Acutely developing threatening Life The pathological process caused by the action on the body of a superproof stimulus and characterized by severe violations of the activity of the central nervous system, blood circulation, breathing and metabolism (for example, pain shock).

General ideas about shock, types of shock and methods for treating shock states

Shock is defined as a state of extreme decline arterial pressureaccompanied by a decrease in oxygen inflow to tissues and accumulation of final metabolic products. Depending on the cause of the cause, the first aid will be different and the tactics of first aid will be different, but in any case the resuscitation algorithm will require rapid accurate accurate actions. What types of shock exist and what can be done for the victim before the arrival of emergency medical care - Medaboutme will tell you about it.

The shock understands such a pathological condition, which is a consequence of decompensation of body protective systems in response to a powerful irritant factor. In fact, the human body can no longer cope with the pathological process (whether intensive pain or allergic reaction) and decompensation reaction affecting the nervous, cardiovascular, hormonal system develops. It is believed that for the first time, this condition was described by a great antique hypocratic doctor, but the term "shock" himself was proposed only in the XVIII century. From this time, the active scientific study of the shock state begins, theories that explain the development and action of shock are proposed, methods of treatment of shock are being developed.

At the moment, shock is considered within the framework of adaptation syndrome, which includes 3 stages:

Compensation.

After the impact of an aggressive irritant factor, the body maintains the ability to cope with the changing conditions. Perfusion (blood flow) in vital organs (brain, heart, kidneys) is maintained in sufficient volume. This stage is completely reversible.

• Decompensation.

After the impact of an aggressive irritant factor, the body already loses the ability to cope with the changing conditions. Perfusion (blood flow) in vital organs is progressively declining. This stage without timely intensive treatment is irreversible.

Terminal stage.

At this stage, even intensive therapy It is not able to restore the activity of vital organs. Development terminal Stage leads to the death of the body.

The symptoms of the shock include:

1. Reduced arterial pressure
2. Heart palpitations
3. Reducing the selection of urine (up to its complete absence)
4. Violation of the level of consciousness (characterized by a change in the period of excitation by a period of inhibition)
5. Circulation centralization (temperature decrease, pallor skin Pokrov, weakness)

Types of Shock.

There are several classifications of the shock state, depending on the factors of its causing, such as hemodynamic disorders, clinical manifestations.

In more detail, we will look at all types of shock in specially designated paragraphs, here we will try to bring a general classification.

Classification by the type of hemodynamic disorders

Reduced pressure by reducing the volume of circulating blood. The reason may be: blood loss, burns, dehydration.

The heart is not able to adequately shrink and maintain a sufficient level of pressure and perfusion. The reason may be: heart failure, myocardial infarction, arrhythmia.

• Distribution shock.

Reduced pressure by expanding the vascular bed with a constant amount of circulating blood. The reason may be: toxic poisoning, anaphylaxis, sepsis.

• Obstructive shock.

The reason may be: thromboembolism pulmonary artery, tense pneumothorax.

• Dissociative shock.

Acute hypoxia due to the violation of the hemoglobin structure. The reason can be: carbon monoxide poisoning

Classification by pathogenesis

• Neurogenic shock (damage to the nervous system, leading to the expansion of the vascular channel, as a rule, is a spinal injury)
• Anaphylactic shock (acute progressive allergic reaction)
• Septic shock
• Infectious-toxic shock
• Combined shock (comprehensive reaction, including various pathogenesis of shock status)

Clinical classification

• Compensated.

The patient is conscious, the pulse is a bit more participated (~ 100 shots per minute), the pressure is slightly reduced (systolic not less than 90 mm.rt.st.), weakness, light inhibition.

• Subcompensated.

The patient in consciousness, stunned, badly, the weakness is growing, the skin is pale. The frequency of heart abbreviations (up to 130 per minute) is growing, pressure drops (systolic not less than 80 mm.rt.st.), the pulse is weak. Correction of the state requires medical intervention, intensive therapy.

• Decompensated.

The patient is controlled, the consciousness is broken, the skin is pale. The pulse of the weak filling "thread-shaped" over 140 beats per minute, the blood pressure is resolved (systolic less than 70 mm.T.). Violation of urine release (up to the complete absence). The forecast without adequate therapy is unfavorable.

• Irreversible.

The level of consciousness of the patient. The pulse on the peripheral arteries is not determined, blood pressure may also not be determined or is at a very low level (systolic less than 40 mm.rt.st.). No urine release. Reflexes and reactions to pain are not traced. Breathing is barely noticeable, neulty. The forecast for life in such a situation is extremely unfavorable, intensive therapy does not lead to a positive effect.

One of the most Grozny complications of allergic reactions is anaphylactic shock. It proceeds as the hypersensitivity of the immediate type and is a life-in-law. The rate of development of anaphylactic shock is quite high and ranges from a few seconds to several hours after reaction with an allergen. Any substance can act as an allergen, but most often these are medicines, food, chemicals, poisons. With a primary meeting of the body with an allergen, anaphylactic shock does not develop, but the sensitivity to this allergen increases sharply in the body. And during a re-meeting the body with an allergen, anaphylactic shock is possible.

Clinical symptoms of anaphylactic shock Next:

• A pronounced local reaction, accompanied by extensive swelling, pain, increasing temperature, redness, rash
• Itching that can take generalized
• Full blood pressure and pulse
• Quite often arises extensive respiratory edema, which can lead to patient death

With anaphylactic shock, first aid includes:

• Call an ambulance
• Tradition to the patient's horizontal position with raised legs
• Provide the influx of fresh air to the room, unzipped clothes, free the cavity of the mouth from foreign objects (chewing, dentures)
• If the anaphylactic shock developed in response to the bite of an insect or injection of the drug, then it is necessary to apply ice to the bite, and above the bite to impose a harness.

A quick medical team has drugs for the treatment of anaphylactic shock and may emerge to hospitalize the patient in the hospital.

At the stage medical care Adrenaline is introduced, which quickly narrows the vessels and expands bronchi, increases blood pressure. Prednisolone is also introduced, which contributes to the active regression of an allergic reaction. Antihistamines (Dimedrol, Tuegyl) are antagonists of histamine, which underlies an allergic reaction. Isotonic solution is injected intravenously. Inhalation of oxygen. Symptomatic therapy is carried out. In some cases, the trachea intubation is required, with a pronounced larynx swelling, tracheostomas are performed.

As measures for the prevention of anaphylactic shock, those medicinal or food allergens should be avoided, which can provoke a shock state. In the house it is advisable to have a first-aid kit for rendering emergencycomprising adrenaline, prednisone or dexamethasone, isotonic solution, diphedroll, eufillin, syringes and droppers, alcohol, bandage and harness.

Infectious-toxic shock

The rapid drop in blood pressure in response to the toxins allocated by bacteria is called infectious-toxic shock. The risk group includes diseases caused by kokkoy microorganisms: pneumonia, tonsillitis, sepsis, etc. Particularly often infectious toxic shock develops against the background of reduced immunity with HIV infection, diabetes mellitus.

