The state of shock is called. General pathogenesis and manifestations of shock conditions

Shock is a form of critical condition of the body, manifested by multiple organ dysfunction, developing in cascade on the basis of a generalized circulatory crisis and, as a rule, ending in death without treatment.

The shock factor is any effect on the body that exceeds adaptive mechanisms in strength. During shock, the functions of breathing, the cardiovascular system, and the kidneys change, the processes of microcirculation of organs and tissues and metabolic processes are disrupted.

Etiology and pathogenesis

Shock is a disease of polyetiological nature. Depending on the etiology of occurrence, types of shock may be different.

1. Traumatic shock:

1) for mechanical injuries - bone fractures, wounds, compression of soft tissues, etc.;

2) for burn injuries (thermal and chemical burns);

3) when exposed to low temperature - cold shock;

4) in case of electrical injuries – electric shock.

2. Hemorrhagic, or hypovolemic, shock:

1) develops as a result of bleeding, acute blood loss;

2) as a result acute disorder water balance dehydration occurs.

3. Septic (bacterial-toxic) shock (generalized purulent processes, the cause of which is gram-negative or gram-positive microflora).

4. Anaphylactic shock.

5. Cardiogenic shock(myocardial infarction, acute heart failure). Discussed in the section emergency conditions in cardiology.

In all types of shock, the main mechanism of development is vasodilation, and as a result, the capacity increases vascular bed, hypovolemia - the circulating blood volume (CBV) decreases, as there are various factors: blood loss, redistribution of fluid between the blood and tissues, or a discrepancy between the normal blood volume and the increasing capacity of the vascular bed. The resulting discrepancy between the blood volume and the capacity of the vascular bed underlies the decrease cardiac output and microcirculation disorders. The latter leads to major changes in the body, since this is where the main function of blood circulation is carried out - the exchange of substances and oxygen between the cell and the blood. Blood thickening occurs, its viscosity increases, and intracapillary microthrombosis occurs. Subsequently, cell functions are disrupted until they die. In tissues they begin to predominate anaerobic processes over aerobic ones, which leads to the development of metabolic acidosis. The accumulation of metabolic products, mainly lactic acid, increases acidosis.

A feature of the pathogenesis of septic shock is a violation of blood circulation under the influence of bacterial toxins, which contributes to the opening of arteriovenous shunts, and blood begins to bypass the capillary bed and rushes from arterioles to venules. By reducing capillary blood flow and the action of bacterial toxins specifically on the cell, cell nutrition is disrupted, which leads to a decrease in the supply of oxygen to cells.

In case of anaphylactic shock under the influence of histamine and other biological active substances capillaries and veins lose their tone, while the peripheral vascular bed expands, its capacity increases, which leads to pathological redistribution of blood. Blood begins to accumulate in capillaries and venules, causing cardiac dysfunction. The resulting bcc does not correspond to the capacity of the vascular bed, and the cardiac output (cardiac output) decreases accordingly. The resulting stagnation of blood in the microvasculature leads to a disorder of metabolism and oxygen between the cell and the blood at the level of the capillary bed.

The above processes lead to ischemia of the liver tissue and disruption of its functions, which further aggravates hypoxia in severe stages of shock development. Detoxification, protein-forming, glycogen-forming and other functions of the liver are disrupted. Disorder of the main, regional blood flow and microcirculation in renal tissue contributes to the disruption of both filtration and concentration functions of the kidneys with a decrease in diuresis from oliguria to anuria, which leads to the accumulation in the patient’s body of nitrogenous wastes, such as urea, creatinine, and other toxic metabolic products. The functions of the adrenal cortex are disrupted, the synthesis of corticosteroids (glucocorticoids, mineralocorticoids, androgenic hormones) is reduced, which aggravates the processes occurring. A circulatory disorder in the lungs explains the disorder external respiration, alveolar gas exchange decreases, blood shunting occurs, microthrombosis forms, and as a result, the development respiratory failure, which aggravates tissue hypoxia.

Clinic

Hemorrhagic shock is the body’s reaction to the resulting blood loss (loss of 25–30% of the blood volume leads to severe shock).

In occurrence burn shock the dominant role is played by the pain factor and massive plasma loss. Rapidly developing oliguria and anuria. The development of shock and its severity are characterized by the volume and rate of blood loss. Based on the latter, compensated hemorrhagic shock, decompensated reversible shock and decompensated irreversible shock are distinguished.

With compensated shock, pale skin, cold sticky sweat are noted, the pulse becomes small and frequent, arterial pressure remains within normal limits or is slightly reduced, but not significantly, urine output decreases.

With uncompensated reversible shock, the skin and mucous membranes become cyanotic in color, the patient becomes lethargic, the pulse is small and frequent, there is a significant decrease in arterial and central venous pressure, oliguria develops, the Algover index is increased, and the ECG shows a disturbance in the supply of oxygen to the myocardium. In case of irreversible shock, there is no consciousness, blood pressure drops to critical levels and may not be detected, skin marble color, anuria develops - cessation of urination. The Algover index is high.

To assess severity hemorrhagic shock great importance has a definition of blood volume, volume of blood loss.

The shock severity analysis map and evaluation of the results obtained are shown in Table 4 and Table 5.

Table 4

Shock severity analysis chart

Table 5

Evaluation of results based on total points

The shock index, or Algover index, represents the ratio of pulse rate to systolic pressure. In case of shock of the first degree, the Algover index does not exceed 1. In case of second degree - no more than 2; with an index of more than 2, the condition is characterized as incompatible with life.

