question: Why are wide open eyes and a gaping mouth the physiological responses of extreme shock?
comment: Fight or flight It’s the body getting ready for extreme action.... more breathing in and better visuals
passages: Reiterating the example in an interview with CBS News several months before Operation Iraqi Freedom, Ullman stated, "You're sitting in Baghdad and all of a sudden you're the general and 30 of your division headquarters have been wiped out. You also take the city down. By that I mean you get rid of their power, water. In 2, 3, 4, 5 days they are physically, emotionally and psychologically exhausted."
  
  Section::::Historical applications.
  
  Ullman and Wade argue that there have been military applications that fall within some of the concepts of shock and awe. They enumerate nine examples:
   According to Jeffrey Browndyke, "the strongest evidence for the facial feedback hypothesis to date comes from research by Lanzetta et al. (1976)" (but see "Studies using Botox" below for more recent and powerful evidence). Participants had lower skin conductance and subjective ratings of pain when hiding the painfulness of the shocks they endured, compared with those who expressed intense pain.
   "I heard the shriek of the whistling bombs as they fell, and then the hollow booms as they detonated deep inside the mud of the beach... The blast blew my parents and me across the road adjacent to the boardwalk. I landed in a garden on my back, opened my eyes and stared at the blue sky, and there was a loud ringing in my ears. The blood was pouring out of my nose, and I felt a terrible tightness and pain in my chest... In a daze, I got up, and soon discovered my parents in the same garden, on all fours, attempting to stand up, also suffering from nosebleeds and chest pains."
   Blast-related traumatic brain injuries are often closed-head injuries and result from rapid changes in atmospheric pressure, objects dislodged by the blast hitting people, or people being thrown into motion by the blast Blast-related injuries have shown a recent increase in occurrence with the return of veterans from Iraq such that traumatic brain injury has been coined the "signature injury" of Operation Iraqi Freedom 
  
  Closed-head injuries can range from mild injuries to debilitating traumatic brain injuries and can lead to severe brain damage or death. Common closed-head injuries include:
   Section::::In other media.:Television.:"Static Shock".
   Section::::Blast-related ocular trauma.:Mechanism of injury.:Skull flexure.
   In shock, you may see cold clammy skin, pale skin (especially around eyes, mouth, and hands), sweating, anxiousness, and loss of consciousness. You may note a fast heartbeat (110 beats per minute or more), low blood pressure (90mmHg systolic or less), and decreased urine output.
   Spontaneous, involuntary surprise is often expressed for only a fraction of a second. It may be followed immediately by the emotion of fear, joy or confusion. The intensity of the surprise is associated with how much the jaw drops, but the mouth may not open at all in some cases. The raising of the eyebrows, at least momentarily, is the most distinctive and predictable sign of surprise.
   Section::::Non-verbal responses.
  
  Surprise is expressed in the face by the following features:
  
  BULLET::::- Eyebrows that are raised so they become curved and high.
  
  BULLET::::- Horizontal wrinkles across the forehead.
  
  BULLET::::- Open eyelids: the upper lid is raised and the lower lid is drawn down, often exposing the white sclera above and below the iris.
  
  BULLET::::- Pupil dilation mydriasis or pupil constriction miosis
  
  BULLET::::- Dropped jaw so that the lips and teeth are parted, with no tension around the mouth.
   An 8-month study in Iraq performed in 2010 and published in 2011 reports on autopsies of 30 gunshot victims struck with high-velocity (greater than 2500 fps) rifle bullets. The authors determined that the lungs and chest are the most susceptible to distant wounding, followed by the abdomen. The study noted that the "sample size was so small [too small] to reach the level of statistical significance". Nevertheless, the authors conclude:
  
  Section::::Inferences from blast pressure wave observations.
   Although minor bumps to the head are reported as the most common precipitants to reflex anoxic seizures, many other stimuli may also be involved. Doctors emphasized the importance of minor injuries and sudden fright. They noted that occipital blows to the head appeared to be particularly provocative. Pain, especially from emotion (surprise, fear, annoyance, frustration, and excitement), crying, and fever were provocative factors. Fever was reported as a provocative factor in 14% of cases. Some cases of fever-induced reflex anoxic seizures are likely to be misdiagnosed as febrile (epileptic) seizures, as has been emphasized by a number of authors. Many, if not most, cases of venipuncture fits are reflex anoxic seizures. When one considers the vast range of situations in which a child (or adult) can be surprised, frightened, upset, or merely excited, it is easy to understand how reflex anoxic seizures can occur in special settings, such as bathing and water immersion; in the anesthetic room; when witnessing “blood and gore”; at the dentist office, school, place of worship, or the hairdresser's; and whilst watching television.
   Section::::Explosion physics.:Impact of explosion upon individuals in the blast radius.
   CT scans of patients with a tension pneumocephalus typically show air that compresses the frontal lobes of the brain, which results in a tented appearance of the brain in the skull known as the Mount Fuji sign.
   Researchers have also attempted to observe the physical, non-verbal reactions to awe by asking participants to remember a time they felt awe and to express the emotion nonverbally. Using this method, researchers observed that awe is often displayed through raised inner eyebrows (78%), widened eyes (61%), and open, slightly drop-jawed mouths (80%). A substantial percent of people also display awe by slightly jutting forward their head (27%) and visibly inhaling (27%), but smiling is uncommon (10%). Cross-cultural research is needed to determine whether physical displays of awe differ by culture.
  