The main symptoms of infectious-toxic shock:

• Fever (above 390s)
• Reduced blood pressure (systolic below 90 mm.rt.)
• Violation of consciousness (depends on the severity of shock)
• Polyorgan insufficiency

Treatment of infectious-toxic shock includes:

• Treatment is carried out under the conditions of the resuscitation department
• Appointment of antibiotics (cephalosporins, aminoglycosides)
• Corticosteroid preparations (prednisolone, dexamethasone)
• Massive infusion therapy
• Heparin (the prevention of thrombosis)
• Symptomatic therapy

Infectious-toxic shock is a serious disease with a high degree of mortality, requiring immediate medical care. Also, at this type of shock there is a risk of developing the following complications:

• Syndrome in DVS (violation of the coagulation system)
• Polyorgan deficiency (renal, pulmonary, cardiac, hepatic)
• Recurner of infectious toxic shock

The forecast of the disease is relatively favorable upon the condition of timely complex treatment.

Under the cardiogenic shock, the state of dysfunction of the pump function of the left ventricle of the heart, leading to a resistant reduction in blood pressure, hypoxia and microcirculation disorders in organs and tissues. The causes of the cardiogenic shock are: arrhythmias, severe injuries of the heart muscle, leading to a violation of its integrity, acute myocardial infarction.

Several subspecies of cardiogenic shock are isolated:

• True
• Reflex
• Arrhythmogenic

Cardiogenic shock, symptoms:

• Resistant hypotension against the background of heart pathology (systolic pressure is maintained at less than 90mm.rt.st.)
• Tachycardia or bradycardia (depending on the severity of shock)
• Circulatory Centralization (Pale and Cool To Skin Skin Covers)
• Reducing urinary release
• Violation of consciousness (up to complete loss)

The severity of the manifestation of certain symptoms of cardiogenic shock by the patient affects: age, availability accompanying pathologies, shock duration, nature and scope of the heart muscle, timeliness of medical care.

True cardiogenic shock

The reason for this state is the death of at least 40% of the cardiomyocytes of the left ventricle of the heart. Forecast with such a type of shock is unfavorable. The remaining capable cardiomyocytes are not able to provide adequate contractual activity of the heart, leading to distinct heavy clinical manifestations of cardiogenic shock. Compensatory mechanisms for supporting blood pressure (through renin-angenetenzine-aldosterone, corticoid, sympathetic and adrenal system) are not able to compensate for the hypotension in full. There is a spasm of the vascular bed and hypercoagulation, leading to the DVS syndrome.

Reflex shock

The reflex cardiogenic shock develops by the type of heart response to the pain caused by myocardial infarction (especially the heart attack of the back wall of the heart). The reason for the development of pathology is precisely reflex mechanism, not the amount of damage to the heart muscle. As a reflex on pain occurs a violation of the tone of blood vessels, a decrease in blood flow to the left ventricle of the heart and as a result, a decrease in the blood volume emitted by heart. For this type The forecast is favorable, it is borne by the appointment of analgesics and infusion therapy.

Arrhythmogenic shock

Groundmogenic shock is formed due to arrhythmias and blockades of conductive pathways. The prognosis is favorable, the shock condition is fastened with the timely treatment of a heart rhythm. Grotter tachycardia, Av-blockade 2-3 degrees can lead to arrhythmogenic shock.

Hypovolemic shock develops due to a sharp decline in circulating blood. The causes of this state may come:

• Blood loss as a result of injury of trunk vessels, extensive fractures, during operational benefits, etc.
• Non-corrosive vomiting in disorders of the water and electrolyte balance
• Abundant diarrhea for some infectious diseases
• Extensive burns
• Intestinal obstruction

The degree of clinical manifestations of hypovolemic shock directly depends on the amount of lost fluid (or circulating blood volume):

• Loss does not exceed 15%.

As such, there are no shock symptoms, however, an insignificant thirst may be present and some increase in the pulse by 10-20 blows per minute compared with the individual norm. The state is compensated by internal reserves of the body

• Loss does not exceed 25%.

The feeling of thirst increases, the blood pressure decreases and the pulse rate is growing. Vertical position is felt dizziness.

• Loss does not exceed 40%.

Persistent hypotension (systolic pressure of 90 mm.T. and below), the pulse frequency exceeds 110 beats per minute. There is a pronounced weakness, the pallor of the skin, the selection of urine is reduced.

• Loss exceeds 40%.

Violation of the level of consciousness, the pronounced pallor of the skin, the pulse on the periphery may not be felt, resistant hypotension, no urine. This condition can threaten the health and life of the patient, the intensive correction of hypovolemia is needed.

The treatment of hypovolemic shock directly proceeds from the cause of it causing. If it is bleeding, then a stop of bleeding is needed if the infectious process then antibacterial therapy, intestinal obstruction is allowed by the operational way. In addition, at all stages of treatment it is necessary to carry out massive infusion therapy in order to correct the water and electrolyte balance. For this purpose, central venous access is performed (for example, the connective vein cathetterized). Transfusion of donor blood and plasma has proven itself as a method for treating hypovolemic shock, especially in the case of a decrease in the level of hemoglobin and protein. With timely, the causes of the hypovolemic shock and the normalization of the water-electrolyte balance prediction for the patient is favorable.

Other reasons for shock

As mentioned above, the shock can also be caused by carbon monoxide poisoning. The thing is that the carbon monoxide has the ability to integrate into the hemoglobin molecule and impede oxygen transport to organs and tissues. Durchable gas is formed as a result of combustion with limited oxygen access. Such a situation occurs during fires in closed rooms. Clinical manifestations directly depend on the concentration carbon monoxide In the air and the duration of it inhalation. The main symptoms are as follows:

• Dizziness, weakness
• Disruption of consciousness
• Increased blood pressure and pulse frequency
• Nausea, vomiting
• Redness of the skin and mucous
• Convulsive syndrome

Despite the fact that blood pressure increases, hypoxia is growing in the body due to the disorder of oxygen transport to tissues. Carbon monoxide poisoning is the main cause of fire mortality. It should be remembered that the filter gas for protection against carbon monoxide should be equipped with hypocalet cartridge.

To prevent the development of shock caused by carbon monoxide poisoning, the victim is necessary:

• remove from the focus of the propagation of carbon monoxide
• provide access to fresh air, put the oxygen mask
• there is a special antidote from carbon monoxide "Atzizol". This drug is also possible to apply as a means of preventing carbon monoxide poisoning.

With a mild degree of poisoning of these measures, it is quite enough, but in any case it is advisable to consult a doctor. Additional methods of treatment and prophylaxis include hyperbaric oxygenation, ultraviolet irradiation, symptomatic therapy. To prevent the development of inflammatory diseases of the upper respiratory tract, it is advisable to appoint antibiotics.

The effect of shock on the internal organs occurs due to a number of factors. These include decrease in blood pressure, insufficient blood supply, perfusion, organs and tissues, hypoxia, edema, disruption of acid-alkaline and water and electrolyte balance.

Each type of shock state has its own individual pathogenesis mechanisms, but in general, any shock leads to the development of hypoxia against the background of inadequate microcirculation, which is the cause of polyorgan deficiency. The effect of shock is the more dangerous than the less resistant organ to hypoxia.

For example, the brain is most sensitive to the deficiency of oxygen and suffers first in the occurrence of a shock state. This is manifested by dizziness, headache, drowsiness, intensity. Shock symptoms are progressing according to the severity of the patient's condition and may be accompanied by the loss of consciousness and the oppression of reflex activity.

The effect of shock on the internal organs has not only physiological, but also morphological character. So, if the cause of the patient's death was shock, then this condition will directly affect the internal organs. There is even a special concept of a "shock body", characterizing morphological changes that have arisen in a particular organ.

