SHO K I G O P O R O V E N T
The term “shock” means blow .
This is a critical, between life and death, state of the body, characterized by deep disorders and inhibition of all vital functions (breathing, blood circulation, metabolism, liver, kidney functions, etc.). A state of shock can occur with severe injuries, extensive burns and large blood losses. The development and deepening of shock is facilitated by painful sensations, cooling of the body, hunger, thirst, shaking transportation of the victim.
Shock is the body's active defense against environmental aggression..
Depending on the reason causing the development of the shock state, there are:
1. Shock due to exposure external reasons: - traumatic, resulting from mechanical injury(wounds, bone fractures, tissue compression, etc.);
- burn associated with burn injury (thermal and chemical burns);
- cold , developing when exposed to low temperature;
- electric , which is a consequence of electrical injury.
2. Shock caused by internal causes:
- hemorrhagic resulting from acute and massive blood loss;
- To ardiogenic , developing during myocardial infarction;
- With eptic, resulting from a general purulent infection in the body.
When a person is faced with the threat of death, his body, in a state of stress, secretes great amount adrenaline.
REMEMBER! A colossal surge of adrenaline causes a sharp spasm of the precapillaries of the skin, kidneys, liver and intestines.
The vascular network of these and many other organs will be practically excluded from the blood circulation. And such vital centers as the brain, heart and partly the lungs will receive much more blood than usual. Centralization of blood circulation occurs in the hope that after overcoming extreme situation they will be able to resume normal life activities again.
REMEMBER! Only due to spasm of skin vessels and its exclusion from blood circulation, the loss of 1.5 - 2 liters of blood is compensated.
That is why in the first minutes of shock, thanks to the spasm of the precapillaries and sharp increase peripheral resistance(PS), the body manages not only to maintain the level blood pressure within normal limits, but also exceed it even with intense bleeding.
The first signs of shock development:
Sharp paleness skin;
Emotional and motor arousal;
Inadequate assessment of the situation and one’s condition;
No complaints of pain even with shockogenic injuries.
The ability to forget about pain at the moment of mortal danger is explained by the fact that a morphine-like substance is produced in the subcortical structures of the brain - endomorphinol( internal, own morphine). Its drug-like effect causes a state of mild euphoria and relieves pain even in severe injuries.
On the other hand, pain activates functions endocrine glands and above all the adrenal glands. It is they who secrete the amount of adrenaline, the action of which will cause a spasm of the precapillaries, an increase in blood pressure and an increase in heart rate.
The adrenal cortex secretes and corticosteroids (their synthetic analogue is prednisolone), which significantly accelerates tissue metabolism.
This allows the body to throw out its entire energy reserve in an extremely short time and concentrate its efforts as much as possible to get away from danger.
There are two phases of shock:
- short-term erectile(period of excitation) phase begins immediately after the injury and is characterized by motor and speech arousal, as well as complaints of pain. While maintaining full consciousness, the victim underestimates the severity of his condition. Pain sensitivity is increased, the voice is muffled, the words are abrupt, the gaze is restless, the face is pale, blood pressure is normal or elevated. The excited state quickly (within a few minutes), or less often gradually, turns into a depressed state, accompanied by a decrease in all vital functions.
- torpid phase (period of depression: lat. torpidum - inhibition) is characterized by general weakness and a sharp drop in blood pressure. Breathing becomes frequent and shallow. The pulse is frequent, uneven, thread-like (barely palpable). The face is pale, with an earthy tint, covered with cold, sticky sweat. The victim is inhibited, does not answer questions, treats others with indifference, pupils are dilated, consciousness is preserved. In severe cases, vomiting and involuntary urination are possible.
This phase usually ends in death and is considered irreversible.
If the victim does not receive medical assistance within 30-40 minutes, then prolonged centralization of blood circulation will lead to gross disturbances of microcirculation in the kidneys, skin, intestines and other organs excluded from the blood circulation. Thus, what played a protective role at the initial stage and gave a chance for salvation will become the cause of death in 30-40 minutes.