  Section::::Research.:Personality and awe.
   It is believed that cytokine storms were responsible for the disproportionate number of healthy young adult deaths during the 1918 influenza pandemic, which killed 50 to 100 million people. In this case, a healthy immune system may have been a liability rather than an asset. Preliminary research results from Hong Kong also indicated this as the probable reason for many deaths during the SARS epidemic in 2003. Human deaths from the bird flu H5N1 usually involve cytokine storms as well. Cytokine storm has also been implicated in hantavirus pulmonary syndrome.
   According to a U.S. Central Intelligence Agency study, "the effect of an FAE explosion within confined spaces is immense. Those near the ignition point are obliterated. Those at the fringe are likely to suffer many internal, and thus invisible injuries, including burst eardrums and crushed inner ear organs, severe concussions, ruptured lungs and internal organs, and possibly blindness." Another Defense Intelligence Agency document speculates that because the "shock and pressure waves cause minimal damage to brain tissue…it is possible that victims of FAEs are not rendered unconscious by the blast, but instead suffer for several seconds or minutes while they suffocate".
   In a survey of documented head injuries followed by unconsciousness, most of which involved sporting activities, two thirds of head impacts demonstrated a fencing response, indicating a high incidence of fencing in head injuries leading to unconsciousness, and those pertaining to athletic behavior. Likewise, animal models of diffuse brain injury have illustrated a fencing response upon injury at moderate but not mild levels of severity as well as a correlation between fencing, blood brain barrier disruption, and nuclear shrinkage within the LVN, all of which indicates diagnostic utility of the response. 
   Tonic posturing (see abnormal posturing) preceding convulsion has been observed in sports injuries at the moment of impact where extension and flexion of opposite arms occur despite body position or gravity. The fencing response emerges from the separation of tonic posturing from convulsion and refines the tonic posturing phase as an immediate forearm motor response to indicate injury force magnitude and location.
  
  Section::::Pathophysiology.
   For example, Ibolja Cernak, a leading researcher in blast wave injury at the Applied Physics Laboratory at Johns Hopkins University, hypothesized, "alterations in brain function following blast exposure are induced by kinetic energy transfer of blast overpressure via great blood vessels in abdomen and thorax to the central nervous system." This hypothesis is supported by observations of neural effects in the brain from localized blast exposure focused on the lungs in experiments in animals.
   Shock of birth
  
  Shock of birth is the transient depression of muscle tone and deep tendon reflexes that occurs in newborns after birth. In 70% of newborns, it lasts less than 24 hours, and in 84.3% less than 48 hours. Its presence is not affected by whether birth happened through vaginal delivery or cesarean delivery. The term was introduced in 1960.
   Although Ullman and Wade claim that the need to "[m]inimize civilian casualties, loss of life, and collateral damage" is a "political sensitivity [which needs] to be understood up front", their doctrine of rapid dominance requires the capability to disrupt "means of communication, transportation, food production, water supply, and other aspects of infrastructure", and, in practice, "the appropriate balance of Shock and Awe must cause ... the threat and fear of action that may shut down all or part of the adversary's society or render his ability to fight useless short of complete physical destruction."
   Section::::Historical applications.:Iraq War.:Conflicting post-war assessments.
   Experiments on sheep show that a lightning strike to the head of a victim enters through the eyes, ears, nose and mouth, converging at the brainstem, which controls breathing. Many unconscious victims, who appear lifeless, actually die of suffocation. Chances of survival may be increased if cardiopulmonary resuscitation (CPR) is started immediately, and continued without interruption until the brainstem recovers.
  
  Section::::Treatment.:Long-term.
   Many of the wounds inflicted by the blast were permanently debilitating, such as those caused by flying glass or by the flash of the explosion. Thousands of people had stopped to watch the ship burning in the harbour, many from inside buildings, leaving them directly in the path of glass fragments from shattered windows. Roughly 5,900 eye injuries were reported, and 41 people lost their sight permanently.
   Mr Gideon Gardiner described the scene of the temporary morgue within the gymnasium: "Some had never woken up; apparently the shock appeared to have stopped their hearts. They were stretched out, white, gaunt, drawn faces, with eyes nearly bolting out of their heads. Others were greatly cut up, mangled, bleeding and some were blown limb from limb".
  