C — Circulation & Shock

Recognize — Simple Field Indicators Of Shock

• Mental status — confusion, agitation, or declining responsiveness.
• Peripheral (radial) pulse quality — weak, thready, or hard to find.
• Skin signs — pale, cool, clammy — interpreted cautiously.
• Trends in vital signs where equipment exists.
• Mechanism and injury pattern — suspect occult hemorrhage from high-energy events even when external bleeding looks minor.

C-TECC active-bystander guidance identifies altered mental status plus weak or absent peripheral pulses as important field indicators of traumatic shock when obvious head injury is absent.

Act — Stop The Spiral

• Re-control any bleeding that recurs — that is M again. The loop is not optional.
• Keep the casualty warm — hypothermia worsens coagulopathy (see Module H). Prevention starts now, not after shivering begins.
• Expedite transport — definitive care for shock lives in an operating room, not on the scene.
• Minimize unnecessary movement and exertion — a compensating casualty can be tipped over the cliff by walking.

Check — Watch The Trend, Not The Moment

• Reassess mental status and pulses at every loop cycle.
• A casualty who was talking and is now confused has told you something — believe them.
• Improvement after intervention must be re-confirmed — compensation can mask ongoing loss.

Don't — The Failure Patterns

• Assuming bleeding control equals resuscitation — the lost volume does not replace itself.
• Missing occult hemorrhage — abdominal and pelvic bleeding hides from a blood sweep.
• Failing to recognize early shock because the casualty "still looks okay."
• Treating a single reassuring vital sign as a stable casualty — trends, not snapshots.

What This Looks Like At Your Level

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