• "Shock kidney"

Against the background of the shock, the selection of urine is reduced, up to its complete absence, protein and erythrocytes can be observed in the urine. In the blood, the content of urea and creatinine increases. On the section, the cortical layer of such kidneys looks pale and edema. Pyramids are brown. Under the microscope, the anemia of the cortical zone, necrosis of the epithelium of the convulsion canal, swelling the interstice.

• "Shock liver"

This condition is often accompanied by the development of a shock kidney within the framework of polyorganic insufficiency syndrome and is developing, as a rule, in the phase of decompensation of shock. Hepatic enzymes are growing in the blood. On the sections, the liver has a pale, yellowish tint. There is no glycogen in hepatocytes. Due to hypoxia, necrosis occurs in the central part of hepatic lobes.

• "Shock light"

In clinical literature, this condition is called a "respiratory distress of adult syndrome." Easy is notometricly filled with blood, essay is developing, multiple necrosis of lung tissue, hemorrhage form. When developing shock lungs, pneumonia always joins.

• "Shock heart"

Hypoxia phenomena is also distinctly expressed in the heart. Muscular cells Hearts are deprived of glycogen, they develop dystrophy phenomena, the accumulation of lipids, foci of necrosis are formed.

• "Shock intestines"

Multiple hemorrhages are observed in the intestines, the area of \u200b\u200bulceration is formed in the layer of the layer. The loss of the barrier function of the intestine walls leads to the release of bacteria and their toxins, which aggravates the severity of the state of such a patient.

It should be remembered that the morphological changes described above in organs are developing in the decompensation phase and to the terminal phase. They are not purely specific, but only complement the overall picture of the action of shock on the internal organs.

Painful shock

Quite often you can hear or read such a term as a "pain shock". Above, we disassemble the main types of shock, according to the main classifications used in medical practice and among them pain shock will not be mentioned, what's the matter? The answer is that the pain itself does not cause a shock state. Yes, the pain in some situations occurs quite strong, sometimes painful, sometimes with a loss of consciousness, but it is not the cause of the development of shock. In case of injury, especially with extensive injury, pain always accompanies a shock state, complementing the common clinical symptoms. The term "pain shock" is used most often as synonymous with traumatic shock, and traumatic shock is a special case of hypovolemic shock, which is based on the loss of circulating blood volume. To call traumatic shock pain in principle does not take place, but in a medical conversation, such non-professional terminology is unacceptable.

Traumatic shock develops as a consequence of external excessive impact on the body (injury of any genesis, extensive burns, blowing). In the development of traumatic shock, the role of 2 types of factors play:

1. Character injury (fracture, burn, stupid injury, cutting wound, electrician, etc.)
2. Concomitant conditions (patient age, hypotension duration, stress, hunger, temperature ambient and etc.)

In the development of the clinical picture of traumatic shock, 2 main phases are distinguished, which first described in detail in their writings outstanding surgeon N.I. Pies:

• excitation (erectile)
• brake (torpid)

During the erectile phase, the patient's overall activation, its endocrine and sympathetic systems is observed. The patient is in consciousness, reflexes are revived, it is overly worried, the pupils are somewhat expanded, the skin pale, the pulse is rapidly, the blood pressure is increased. The most often erectile phase of shock accompanies injuries of the central nervous system. This phase is observed in 1/10 of all clinical cases traumatic shock.

During the trapid phase, the patient's overall injection is observed, with a gradual regression of activity, both from its motor activity, and in the emotional plan. Consciousness of the patient is broken, it is badly, adamissed, the skin is pale, cold to the touch, hypotension, pulse is ridiculous, surface, reduced urine release. This phase is observed in 9/10 of all clinical cases of traumatic shock.

According to the clinical picture, traumatic shock is divided into 3 degrees:

1. The easy degree of shock develops, as a rule, with an isolated injury, the volume of blood loss is small and amounts to 20% of the volume of circulating blood. A man in a shock of a lightly degree is in consciousness, the pressure is slightly reduced, the pulse is rapidly, weakness is felt. The forecast in this case is favorable, anti-deposit measures are symptomatic.
2. The average degree of shock develops, as a rule, with severe isolated or combined injury. The volume of blood loss is approximately 20 to 40% of the circulating blood volume. The man in shock is stunned, the skin pale, hypotension reaches a level below 90mm.rt. The pulse is rapid up to 110 beats per minute. Forecast B. this case It is closely interconnected from concomitant conditions exacerbating the course of shock. If medical care is provided in a timely manner, the forecast for further recovery is favorable.
3. A severe degree of shock is developing, as a rule, with an extensive combined injury from the injury of trunk vessels and vital organs. The person in a shock of severe ADINAMIC, the consciousness is broken, the skin of pale, reflexes are injected, the arterial systolic pressure can fall below 60mm.rt.st., the pulse is frequent, weak, may not listen to peripheral arteries, the breath of the rapid, superficial, urine does not stand out . The volume of blood loss exceeds 40% of the volume of circulating blood. The forecast in this case is not favorable.

Treatment of traumatic shock implies early diagnosis and an integrated approach. Therapeutic measures should be aimed at eliminating factors causing a shock condition, factors exacerbating the course of shock and maintaining the organism homeostasis. The first thing to be stopped during injury is painful syndrome. To achieve this, the following activities are provided:

• Careful patient transportation from the lesion focus
• Immobilization of the damaged body
• Alestruction (narcotic and nonarcotic analgesics, Novocaine blockades, anesthesia)

After anesthesia, the source of bleeding is revealed and eliminated. It can be both outdoor and inner. Stopping bleeding is temporary (overlaying the gulling bandage, harness) and the final (bandage of the vessel or its reconstruction). Blood accumulations in the cavities of the organism (abdominal, pleural) are subject to evacuation by drainage. Simultaneously with the bleeding stop, it is necessary to ensure the infusion correction of the lost liquid volume. For this, colloid, crystalloid solutions, plasma and blood components are used. With a reduction in blood pressure, the following is used medications With pressing properties: Noradrenaline, extra, Mesoth. Also introduced corticosteroids (Solumedrol, dexamethasone).

Respiratory failure is also an integral component in the treatment of traumatic shock. It is necessary to restore the patency of the respiratory tract, to establish adequate ventilation, eliminate pneumothorax, hemotorax, to ensure inhalation of oxygen, if it is impossible to translate the patient to artificial (IVL apparatus). The correction of homeostasis is carried out by bringing to the norm of water-electrolyte balance and the pH of equilibrium.

The main point of the final treatment of traumatic shock is the performance of operational intervention. Depending on the type of injury, the operation helps to stop the bleeding, asphyxia, restore the integrity of damaged organs and tissues, remove the accumulated blood and others. All of the above measures to combat traumatic shock are, in fact, preoperative preparation of the patient in order to output from the shock state. During operation, it is necessary to monitor vital important indicatorsCompensate blood loss and hypoxia. In a state of shock, it is permissible to perform operations only on life indications (tracheostomy during asphyxia, stopping the ongoing bleeding, elimination of intense pneumothorax).

How to quickly appreciate that man is shocked

Clinical symptoms of shock is quite characteristic. It includes a violation of the level of consciousness, a resistant reduction in blood pressure, the increase in heart rate and pulse. Later, a polyorgan deficiency increases due to a violation of perfusion and hypoxia in organs and tissues.

Any shock is preceded by the reason that causes it. So, with anaphylactic shock, there is always a substance-allergen, with a cardiogenic shock - a violation of the work of the heart, etc.

At traumatic shock it is possible to assess the patient's condition by character injury.