A sharp decrease in the speed of blood flow in the capillaries, up to a complete stop, will cause disruption of oxygen transport and accumulation of under-oxidized metabolic products in the tissues - acidosis, lack of oxygen - hypoxia, and necrosis in a living body of individual organs and tissues - necrosis.
This stage very quickly gives way to agony and death. .
COMPLEX OF ANTI-SHOCK MEASURES.
It is necessary to free the victim from the action of the traumatic factor;
Ensure bleeding stops;
To stabilize breathing, provide an influx fresh air and give a position that allows breathing;
Give painkillers (analgin, baralgin, pentalgin);
Give drugs that tonic the activity of the heart vascular system(corvalol - 10-15 drops, cordiamin, tincture of lily of the valley);
The victim should be kept warm;
Give plenty of warm drink (tea, coffee, water with added salt and baking soda - 1 teaspoon of salt and 0.5 teaspoon of soda per 1 liter of water);
Immobilize injured body parts;
In case of cardiac and respiratory arrest, urgent resuscitation measures (ventilation, external massage hearts);
THE VICTIMS MUST NOT BE LEFT ALONE!
Shock states - acute severe pathological processes, the cause of which may be injury, infection, poisoning. They are designed to support life, but if rescue is not started in time, they can lead to irreversible, lethal damage.
general description
The most famous doctor, N. Burdenko, described shock not as a stage of dying, but as a struggle of the body trying to survive. Indeed, in this state the metabolism slows down, brain activity, blood pressure, and temperature decrease. All forces are directed to maintaining the vital functions of the most important organs: the brain, liver, lungs.
However, unfortunately human body not suitable for long-term shock. Redistribution of blood flow and the resulting lack of nutrition and respiration of peripheral tissues inevitably cause cell death.
The task of a person who finds himself next to a patient who develops shock is call immediately Ambulance . The sooner they start resuscitation measures, the greater the patient’s chances of surviving and regaining health.
Causes of shocks
Doctors distinguish the following types of shock states:
- Hypovolemic shock - with a sudden loss of a large volume of fluid;
- Traumatic - in case of injury, burn, electric shock, and so on;
- Painful endogenous - for acute pain associated with pathologies internal organs(nephrogenic, cardiogenic, etc.);
- Infectious-toxic - with acute poisoning substances secreted by microorganisms;
- Anaphylactic - when substances enter the body that cause an acute and powerful allergic reaction;
- Post-transfusion - after injection.
It is easy to see that in each specific case shock may have several causes. For example, with an extensive burn, acute loss of fluid and unbearable pain are observed, and intoxication develops.
It is more important for us to learn about how the state of shock develops, what its external signs are - symptoms.
Stages of shock
Excitation stage
This period usually goes unnoticed. It is characterized by increased patient activity, increased breathing, and increased heart rate. In this condition, the patient can make some efforts to save his life. But the duration of this stage is short.
Braking stage
It is this state that becomes noticeable to others. The mechanisms of its development are as follows:
Activity slows down various departments brain. The victim becomes lethargic, sleepy, and loses consciousness.
Circulating blood is redistributed - its main volume flows to the internal organs. At the same time, the heartbeat increases, but the strength of myocardial contractions decreases. Vessels constrict to maintain normal pressure. But this state is replaced by overstrain of the vascular wall - at some point the vessels relax, and the pressure drops critically. At the same time, the person’s blood thickens (DIC syndrome). On late stage the opposite state may occur - critical inhibition of coagulation. A person’s skin becomes pale, marbled, limbs become cold, lips turn blue. Breathing is shallow and weak. Speedy, but weak pulse. Convulsions are possible.
Terminal stage
Stopping normal metabolic processes leads to tissue damage and dysfunction of internal organs. The more systems are damaged, the less hope there is for saving lives and restoring health.
