pretty bad medicine, though it's not quite as bad as the usual medicine on, say, Star Trek. "Shock" in that case invariably looks like someone being, well, shocked, usually with much theatrical writhing around and screaming. Still, I am partial to the Trek physicians as characters (well, some of them), so here's a fine scene featuring the holographic Doctor from Voyager, surely that show's only consistently redeeming character:

*Technically he shouldn't be doing this either. A gunshot wound ("GSW") to the abdomen is an absolute indication for an exploratory laparotomy. Kaylee's wound just left of the midline could affect any number of structures - bowel, kidney, ureter, spine, to say nothing of different nerves and vessels, most significantly the left iliacs and the abdominal aorta. Retrieving the bullet isn't a bad idea, but it's not really the main priority.