• Easy shock: an extensive wound injury of soft tissues, a shoe fracture, legs, a closed fracture of the hip, a bearing of a foot or brush, sharp blood loss (up to 1.5 liters).
• The average degree of shock: a combination of two signs of a light shock, a fracture of the pelvis, the sharp of blood loss (up to 2 liters), the separation of the leg or the forearm, the open fracture of the hip, penetrating the wound of the chest or abdomen.
• Severe shock: combination of two signs middle degree Shock or three signs of light degree of shock, sharp blood loss (over 2 liters), beating thigh.

For a preliminary assessment of gravity of traumatic shock, the so-called "shock index" is used. To calculate the shock index, it is necessary to divide the heart rate (blows per minute) to the systolic blood pressure indicator (in mm.rt.st.). Under normal conditions, the index is 0.5, with a light shock ranges from 0.6 to 0.8, with an average of 0.9 to 1.2 and with severe shock exceeds 1.3.

If suddenly such a situation happened that a person in a shock was held next to you, do not pass by. Another an important rule - Do not panic. Calm down, rate the situation, think than you can help. It should be remembered that a person in a shock state himself cannot help himself. Therefore, you will cause ambulance and, desirable, stay close to the arrival of physicians. In principle, this is all that you are required at this stage. You can also try to find out the cause and circumstances of the shock, eliminate the damaging factor if possible. In some cases, to stop the outer bleeding is possible by handicrafts. You should not rush to the victim and provide him with cardiovascular resuscitation, if you do not know how to do this in practice.

Treatment with shock

Sometimes you can meet such headlines as "shock treatment". Yes, such a type of treatment really exists, only it is called completely "electric shock therapy". Treatment is carried out at the expense electric current, not a shock state. The shock itself cannot be cured by any pathology, because shock itself is heavy pathological statewhich requires medical intervention.

The confusion of terms, of course, is present and to figure out, briefly describe electrocontal therapy here (synonyms: electrosusproy or electroconvulsive therapy). This type of treatment is based on the effects of electric current on the human brain. Electric therapy is used in psychiatric practice for the treatment of schizophrenia and severe depressive disorders. This method It has a narrow list of indications for use and a number of side effects.

First aid for shock

As noted above, the shock comes down to a small list of rules that are not difficult to remember. Of course, it should be taken into account the cause that caused shock, however general rules Pretty similar. Next will be described an exemplary algorithm for the identification of a person in shock. In principle, the most important thing is not to remain indifferent and promptly call an ambulance. It is also important not to succumb to a panic, especially shouting on a patient in a shock. It is also not recommended to beat it on the cheeks and leading to feelings is also not recommended, external aggression can only aggravate and without that serious condition of the victim. After calling ambulance, you are next to the victim. All other measures listed below in the algorithm are certainly important, but they are secondary in nature, and no one forces you to perform them.

Do not have a cardiovascular resuscitation if you have no experience. Firstly, the reason that caused a shock condition in humans is not always reliably known, especially if it is an unfamiliar man on the street. Secondly, the inept execution of cardiovascular intensive care can aggravate the severity of a person in shock.

The same situation and when the harness is applied. It is necessary to remember the basic rules for its overlay:

• The harness is superimposed on the limb above the level of bleeding
• Harness can not be imposed on a naked body, put a fragment of clothes under it
• Harness are tightened to stop arterial bleeding
• You must specify the exact time of the harness
• The harness should be well visible, warn about this ambulance

Emergency care with shock includes:

• Anesthesia. Especially relevant at traumatic shock. Narcotic and nonarcotic analgesics are used, sometimes anesthesia is required.
• In an anaphylactic shock, the introduction of adrenaline and antihistamine preparations and glucocorticoids is necessary.
• In case of infectious toxic shock, it is necessary to choose adequate antibacterial therapy.
• Hypovolemic shock requires massive infusion therapy and eliminating the source of hypovolemia (especially if it is continuing bleeding).
• If the cardiogenic shock is caused by arrhythmia, it is prescribed anticultimitic drugs.
• In cases of combined shock, treatment is starting with the elimination of life-threatening states.

Operational benefits are produced after stabilization of the patient's hemodynamics. Except may be only operations on life indications (continued bleeding, the imposition of tracheostas at asphyxia).

Help with shock: action algorithm

An exemplary algorithm for the shock is as follows:

• Call an ambulance. Self-treatment with a developed shock is contraindicated.
• Do not leave a person in a shock of one, watch it for its condition.
• If possible, the damaging factor should be eliminated. For example, discontinue the introduction of the medication if it caused an anaphylaxis, impose a bandage or harness during outer bleeding.
• If a person in shock has no consciousness, then his head must be turned his head. This measure prevents asphyxia.
• Estate the shocking clothes, ensure the influx of fresh air into the room, free the mouth of the patient from foreign objects (chewing, dentures).
• It is necessary to prevent the patient's supercooling, cover it with a blanket or jacket.
• In case of injury, the fracture damaged part of the body must be immobilized.
• Transporting a person in shock should be carried out gently, without sharp movements.
• After the emergency arrival, let me know you have information about a person in shock. Specify the exact time of the imposition of the harness, if it was imposed.

When anaphylactic shock develops, the first help is as follows:

• It is necessary to immediately stop the contact of the allergen substance with the patient: no longer enter the drug that caused an anaphylaxius, impose a harness above the insect bite, impose ice on the wound.
• Call the ambulance
• Put the patient, slightly raise my legs
• Release the oral cavity from foreign objects (chewing, dentures of teeth)
• Ensure the access of oxygen into the room, unzipped the shy
• Take antihistamine drug
• Stay next to the patient before the arrival of ambulance

The ambulance brigade has drugs for the treatment of anaphylactic shock, therapeutic measures will be reduced to the following:

• The introduction of adrenaline. This drug quickly raises pressure, reduces swelling, expanding bronchi
• Introduction glucocorticoids. Preparations of this group have an antiallergic effect, increase pressure
• Introduction of antihistamine drugs.
• Eufillin contributes to the regression of the resulting spasm of bronchi
• Inhalation of oxygen reduces hypoxia phenomena
• Preparations can be reused to achieve the therapeutic effect.

Hundreds of situations that can cause shock can happen in life. Most people associate it only with the strongest nervous shock, but this is true only in part. In medicine there is a shock classification that determines its pathogenesis, the degree of gravity, the nature of changes in organs and the methods of their elimination. For the first time, this state was characterized by more than 2 thousand years ago, the famous hippocrates, and the term "shock" introduced into medical practice in 1737, the Paris Surgeon Henri Ledran. The proposed article discusses the reasons for causing shocks, classification, clinic, urgent assistance in the occurrence of this difficult state and forecasts.

Concept of shock

From English Shock can be translated as the highest shock, that is, no illness, not a symptom and not a diagnosis. In world practice, under this term, the response of the body and its systems on a strong stimulus (external or internal), in which the work of the nervous system, metabolism, respiration and blood circulation is disturbed. This is currently a shock definition. The classification of this state is needed to identify the causes of the shock, the degree of its gravity and begin an effective treatment. The forecast will be favorable only with proper diagnosis and immediate start of resuscitation activities.

Classifications

Canadian Pathologist Selle allocated three stages, approximately the same for all types of shock:

1. Map (compensated), in which the blood supply to the brain, heart, lungs and other organs is violated, but not stopped. The forecast at this stage is usually favorable.

2. Personally reversible (decompensated). At the same time, a violation of blood supply (perfusion) is significant, but with urgent and proper medical intervention there is a chance of restoring functions.