Hypovolemic shock
Associated with sudden loss of fluid from the body. In this regard, the volume of circulating blood decreases and the water-salt (electrolyte) balance is disturbed. It can occur not only with bleeding (injuries, internal bleeding), but also with severe vomiting, profuse diarrhea, increased sweating, overheating.
Hypovolemia - the most common shock condition in children of the first years of life (especially infants). Parents often do not realize that over several episodes of vomiting or diarrhea, even when in a hot and stuffy room, the baby can lose a significant amount of fluid. And this condition can lead to shock and the most tragic consequences.
You need to understand that when vomiting, loose stools, increased sweating are removed from the body important microelements: potassium, sodium, calcium. And this affects all systems - the tone of muscles (including those that ensure the functioning of internal organs) and the transmission of nerve impulses are disrupted.
The rate of fluid loss plays an important role in the development of shock. In infants, even a single dose (about 200 ml) can cause severe hypovolemia.
Symptoms of hypovolemia are: pallor and cyanosis of the skin, dry mucous membranes (tongue like a brush), cold hands and feet, shallow breathing and heartbeat, low blood pressure, apathy, lethargy, lack of reactions, convulsions.
Parents should always monitor drinking regime child. Especially during periods of illness, in hot weather. If your baby begins to have diarrhea or vomiting, you should immediately consult a doctor. It is best to call an ambulance. Lost fluid is restored most quickly and completely when administered intravenously.
Burn shock
Has its own characteristics. initial stage excitement lasts noticeably longer. At the same time, blood pressure remains normal or even elevated. This is due to a significant concentration of adrenaline, which is released into the blood during stress and severe pain.
When tissues are damaged by high temperatures, a large amount of potassium enters the blood, which negatively affects nerve conduction and heart rate, and the condition of the kidneys.
Through burned skin, a person loses a critical volume of plasma - the blood thickens sharply, and blood clots arise that can block the flow of blood to vital organs.
When it comes to children in the first three years of life, any burn is a reason to urgently consult a doctor. In case of electrical injury, patients of any age are hospitalized.
To estimate the burn area, percentages are used - 1% equal to area the victim's palms. If 3% or more percent of the body is burned, in order to avoid serious consequences, you should seek medical help.
Cardiogenic shock
Associated with acute cardiac dysfunction. The reasons causing this condition can be different:
- myocardial infarction,
- Congenital heart defect,
- injury and so on.
At the beginning, the patient experiences a lack of air - he begins to cough, tries to take a sitting position (the most comfortable for forced breathing). The skin becomes covered with cold sweat, the hands and feet become cold. Possible heart pain.
As cardiogenic shock develops, breathing becomes even more difficult (pulmonary edema begins) - it becomes bubbling. Sputum appears. Sharply increasing swelling is possible.
Anaphylactic shock
Another common type of shock. Is an immediate allergic reaction that occurs upon contact (often during or immediately after injection) with active substances- medicines, household chemicals, food and so on; or when bitten by an insect (usually bees, wasps, hornets).
A huge number of compounds are released into the blood, causing inflammatory reaction. Including histamine. Because of this, a sharp relaxation occurs vascular walls- the volume of the bloodstream increases critically, although the blood volume does not change. The pressure drops.
An outside observer may notice the appearance of a rash (urticaria), difficulty breathing (due to swelling respiratory tract). Pulse - rapid, weak. Blood pressure is sharply reduced.
The victim requires immediate resuscitation.
Infectious-toxic shock
It develops during acute poisoning of the body with toxins released by microorganisms and the decay products of the microorganisms themselves. It is especially important for parents of young children to know about this condition. After all, such a shock can occur in children (dangerous toxins are released by diphtheria bacillus and other bacteria).
A child's body is not balanced compared to an adult. Poisoning quickly leads to disturbances in the autonomic vascular system (reflex) and cardiovascular activity. It is important to understand that tissues deprived of sufficient nutrition produce their own toxins. These compounds enhance poisoning.