3. Employed (terminal). This is the hardest stage in which the violations in the body are not restored even with the most powerful medical influence. The forecast here is 95% unfavorable.

Another classification divides partially reversible stage at 2 - subcompensation and decompensation. As a result, they are obtained 4:

• 1st compensated (the easiest, having a favorable forecast).
• The 2nd subcompensated (medium-haul, requiring immediate resuscitation activities. The forecast is controversial).
• The 3rd decompensation (very heavy, even with immediate conduct of all necessary measures the forecast is very complex).
• 4th irreversible (adverse outlook).

Our famous pies allocated two phases from the shock state:

Thorpid (patient in stupor or extremely badly, does not respond to combat irritants, does not answer questions);

Erectile (the patient is extremely excited, shouts, makes many uncontrolled unconscious movements).

Types of Shock.

Depending on the reasons that caused imbalance in the work of the body systems, there are different types of shock. Classification according to the indicators of the circulatory disorder is this:

Hypovolemic;

Distributive;

Cardiogenic;

Obstructive;

Dissociative.

Classification of shock on the pathogenesis is such:

Hypovolemic;

Traumatic;

Cardiogenic;

Septic;

Anaphylactic;

Infectious toxic;

Neurogenic;

Combined.

Hypovolemic shock

A difficult term is easy to understand, knowing that hypovolemia is a state when blood circulates in a smaller vessels than the volume. The reasons:

Dehydration;

Extensive burns (many plasma is lost);

Adverse reactions to drugs, for example, on vasodilators;

Symptoms

We looked at what exists the classification of hypovolemic shock. The clinic of this state, regardless of the reasons that caused it, approximately the same. At the reversible stage in a patient in a lying position, pronounced symptoms may be absent. Signs of the start of the problem serve:

Heart palpitations;

A slight decrease in blood pressure;

Cold wet skin on the limbs (due to a decrease in perfusion);

When dehydration, there is a drying of lips, mucosa in the mouth, the absence of tears.

At the third stage of the shock, the initial symptoms become more pronounced.

In patients noted:

Tachycardia;

Reduction of blood pressure values \u200b\u200bbelow critical;

Breathing disorder;

Oliguria;

Cold skin on touch (not only limbs);

The marble of the skin and / or the change of their color with normal on pale cyanotic;

When pressing the fingertips on the tips, they pale, and the color after the removal of the load is restored in more than 2 seconds. The same clinic has a hemorrhagic shock. The classification of its stages depending on the volume circulating in blood vessels, additionally includes characteristics:

On the reversible stage of tachycardia to 110 shots per minute;

On a partly reversible - tachycardia to 140 beats / min;

On irreversible - cardiac abbreviations 160 and above shock / min. In the critical position, the pulse is not auditioned, and the systolic pressure drops to 60 and less mm Hg. Point.

When dehydration, symptoms are added in the state of hypovolemic shock:

Dryness mucous

Reducing the tone of eyeballs;

In babies, the omission of a large spring.

It's all exterior signsBut to accurately determine the degree of problem, laboratory research is carried out. The patient urgently perform biochemical blood tests, set the level of hematocrit, acidosis, in complex cases examine the plasma density. In addition, doctors are controlled by the level of potassium, the main electrolytes, creatinine, blood urea. If conditions are allowed, the minute and shock volumes of the heart are investigated, as well as central venous pressure.

Traumatic shock

This type of shock on many signs is similar to hemorrhagic, but only external wounds can act, only external wounds (crushed, firearms, burns) or internal (tissue breaks and organs, for example, from strong hit). Traumatic shock is almost always accompanied by a difficult endless pain syndrome, even more aggravating the position of the victim. In some sources, this is called painful shock, often leading to death. The severity of the traumatic shock is determined not so much by the amount of damaged blood, how much the speed of this loss. That is, if the blood leaves the body slowly, the victim is more likely to be saved. Also exacerbates the situation and the degree of importance of the damaged organ for the body. That is, to survive when the wounded in the hand will be easier than when injured in the head. These features are traumatic shock. Classification of this state by severity as follows:

Primary shock (arises almost instantly after injury);

Secondary shock (appears after the operation, removal of harness, with additional loads on the affected, for example, its transportation).

In addition, with traumatic shock, two phases are observed - erectile and torpid.

Symptoms erectile:

Strong pain;

Inadequate behavior (cry, overexcitation, anxiety, sometimes aggression);

Cold sweat;

Extended pupils;

Tachycardia;

Tahipne.

Symptoms of torpid:

The patient becomes indifferent;

The pain is felt, but the person does not react to her;

Blood pressure decreases sharply;

Eyes dump;

Skin pallor appears, lip cyanosis;

Oliguria;

Language Cover;

Typical (there is a redness at the place of bite (injection) or abdominal pain, throat for oral allergen, lowering pressure, squeezing under the edges, causing diarrhea or vomiting);

Hemodynamic (in the first place cardiovascular violations);

Asphisical (respiratory failure, suffocation);

Cerebral (violations in the work of the CNS, convulsions, loss of consciousness, stop breathing);

Abdominal (acute stomach).

Treatment

To make emergency measures, the correct classification of shocks is extremely important. Emergency resuscitation in each case has its own specifics, but the earlier it begins to appear, the patient has more chances. With an irreversible stage, the fatal outcome is observed in more than 90% of cases. When traumatic shock, it is important to immediately block blood loss (impose a harness) and deliver the victim to the hospital. There is carried out intravenous administration of salt and colloidal solutions, blood transfusion, plasma, pain relief, if necessary, connect to the artificial respiratory unit.

With anaphylactic shock, adrenaline is urgently introduced, asphyxia is intubated by the patient. In the future, glucocorticoids and antihistamines are introduced.

With toxic shock, massive infusion therapy is carried out with strong antibiotics, immunomodulators, glucocorticoids, plasma.

In the hypovolemic shock, the main tasks are to restore the blood supply to all organs, elimination of hypoxia, normalization of pressure and heart work. With a shock caused by dehydration, it is additionally required to resume the lost volume of fluid and all electrolytes.

Shock is a general response of the body to supest, for example, painful, irritation. It is characterized by severe disorders of the functions of vital organs, nervous and endocrine systems. Shock is accompanied by pronounced circulatory disorders, breathing and metabolism. There are a number of shock classifications.

Types of shock.

Depending on the mechanism of development, shock is divided into several main species:

- hypovolemic (with blood loss);
- cardiogenic (with a pronounced heart function);
- redistributive (with circulatory impairment);
- pain (during injury, myocardial infarction).

Also, shock are determined by reasons provoked its development:

- traumatic (due to extensive injuries or burns, leading causing factor - pain);
- anaphylactic, which is the most severe allergic reaction to certain substances in contact with the organism;
- Cardigenic (develops as one of the most severe complications of myocardial infarction);
- hypovolemic (with infectious diseases with multiple vomiting and diarrhea, during overheating, blood loss);
- septic, or infectious toxic (with severe infectious diseases);
- Combined (combines several causal factors and development mechanisms).

Painful shock.

The pain shock is caused by pain, which by force exceeds the individual pain threshold. It is more often observed with multiple traumatic injuries or extensive burns. Shock symptoms are divided by phases and stages. In the initial phase (erectile) traumatic shock, the victim marked the excitation, the pallor of the skin of the face, a restless look and inadequate assessment of the severity of their condition.