Symptoms may vary. In general, it corresponds to other shock conditions. It is important that parents are aware of the possibility of such a condition and correctly assess increased agitation or lethargy, pallor, cyanosis, marbling of the skin, chills, muscle twitching or convulsions, and tachycardia.
What to do in case of any shock?
In all the above descriptions of the most common types of shocks, we mentioned the main thing that needs to be done: to ensure the provision of full medical care.
There is nothing to expect: Call an ambulance immediately or take the victim to the hospital yourself (if it’s faster!). When transporting yourself, choose a hospital that has an intensive care unit.
It's okay if you confuse shock with less dangerous condition. If you simply observe the patient and try to help him yourself, it is possible that irreversible damage and death will occur.
Swiftly developing condition against the background of a severe injury that poses a direct threat to a person’s life, it is commonly called traumatic shock. As is already clear from the name itself, the cause of its development is severe mechanical damage and unbearable pain. In such a situation, you should act immediately, since any delay in providing first aid can cost the patient’s life.
Table of contents:Causes of traumatic shock
The cause may be severe injuries - hip fractures, gunshots or stab wounds, major gap blood vessels, burns, damage to internal organs. This may include injuries to the most sensitive areas of the human body, such as the neck or perineum, or to vital organs. The basis for their occurrence, as a rule, is extreme situations.
note
Very often, painful shock develops when large arteries are injured, where rapid blood loss occurs, and the body does not have time to adapt to new conditions.
Traumatic shock: pathogenesis
The principle of development of this pathology is a chain reaction of traumatic conditions that carry severe consequences for the patient’s health and aggravated one after another in stages.
For intense, unbearable pain and high blood loss, a signal is sent to our brain that provokes severe irritation. The brain suddenly releases a large amount of adrenaline, such an amount is not typical for normal human activity, and this disrupts the functioning of various systems.
With sudden blood loss A spasm of small vessels occurs, at first this helps to save some of the blood. Our body is unable to maintain this state for a long time; subsequently, the blood vessels dilate again and blood loss increases.
In case of closed injury the mechanism of action is similar. Thanks to the hormones released, the vessels block the outflow of blood and this condition is no longer a defensive reaction, but, on the contrary, is the basis for the development of traumatic shock. Subsequently, a significant amount of blood is retained, a lack of blood supply to the heart occurs, respiratory system, hematopoietic system, brain and others.
Subsequently, intoxication of the body occurs, vital important systems They fail one after another, and necrosis of the tissue of internal organs occurs due to lack of oxygen. In the absence of first aid, all this leads to death.
The development of traumatic shock against the background of injury with intense blood loss is considered the most severe.
In some cases, recovery of the body with mild to moderate pain shock can occur on its own, although such a patient should also be given first aid.
Symptoms and stages of traumatic shock
Symptoms of traumatic shock are pronounced and depend on the stage.
Stage 1 – erectile
Lasts from 1 to several minutes. The resulting injury and unbearable pain provoke an atypical state in the patient; he may cry, scream, be extremely agitated, and even resist assistance. The skin becomes pale, sticky sweat appears, and the rhythm of breathing and heartbeat is disrupted.
note
At this stage, it is already possible to judge the intensity of the manifested pain shock; the brighter it is, the stronger and more rapidly the subsequent stage of shock will manifest itself.
Stage 2 – torpid
Has rapid development. The patient's condition changes sharply and becomes inhibited, consciousness is lost. However, the patient still feels pain, first aid procedures should be carried out with extreme caution.
The skin becomes even paler, cyanosis of the mucous membranes develops, blood pressure drops sharply, and the pulse can barely be felt. The next stage will be the development of dysfunction of internal organs.
Degrees of development of traumatic shock
Symptoms of the torpid stage can have different intensity and severity, depending on this, the degrees of development of pain shock are distinguished.
1st degree
Satisfactory condition, clear consciousness, the patient clearly understands what is happening and answers questions. Hemodynamic parameters are stable. Slightly increased breathing and heart rate may occur. It often occurs with fractures of large bones. Mild traumatic shock has a favorable prognosis. The patient should be given assistance in accordance with the injury, given analgesics and taken to a hospital for treatment.