Also there is an increased motor activity: he jumps out, strives to leave somewhere, and it is difficult to keep it enough. Then, as the second phase of shock (torpid) occurs, against the background of the preserved consciousness, an oppressed mental state is developing, complete indifference to the surrounding, decrease or complete absence of pain reaction. The face remains pale, his features are sharpened, the skin covers of the whole body are cold to the touch and covered with sticky sweat. The patient's breathing is much more expensive and becomes superficial, the victim is thirsty, it is often a vomiting. For different types Shock Thorpid phase varies mainly by duration. It can be divided into 4 stages.

Shock I degree (light).

The overall condition of the victim is satisfactory, accompanied by a weakly pronounced inhibition. The pulse frequency is 90-100 shots per minute, its filling is satisfactory. Systolic (maximum) blood pressure is 95-100 mm Hg. Art. or a little higher. The body temperature is saved within the normal range or slightly reduced.

Shock II degree (moderate severity).

The injection of the victim is clearly expressed, the skin is pale, the body temperature is reduced. Systolic (maximum) blood pressure is 90-75 mm Hg. Art., and pulse - 110-130 beats per minute (weak filling and voltage changing). Breath marked superficial, rapid.

Shock III degree (heavy).

Systolic (maximum) blood pressure below 75 mm RT. Art., Pulse - 120-160 beats per minute, threaded, weak filling. This stage of shock is considered critical.

Shock IV degree (it is called a pre-arbitrary condition).

Arterial pressure is not determined, and the pulse can be revealed only on large vessels (carotid arteries). Patient's breathing is very rare, superficial.

Cardiogenic shock.

Cardiogenic shock is one of the most serious and life-threatening patient complications of myocardial infarction and severe violations heart Rhythm and conductivity. This type of shock can develop in the period strong pain In the region of the heart and is characterized at first exclusively sharply emerging weakness, the poverty of the skin and lip sinusiness. In addition, the patient has a cooling of the limbs, a cold sticky sweat, covering the whole body, and often - loss of consciousness. Systolic blood pressure drops below 90 mm RT. Art., and pulse pressure - below 20 mm RT. Art.

Hypovolemic shock.

Hypovolemic shock develops as a result of a relative or absolute decrease in the volume of fluid circulating in the body. This leads to insufficient filling of the heart of the heart, a decrease in the impact volume of the heart and, as a result, a significant reduction in the heart ejection of blood. In some cases, the victim helps the "inclusion" of such a compensatory mechanism as the increase in heartbeat. Enough frequent cause The development of hypovolemic shock is a significant blood loss as a result of extensive injuries or damage to large blood vessels. In this case, we are talking about hemorrhagic shock.

In the mechanism of development of this type of shock, the most important significance belongs to the actual blood loss, which leads to a sharp fall blood pressure. Compensatory processes, such as spasm of small blood vessels, exacerbate the pathological process, since inevitably lead to a disruption of microcirculation and as a result - to systemic oxygen deficiency and acidosis.

The accumulation of unsophisticated substances in various organs and tissues causes intoxicating the body. Multiple vomiting and diarrhea in infectious diseases also lead to a decrease in the volume of circulating blood and the fall of blood pressure. The factors predispose to the development of shock are: a significant loss of blood, the supercooling of the body, physical fatigue, mental injury, hungry state, hypovitaminosis.

Infectious toxic shock.

This type of shock is the most difficult complication. infectious diseases and direct consequence of the effects of the toxin of the pathogen's pathogen on the body. There is a pronounced centralization of blood circulation, in connection with which most of The blood turns out to be practically unused, accumulates in peripheral tissues. The result is a disruption of microcirculation and tissue oxygen fasting. Another feature of infectious toxic shock is a significant deterioration in myocardial blood supply, which will soon lead to a pronounced reduction in blood pressure. For this type of shock, the appearance of the patient is characterized - microcirculation disorders give the skin "marble".

General principles of emergency care at shock.

The basis of all anti-shock events is the timely provision of medical care at all stages of the victim's movement: at the scene, on the road to the hospital, directly in it. The main principles of anti-shifting events at the scene are concluded in carrying out an extensive complex of actions, the procedure for the implementation of which depends on the specific situation, namely:

1) eliminating the action of a traumatic agent;
2) stop bleeding;
3) careful shifting of the victim;
4) giving it a position that facilitates the state or preventing additional injuries;
5) exemption from tightening clothes;
6) closure of wounds aseptic bandages;
7) anesthesia;
8) the use of soothing funds;
9) Improving the activities of respiratory and blood circulation.

In emergency care with shock priority is the cessation of bleeding and anesthesia. It should be remembered that shifting the victims, as well as their transportation, should be careful. Patients in sanitary transport are needed, taking into account the convenience of resuscitation activities. The anesthesia under shock is achieved by introducing neurotropic drugs and analgesics. The sooner it starts, the weaker the painful syndrome, which, in turn, increases the effectiveness of anti-deposit therapy. Therefore, after stopping massive bleeding, before carrying out immobilization, ligation of the wound and laying the victim, it is necessary to carry out an anesthesia.

For this purpose, a victim is intravenously introduced 1-2 ml of 1% of the propellant solution divorced in 20 ml of 0.5% novocaine solution, or 0.5 ml of 0.005% fentanyl solution, diluted in 20 ml of 0.5% novocaine solution or 20 ml 5% glucose solution. Intramuscularly analgesics are injected without a solvent (1-2 ml of 1% properol solution, 1-2 ml of tram). The use of other narcotic analgesics is contraindicated, as they cause the oppression of respiratory and vasomotory centers. Also in abdominal injuries with suspected damage internal organs Fentanyl administration is contraindicated.

It is not allowed to use when providing emergency care with a shock of alcohol-containing liquids, as they can cause bleeding, which will lead to a decrease in blood pressure and the oppression of the functions of the central nervous system. It must always be remembered that the spasm of peripheral blood vessels occurs during shock states, so the administration of drugs is carried out intravenously, and in the absence of access to Vienna - intramuscularly.

Local anesthesia and cooling of a damaged body part have a good analgesic effect. Local anesthesia is carried out by a novocaine solution, which is injected into the area of \u200b\u200bdamage or wounds (within the limits of intact tissues). With extensive screams of tissues, bleeding from internal organs, increasing tissue edema local anesthesia It is desirable to supplement the local impact of dry cold. Cooling not only enhances the anesthetic effect of novocaine, but also has pronounced bacteriostatic and bactericidal action.

In order to remove the excitation and enhancement of an anesthetic effect, it is advisable to use antihistamine preparations, such as DIMEDROL and PROMETASIN. To stimulate the respiratory function and blood circulation, a respiratory analeptic is introduced - a 25% solution of Cordiamine in a volume of 1 ml. At the time of injury, the victim may be able to clinical death. Therefore, when stopping cardiac activities and respiration, regardless of the reasons that caused them, immediately begin to resuscitative measures - artificial ventilation of the lungs and the massage of the heart. Resuscitation activities are considered effective only if the victim has independent breathing and heartbeat.

When rendering emergency care at the transportation phase, the patient is carried out intravenous infusion of large-molecular weight plasma substitutes that do not require special conditions For storage. Polyglyukin and other large-molecular weight solutions due to their osmotic properties cause a quick inflow into the blood of the tissue fluid and thereby increase the mass circulating in the body of the blood. With a large blood loss, it is possible to transfusion of the injured blood plasma.