2nd degree
The patient is marked by lethargy; he may take a long time to respond to asked question and does not immediately understand when someone addresses him. The skin is pale, the limbs may take on a bluish tint. Blood pressure is reduced, pulse is frequent but weak. Lack of proper assistance can provoke the development of the next degree of shock.
3rd degree
The patient is unconscious or in a state of stupor, there is practically no reaction to stimuli, the skin is pale. A sharp drop in blood pressure, the pulse is frequent, but weakly palpable even in large vessels. The prognosis for this condition is unfavorable, especially if the procedures performed do not lead to positive dynamics.
4th degree
Fainting, no pulse, extremely low or no blood pressure. The survival rate for this condition is minimal.
Treatment
The basic principle of treatment for the development of traumatic shock is immediate action to normalize the patient's health status.
First aid for traumatic shock must be carried out immediately, with clear and decisive action.
First aid for traumatic shock
What specific actions are necessary is determined by the type of injury and the cause of the development of traumatic shock, final decision comes according to actual circumstances. If you witness the development of painful shock in a person, it is recommended to immediately take the following actions:
The tourniquet is used when arterial bleeding(blood spurts out) is applied above the wound site. It can be used continuously for no more than 40 minutes, then it should be relaxed for 15 minutes. When the tourniquet is applied correctly, the bleeding stops. In other cases of injury, a pressure gauze bandage or tampon is applied.
- Provide free access of air. Remove or unfasten constrictive clothing and accessories, remove foreign objects from the respiratory passages. The unconscious patient should be placed on his side.
- Warming procedures. As we already know, traumatic shock can manifest itself in the form of paleness and coldness of the extremities, in which case the patient should be covered or additional access to heat should be provided.
- Painkillers. Ideal option in in this case will be intramuscular injection analgesics. In an extreme situation, try to give the patient an analgin tablet sublingually (under the tongue for faster action).
- Transportation. Depending on the injuries and their location, it is necessary to determine the method of transporting the patient. Transportation should be carried out only in cases where waiting for medical assistance may take a very long time.
Forbidden!
- Disturb and excite the patient, make him move!
- Shift or move the patient from
Shock is a specific condition in which there is a sharp lack of blood to the most important human organs: the heart, brain, lungs and kidneys. Thus, a situation arises in which the available volume of blood is not enough to fill the existing volume of blood vessels under pressure. To some extent, shock is a state that precedes death.
Causes
The causes of shock are due to a violation of the circulation of a fixed volume of blood in a certain volume of vessels, which are capable of narrowing and expanding. Thus, among the most common causes of shock are a sharp decrease in blood volume (blood loss), a rapid increase in blood vessels (vessels dilate, usually in response to sharp pain, exposure to an allergen or hypoxia), as well as the inability of the heart to perform its assigned functions (cardiac contusion during a fall, myocardial infarction, “bending” of the heart during tension pneumothorax).
That is, shock is the body’s inability to ensure normal blood circulation.
Among the main manifestations of shock are a rapid pulse above 90 beats per minute, a weak thread-like pulse, a decreased blood pressure(up to its complete absence), rapid breathing, in which a person at rest breathes as if he were performing heavy physical activity. Pale skin (skin becomes pale blue or pale yellow), lack of urine, and severe weakness in which a person cannot move or speak are also signs of shock. The development of shock can lead to loss of consciousness and lack of response to pain.
Types of shock
Anaphylactic shock is a form of shock characterized by a sharp dilation of blood vessels. The cause of anaphylactic shock may be a certain reaction to an allergen entering the human body. This could be a bee sting or the injection of a drug to which the person is allergic.