Upon receipt of the victim in the medical institution, they check the correctness of immobilization, the deadlines for the imposition of a hemostatic harness. In the case of the receipt of such victims, first of all, the final stop of bleeding is carried out. In case of injuries of the extremities, ancient blockade of the Vishnevsky, which is carried out above the place of damage is advisable. The reinstalling of priedol is permissible only 5 hours after its primary administration. At the same time begin to inhalation of oxygen by the victim.

A good effect in contrast treatment has an inhalation of a mixture of nitrogen and oxygen oxygen in a ratio of 1: 1 or 2: 1 with anesthesia. In addition, hearty drugs should be used to achieve a good neurotropic effect: Cordiamin and caffeine. Caffeine stimulates the function of the respiratory and vascular centers of the brain and thereby increasing and enhances myocardial cuts, improves coronary and brain circulation, increases blood pressure. Confined to the use of caffeine are only non-replaced bleeding, a pronounced spasm of peripheral vessels and the increase in cardiac rhythm.

Cordiamin improves the activity of the central nervous system, stimulates breathing and blood circulation. In optimal dosages, it helps to increase blood pressure and strengthening the work of the heart. For heavy injuryah, when pronounced disorders of external respiration and progressive oxygen starvation (respiratory hypoxia) arise, these phenomena are aggravated by circulatory disorders characteristic of circulatory disorders and blood loss - circulatory and anemic hypoxia develop.

With unexpressed respiratory failure, antihypoxic measures can be limited to the release of victims of tightening clothes and feeding for inhalation of a clean air jet or a moistened oxygen mixture with air. These activities are necessarily combined with blood circulation stimulation. In cases of acute respiratory failure, the tracheostomy is shown if necessary. It is to create an artificial fistula, which provides air from entering the trachea through a hole on the neck surface. The tracheostomy tube is introduced into it. In emergency situations, it can replace any hollow subject.

If the tracheostomy and the toilet of the respiratory tract do not eliminate acute respiratory failure, therapeutic measures are complemented by artificial ventilation of the lungs. The latter not only helps to reduce or eliminate respiratory hypoxia, but also eliminates stagnant phenomena in a small circulation circle and at the same time stimulates the respiratory center of the brain.

The emerging metabolic disorders are most pronounced with a severe form of shock. Therefore, in a complex of anti-cooker therapy and intensive care, regardless of the causes of the severe condition of the affected, drugs of metabolic action, which primarily include water-soluble vitamins (B1, B6, C, RR), 40% glucose solution, insulin, hydrocortisone or its analog prednisolone.

As a result of metabolic disorders in the body, oxidatively reduction processes are upset, requiring inclusion in anti-current therapy and resuscitation of blood ochuli. It is most convenient to use 4-5% sodium solutions of bicarbonate or bicarbonate, which are administered intravenously at a dose to 300 ml. Blood transfusion, plasma and some plasma changes - an integral part of anti-shock therapy.

According to the materials of the book " Fast help in emergency situations. "
Kashin S.P.

Extreme, i.e. Emergency conditions, in most cases they put the body on the line of life and death, are more often completed, the final stage of many serious diseases. The degree of severity of manifestations is different and, accordingly, there are differences in development mechanisms. In principle, extreme states express the general reactions of the body in response to damage caused by various pathogenic factors. These include stress, shock, long-term compression syndrome, collapse, coma. Recently, an idea of \u200b\u200bthe group of mechanisms denoted as the reaction of the "acute phase" was formed. They develop when damaged in acute period and acute in cases where damage leads to the development of the infectious process, the activation of phagocytic and immune systems, development of inflammation. All these states require the adoption of urgent effects of therapy, since mortality in them is very large.

2.1. Shock: Definition of concept, general pathogenetic patterns, classification.

The word shock itself (eng. "Shock" - a blow) was introduced into the Latta medicine in 1795. It replaced the term "Clearance", "Okocheniya" previously extended in Russia.

« Shock"- a complex typical pathological process arising under action on the body of extreme factors of the outer and internal medium, which, along with primary damage, cause excessive and inadequate reactions of adaptation systems, especially sympathetic-adrenal, resistant disorders of neuroendocrine regulation of homeostasis, especially hemodynamics, microcirculation, organism oxygen regime and metabolism "(V.K.Kulagin).

According to the terminology of pathophysiology: shock is a condition in which a sharp reduction in the effective delivery of oxygen and other nutrients in tissue leads first to reversible, and then - irreversible cell damage.

From the standpoint of the shock clinic is a condition in which inadequate cardiac output and / or peripheral blood flow leads to a sharp hypotension with a violation of peripheral blood perfect tissues that are incompatible with life.

In other words, a fundamental defect with any form of shock is a reduction in the perfusion of vital tissues, which begin to receive oxygen and other nutrients in an amount that does not correspond to their metabolic requests of the body.

Classification. Distinguish the following types of shocks:

I. pain:

A) traumatic (with mechanical damage, burns,

frostbite, electricians, etc.);

B) endogenous (cardiogenic, nephrogenic, in abdominal

catastrophes, etc.);

II. Humoral (hypovolemic, hemotransfusion,

anaphylactic, septic, toxic, etc.);

III. Psychogenic.

IV. MIXED.

The literature describes more than a hundred separate types of shock. The ethiology is diverse, but the nature of the response of the body is largely typical. On this basis, general pathogenetic patterns can be distinguished, which are noted with most types of shocks.

1. The deficiency of the effectively circulating volume of blood, absolute or relative, always combined with the primary or secondary decrease in cardiac emission against the background of increasing the peripheral resistance of the vessels.

2. The pronounced activation of the sympatho-adrenal system. Catecholaminic link includes a decrease in cardiac output and an increase in peripheral resistance (vasoconstricter type of compensatory-adaptive mechanisms) in a large hemodynamic self-rigging circle.

3. Reodynamic disorders in the field of microcirculate blood vessels leads to a violation of the supply of cells with oxygen and energy, the release of toxic exchange products is also disturbed.

4. Clinical hypoxia leads to the activation of anaerobic processes, resulting in a decrease in energy supply in conditions increased loadwhich is subjected to a microsystem, as well as over-accumulation of metabolites. At the same time, out-of-archful vasoactive amines (histamine, serotonin) are activated, followed by the activation of the kinine blood system (vasodilee type of compensation).

5. Progressive acidosis, reaching a critical level, in which cells are dying, the foci of necrosis merge and become generalized.

6. Cell damage - develops very early and progresses with shock. At the same time, the chains of the DNA of the linings, the enzymatic circuit of the cytoplasm and cell membranes are violated - all this leads to an irreversible cell disorganization.

7. The phenomenon of hypotension when shocked as a symptom, often has a secondary meaning. The state of shock, apparent compensated according to the value of blood pressure, may be accompanied by insufficient cell perfusion, since vasoconstriction aimed at maintaining systemic blood pressure ("blood circulation") is accompanied by a decrease in blood flow of peripheral organs and tissues.

- This is a pathological condition that arises due to bloodstures and painful syndrome during injury and presents a serious threat to the patient's life. Regardless of the cause of development, it is always manifested by the same symptoms. Pathology is diagnosed on the basis of clinical signs. Urgent cessation of bleeding, anesthesia and immediate delivery of the patient to the hospital. Treatment of traumatic shock is carried out under the conditions of the intensive care unit and includes a set of measures to compensate for the disorders. The forecast depends on the severity and phase of shock, as well as the severity of the injury.

MKB-10.

T79.4.