The development of anaphylactic shock occurs when an allergen enters the human body, regardless of the quantities in which it enters the body. For example, it does not matter at all how many bees have bitten a person, since the development of anaphylactic shock will occur in any case. However, the location of the bite is important, since if the neck, tongue or facial area is affected, the development of anaphylactic shock will occur much faster than with a bite to the leg.
Traumatic shock is a form of shock characterized by an extremely serious condition of the body, provoked by bleeding or painful irritation.
Among the most common causes of traumatic shock are pale skin, sticky sweat, indifference, lethargy, and rapid pulse. Other causes of traumatic shock include thirst, dry mouth, weakness, anxiety, unconsciousness or confusion. These signs of traumatic shock are to some extent similar to the symptoms of internal or external bleeding.
Hemorrhagic shock is a form of shock in which there is emergency of the body, developing as a result of acute blood loss.
The degree of blood loss has a direct impact on the manifestation of hemorrhagic shock. In other words, the strength of the manifestation of hemorrhagic shock directly depends on the amount by which the circulating blood volume (CBC) decreases in a fairly short period of time. A blood loss of 0.5 liters, which occurs over the course of a week, will not provoke the development of hemorrhagic shock. In this case, the clinic of anemia develops.
Hemorrhagic shock occurs as a result of blood loss in total volume 500 or more ml, which is 10-15% of the circulating blood volume. A loss of 3.5 liters of blood (70% of the blood volume) is considered fatal.
Cardiogenic shock is a form of shock characterized by a complex of pathological conditions in the body, provoked by a decrease in the contractile function of the heart.
Among the main signs of cardiogenic shock are interruptions in the functioning of the heart, which are a consequence of a violation heart rate. In addition, when cardiogenic shock There are interruptions in the functioning of the heart, as well as chest pain. Myocardial infarction is characterized by a strong feeling of fear with thromboembolism pulmonary artery, shortness of breath and acute pain.
Other signs of cardiogenic shock include vascular and autonomic reactions that develop as a result of a decrease in blood pressure. Cold sweat, pallor, followed by blueness of the nails and lips, as well as severe weakness are also symptoms of cardiogenic shock. There is often a feeling of intense fear. Due to the swelling of the veins, which occurs after the heart stops pumping blood, the jugular veins of the neck become swollen. With thromboembolism, cyanosis occurs quite quickly, and marbling of the head, neck and chest is also noted.
In cardiogenic shock, loss of consciousness may occur after breathing and cardiac activity ceases.
First aid for shock
Timely rendered health care in case of severe injury and trauma, it can prevent the development of a state of shock. The effectiveness of first aid for shock largely depends on how quickly it is provided. First aid for shock is to eliminate the main causes of the development of this condition (stopping bleeding, reducing or relieving pain, improving breathing and cardiac activity, general cooling).
Thus, first of all, in the process of providing first aid for shock, one should address the causes that caused this state. It is necessary to free the victim from the rubble, stop the bleeding, extinguish burning clothing, neutralize the damaged part of the body, eliminate the allergen, or provide temporary immobilization.
If the victim is conscious, it is recommended to offer him an anesthetic and, if possible, drink hot tea.
In the process of providing first aid for shock, it is necessary to loosen tight clothing on the chest, neck or belt.
The victim must be placed in such a position that the head is turned to the side. This position allows you to avoid retraction of the tongue, as well as suffocation with vomit.
If shock occurs in cold weather, the victim should be warmed up, and if in hot weather, he should be protected from overheating.
Also, in the process of providing first aid for shock, if necessary, the victim’s mouth and nose should be freed from foreign objects, after which closed heart massage and artificial respiration should be performed.
The patient should not drink, smoke, use heating pads or bottles with hot water, and also to remain alone.
Attention!
This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.
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is a pathological condition that occurs as a result of blood loss and pain during injury and poses a serious threat to the patient’s life. Regardless of the cause of development, it always manifests itself with the same symptoms. Pathology is diagnosed based on clinical signs. Urgent stoppage of bleeding, anesthesia and immediate delivery of the patient to the hospital are necessary. Treatment of traumatic shock is carried out in conditions intensive care unit and includes a set of measures to compensate for violations that have occurred. The prognosis depends on the severity and phase of shock, as well as the severity of the injury that caused it.
ICD-10
T79.4
General information
Traumatic shock is a serious condition that is the body’s reaction to acute injury, accompanied by severe blood loss and intense pain. It usually develops immediately after injury and is an immediate reaction to damage, but under certain conditions (additional trauma) it can occur after some time (4-36 hours). It is a condition that poses a threat to the patient’s life and requires urgent treatment in an intensive care unit.
Causes
Traumatic shock develops with all types of severe injuries, regardless of their cause, location and mechanism of injury. Its cause can be knife and gunshot wounds, falls from heights, car accidents, man-made and natural disasters, industrial accidents, etc. In addition to extensive wounds with damage to soft tissues and blood vessels, as well as open and closed fractures of large bones (especially multiple and accompanied by damage to the arteries), traumatic shock can cause extensive burns and frostbite, which are accompanied by significant loss plasma.
The development of traumatic shock is based on massive blood loss, pronounced pain syndrome, dysfunction of vital organs and mental stress caused by acute injury. In this case, blood loss plays a leading role, and the influence of other factors can vary significantly. Thus, if sensitive areas (perineum and neck) are damaged, the influence of the pain factor increases, and if the chest is injured, the patient’s condition is aggravated by impaired breathing function and oxygen supply to the body.
Pathogenesis
The triggering mechanism of traumatic shock is largely associated with the centralization of blood circulation - a state when the body directs blood to vital organs (lungs, heart, liver, brain, etc.), diverting it from less important organs and tissues (muscles, skin, fatty tissue). The brain receives signals about a lack of blood and reacts to them by stimulating the adrenal glands to release adrenaline and norepinephrine. These hormones act on peripheral blood vessels, causing them to constrict. As a result, blood flows away from the extremities and there is enough of it for the functioning of vital organs.
After some time, the mechanism begins to malfunction. Due to the lack of oxygen, peripheral vessels dilate, causing blood to flow away from vital organs. At the same time, due to disturbances in tissue metabolism of the wall peripheral vessels stop responding to signals nervous system and the action of hormones, so re-constriction of blood vessels does not occur, and the “periphery” turns into a blood depot. Due to insufficient blood volume, the heart's function is impaired, which further aggravates circulatory problems. Blood pressure drops. With a significant decrease in blood pressure, the normal functioning of the kidneys is disrupted, and a little later - the liver and intestinal wall. Toxins are released from the intestinal wall into the blood. The situation is aggravated due to the occurrence of numerous foci of dead tissue without oxygen and severe metabolic disorders.
Due to spasm and increased blood clotting, some small vessels become clogged with blood clots. This causes the development of DIC syndrome (disseminated intravascular coagulation syndrome), in which blood clotting first slows down and then practically disappears. With DIC, bleeding may resume at the site of injury, pathological bleeding occurs, and multiple small hemorrhages appear in the skin and internal organs. All of the above leads to a progressive deterioration of the patient’s condition and becomes the cause fatal outcome.
Classification
There are several classifications of traumatic shock depending on the causes of its development. Yes, in many Russian manuals in traumatology and orthopedics, surgical shock, endotoxin shock, shock due to crushing, burn, shock air wave and tourniquet are distinguished. The classification of V.K. is widely used. Kulagin, according to which there are the following types of traumatic shock:
- Wound traumatic shock (arising due to mechanical trauma). Depending on the location of the injury, it is divided into visceral, pulmonary, cerebral, with trauma to the extremities, with multiple trauma, with compression of soft tissues.
- Operational traumatic shock.
- Hemorrhagic traumatic shock (developing with internal and external bleeding).
- Mixed traumatic shock.