General

Traumatic shock is a severe condition, which is a reaction of an organism to an acute injury accompanied by severe blood loss and intense pain syndrome. It is usually developing immediately after injury and is a direct response to damage, but under certain conditions (additional traumatization) may occur after some time (4-36 hours). It is a state of threatening for the patient's life, and requires urgent treatment in the conditions of the intensive care unit.

The reasons

Traumatic shock develops with all types of severe injuries, regardless of their cause, location and damage mechanism. Its cause can be knife and gunshot wounds, drops from height, car crashes, technogenic I. natural disasters, accidents in production, 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 accompanying arteries damage), traumatic shock can cause extensive burns and frostbite, which are accompanied by a significant loss Plasma.

The development of traumatic shock is based on massive blood loss, expressed by pain syndrome, violation of the function of vital organs and mental stress caused by acute injury. At the same time, blood loss plays a leading role, and the influence of other factors can differ significantly. Thus, if there is damage to the sensitive zones (perineum and neck), the influence of the painful factor increases, and in the injury of the chest, the patient's condition is aggravated by a violation of the respiratory function and providing the organism with oxygen.

Pathogenesis

The launcher mechanism of traumatic shock is largely associated with the centralization of blood circulation - a state when the body sends blood to vital organs (easy, heart, liver, brain, etc.), having reducing it from less important organs and tissues (muscles, skin, fatty fiber). The brain receives signals about the lack of blood and reacts to them, stimulating the adrenal glands to throw out adrenaline and norepinephrine. These hormones act on the peripheral vessels, forcing them to narrow them. As a result, blood flows from the limbs and it becomes enough for the work of vital organs.

After some time, the mechanism begins to malfunctions. Due to the lack of oxygen, peripheral vessels are expanding, so blood flows from vital organs. At the same time, due to disorders of the tissue metabolism of peripheral vessels, they cease to respond to signals of the nervous system and the effect of hormones, so the re-narrowing of the vessels does not occur, and the "periphery" turns into a blood depot. Due to the insufficient volume of blood, the work of the heart is disturbed, which further aggravates the circulatory disorders. Arterial pressure drops. With a significant reduction, hell is broken normal work Kidney, and a little later - liver and intestinal wall. From the wall of the intestine to the blood is thrown toxins. The situation is exacerbated due to the occurrence of numerous foci of dead without oxygen of tissues and a coarse metabolic disorder.

Due to the spasm and increasing blood clotting, some of the small vessels are blocked by blood closures. This causes the development of the DVS-syndrome (disseminated intravascular coagulation syndrome), in which blood coagulation is first slowed down, and then almost disappears. When IC-syndrome, bleeding can be resumed at the injury, pathological bleeding occurs, multiple fine hemorrhages appear in the skin and internal organs. All of the above leads to a progressive deterioration of the patient's condition and is caused by death.

Classification

There are several classifications of traumatic shock depending on the causes of its development. Thus, in many Russian manuals on traumatology and orthopedics, surgical shock, endotoxin shock, shock due to fragmentation, burn, shock air wave and harness impositions. The classification of VK is widely used. Kulagina, according to which the following types of traumatic shock exist:

• Wounded traumatic shock (resulting from mechanical injury). Depending on the localization of damage, it is divided into visceral, pulmonary, cerebral, during the injury of the limbs, with multiple injury, when squeezing soft tissues.
• Operating traumatic shock.
• Hemorrhagic traumatic shock (developing with internal and outer bleeding).
• Mixed traumatic shock.

Regardless of the causes of the occurrence, traumatic shock flows into two phases: an erectile (the body is trying to compensate for the disorders) and the torpid (compensation capabilities are depleted). Taking into account the severity of the patient's condition in the trapid phase, 4 degrees of shock are distinguished:

• I (Easy). Patient pale, sometimes slightly slowed down. Consciousness is clear. Reflexes are reduced. Dyspnea, pulse up to 100 ot / min.
• II (moderate severity). The patient is sluggish, inhibited. Pulse about 140 Ud / min.
• III (heavy). Consciousness is preserved, the possibility of perception of the surrounding world is lost. Earth-gray leather, lips, nose and tips of the fingers of blue. Sticky sweat. Pulse about 160 Ud / min.
• IV (Predagonia and Agony). Consciousness is absent, the pulse is not determined.

Symptoms of traumatic shock

In the erectile phase, the patient is excited, complains of pain, can shout or moan. He is anxious and scared. Often there is aggression, resistance to examination and treatment. Pale skin, blood pressure is slightly increased. Tachycardia is noted, tachipne (respiratory increase), trembling limbs or minor twitching of individual muscles. Eyes shine, pupils are extended, a restless look. The skin is covered with cold sticky sweat. Rhythmic pulse, body temperature is normal or slightly elevated. At this stage, the organism also compensates for the disorders. Rough violations of the activities of the internal organs are absent, the DVS-syndrome is not.

With the onset of the trapid phase of traumatic shock, the patient becomes apatic, sluggish, drowy and depressive. Despite the fact that pain during this period does not decrease, the patient ceases or almost ceases to signal. He no longer screams and does not complain, it can lie silently, quietly posting, or losing consciousness at all. The reaction is absent even when manipulations in the area of \u200b\u200bdamage. Arterial pressure is gradually decreasing, and the heart rate increases. The pulse on the peripheral arteries weakens, becomes filamentous, and then ceases to be determined.

The eyes of the patient dull, spawned, pupils are extended, the view is still, under the eyes of the shade. There is a pronounced pallor of the skin, cyanoticity of mucous, lips, noses and fingertips. The skin is dry and cold, the elasticity of the fabrics is reduced. Face features pointed, nasolabial folds smoothed. The body temperature is normal or low (it is also possible to increase the temperature due to the wound infection). Patient beats chills even in the warm room. Often, convulsions, involuntary selection of feces and urine, are observed.

Symptoms of intoxication are detected. The patient suffers from thirst, the language is covered, the lips baked, dry. A nausea may be observed, and in severe cases, even vomiting. Because of the progressive disorders of the kidney, the amount of urine decreases even with abundant drink. Watering dark, concentrated, with severe shock can Anuria (complete lack of urine).

Diagnostics

Traumatic shock is diagnosed when identifying the corresponding symptoms, the presence of fresh injury or another possible cause of the occurrence of this pathology. To assess the state of the victim, periodic measurements of the pulse and blood pressure produce, laboratory studies are prescribed. The list of diagnostic procedures is determined by the pathological state, which caused the development of traumatic shock.

Treatment of traumatic shock

At the first aid stage, it is necessary to carry out a temporary stopping of bleeding (harness, tight bandage), restore the airways permeability, perform pain relief and immobilization, as well as prevent hypothermia. Move the patient should be very careful to prevent repeatance.

In hospital on initial stage Resuscitation-anesthesiologists carry out the suspension of salt (lactasol, Ringer's solution) and colloidal (reopolyglyukin, polyglyukin, gelatinoly, etc.) of solutions. After determining the resume and blood group, the transfusion of these solutions continues in combination with blood and plasma. Provide adequate breathing using ducts, oxygen therapy, trachea intubation or IVL. Continue anesthesia. Perform the catheterization of the bladder for accurate definition The number of urine.

Operational interventions are carried out according to life indications in the amount necessary to preserve the vital activity and prevent further exacerbation of the shock. Carry out the bleeding and processing of the Russian Academy of Sciences, blockade and immobilization of fractures, elimination of pneumothorax, etc. Assigns hormone therapy, and dehydration, apply drugs to combat brain hypoxia, adjust exchange violations.