Regardless of the causes of occurrence, traumatic shock occurs in two phases: erectile (the body tries to compensate for the violations that have arisen) and torpid (compensatory capabilities are depleted). Taking into account the severity of the patient’s condition in the torpid phase, 4 degrees of shock are distinguished:
- I (light). The patient is pale and sometimes a little lethargic. Consciousness is clear. Reflexes are reduced. Shortness of breath, pulse up to 100 beats/min.
- II (moderate). The patient is lethargic and lethargic. Pulse is about 140 beats/min.
- III (severe). Consciousness is preserved, the ability to perceive the surrounding world is lost. The skin is earthy gray, the lips, nose and fingertips are bluish. Sticky sweat. Pulse is about 160 beats/min.
- IV (preagonia and agony). There is no consciousness, the pulse is not detected.
Symptoms of traumatic shock
During the erectile phase, the patient is excited, complains of pain, and may scream or moan. He is anxious and scared. Aggression and resistance to examination and treatment are often observed. The skin is pale, blood pressure is slightly elevated. Tachycardia, tachypnea (increased breathing), trembling of the limbs or small twitching of individual muscles are noted. The eyes shine, the pupils are dilated, the look is restless. The skin is covered with cold, sticky sweat. The pulse is rhythmic, body temperature is normal or slightly elevated. At this stage, the body is still compensating for the disturbances that have arisen. There are no gross disturbances in the functioning of internal organs, no disseminated intravascular coagulation syndrome.
With the onset of the torpid phase of traumatic shock, the patient becomes apathetic, lethargic, drowsy and depressed. Despite the fact that the pain does not decrease during this period, the patient stops or almost stops signaling about it. He no longer screams or complains; he can lie silently, moaning quietly, or even lose consciousness. There is no reaction even with manipulations in the area of damage. Blood pressure gradually decreases and heart rate increases. The pulse in the peripheral arteries weakens, becomes thread-like, and then becomes undetectable.
The patient's eyes are dull, sunken, the pupils are dilated, the gaze is motionless, there are shadows under the eyes. There is marked pallor of the skin, cyanotic mucous membranes, lips, nose and fingertips. The skin is dry and cold, tissue elasticity is reduced. Facial features are sharpened, nasolabial folds are smoothed. Body temperature is normal or low (temperature may also increase due to wound infection). The patient gets chills even in a warm room. Convulsions and involuntary release of feces and urine are often observed.
Symptoms of intoxication are revealed. The patient suffers from thirst, his tongue is coated, his lips are parched and dry. Nausea and, in severe cases, even vomiting may occur. Due to progressive impairment of kidney function, the amount of urine decreases even with heavy drinking. Urine is dark, concentrated, with severe shock anuria is possible ( complete absence urine).
Diagnostics
Traumatic shock is diagnosed when appropriate symptoms are identified, a fresh injury or other possible reason the occurrence of this pathology. To assess the condition of the victim, periodic measurements of pulse and blood pressure are carried out, and laboratory research. Scroll diagnostic procedures determined pathological condition which caused the development of traumatic shock.
Treatment of traumatic shock
At the first aid stage, it is necessary to temporarily stop bleeding (tourniquet, tight bandage), restore airway patency, perform anesthesia and immobilization, and also prevent hypothermia. The patient should be moved very carefully to prevent re-traumatization.
In the hospital, at the initial stage, resuscitators-anesthesiologists transfuse saline (lactasol, Ringer's solution) and colloid (reopolyglucin, polyglucin, gelatinol, etc.) solutions. After determining the rhesus and blood group, the transfusion of these solutions in combination with blood and plasma is continued. Provide adequate breathing using airways, oxygen therapy, tracheal intubation, or mechanical ventilation. Pain relief is continued. Bladder catheterization is performed to accurately determine the amount of urine.
Surgical interventions are carried out according to vital signs to the extent necessary to preserve vital functions and prevent further deterioration of shock. They stop bleeding and treat wounds, block and immobilize fractures, eliminate pneumothorax, etc. Prescribe hormone therapy and dehydration, use drugs to combat cerebral hypoxia, and correct metabolic disorders.