Types of shocks

Anaphylactic shock- a complex of various allergic reactions immediate type reaching extreme gravity.

Distinguish following forms anaphylactic shock:

1) cardiovascular form, in which it develops acute failure blood circulation, manifested by tachycardia, often with disturbances in heart rhythm, ventricular and atrial fibrillation, and decreased blood pressure;

2) respiratory form, accompanied by acute respiratory failure: shortness of breath, cyanosis, stridorous, bubbling breathing, moist rales in the lungs. This is due to a violation capillary circulation, edema lung tissue, larynx, epiglottis;

3) cerebral form caused by hypoxia, impaired microcirculation and cerebral edema.

Based on the severity of the course, there are 4 degrees of anaphylactic shock.

I degree (mild) is characterized by itching of the skin, the appearance of a rash, headache, dizziness, and a feeling of a rush to the head.

II degree (moderate) – the previously mentioned symptoms are joined by Quincke’s edema, tachycardia, decreased blood pressure, and increased Algover’s index.

III degree (severe) is manifested by loss of consciousness, acute respiratory and cardiovascular failure (shortness of breath, cyanosis, wheezing, rapid pulse, a sharp decline blood pressure, high Algover index).

IV degree (extremely severe) is accompanied by loss of consciousness, severe cardiovascular failure: the pulse is not detectable, blood pressure is low.

Treatment. Treatment is carried out according to general principles treatment of shock: restoration of hemodynamics, capillary blood flow, use vasoconstrictors, normalization of bcc and microcirculation.

Specific measures are aimed at inactivating the antigen in the human body (for example, penicillinase or b-lactamase in shock caused by antibiotics) or preventing the effect of the antigen on the body - antihistamines and membrane stabilizers.

1. Intravenous infusion of adrenaline until hemodynamic stabilization. You can use dopmin 10–15 mcg/kg/min, and for symptoms of bronchospasm and b-adrenergic agonists: alupent, bricanil intravenously.

2. Infusion therapy in a volume of 2500–3000 ml with the inclusion of polyglucin and rheopolyglucin, unless the reaction is caused by these drugs. Sodium bicarbonate 4% 400 ml, glucose solutions to restore blood volume and hemodynamics.

3. Intravenous membrane stabilizers: prednisolone up to 600 mg, ascorbic acid 500 mg, troxevasin 5 ml, sodium ethamsylate 750 mg, cytochrome C 30 mg (daily doses are indicated).

4. Bronchodilators: aminophylline 240–480 mg, noshpa 2 ml, alupent (bricanil) 0.5 mg drip.

5. Antihistamines: diphenhydramine 40 mg (suprastin 60 mg, tavegil 6 ml), cimetidine 200–400 mg intravenously (daily doses are indicated).

6. Protease inhibitors: trasylol 400 thousand units, contrical 100 thousand units.

Traumatic shock- this is pathological and critical condition of the body, arising in response to injury, in which the functions of vital systems and organs are disrupted and inhibited. During traumatic shock, torpid and erectile phases are distinguished.

According to the time of occurrence, shock can be primary (1–2 hours) and secondary (more than 2 hours after injury).

Erectile stage or emergence phase. Consciousness remains, the patient is pale, restless, euphoric, inadequate, can scream, run somewhere, break out, etc. At this stage, adrenaline is released, due to which the pressure and pulse can remain normal for some time. The duration of this phase ranges from several minutes and hours to several days. But in most cases it is short in nature.

The torpid phase replaces the erectile phase, when the patient becomes lethargic and adynamic, blood pressure decreases and tachycardia appears. Injury severity estimates are shown in Table 6.

Table 6

Assessing the volume of injury severity

After calculating the points, the resulting number is multiplied by a coefficient.

Notes

1. If there are injuries not specified in the list of the volume and severity of the injury, a number of points are awarded according to the type of injury, the severity corresponding to one of those listed.

2. Subject to availability somatic diseases, reducing the adaptive functions of the body, the found sum of points is multiplied by a coefficient from 1.2 to 2.0.

3. At the age of 50–60 years, the sum of points is multiplied by a factor of 1.2, older - by 1.5.

Treatment. Main directions in treatment.

1. Elimination of the action of the traumatic agent.

2. Elimination of hypovolemia.

3. Elimination of hypoxia.

Pain relief is carried out by administering analgesics and narcotics, and performing blockades. Oxygen therapy, tracheal intubation if necessary. Reimbursement of blood loss and bcc (plasma, blood, rheopolyglucin, polyglucin, erythromass). Normalization of metabolism, as metabolic acidosis develops, is introduced calcium chloride 10% - 10 ml, sodium chloride 10% - 20 ml, glucose 40% - 100 ml. Combating vitamin deficiency (B vitamins, vitamin C).

Hormone therapy with glucocorticosteroids - intravenous prednisolone 90 ml once, and subsequently 60 ml every 10 hours.

Stimulation of vascular tone (mesaton, norepinephrine), but only when the volume of circulating blood is replenished. Antihistamines (diphenhydramine, sibazon) are also involved in anti-shock therapy.

Hemorrhagic shock- this is an acute condition cardiovascular failure which develops after loss significant amount blood and leads to a decrease in perfusion of vital important organs.

Etiology: injuries with damage to large vessels, acute ulcer stomach and duodenum, rupture of an aortic aneurysm, hemorrhagic pancreatitis, rupture of the spleen or liver, rupture of a tube or ectopic pregnancy, the presence of placenta lobules in the uterus, etc.

According to clinical data and the magnitude of the blood volume deficit, the following degrees of severity are distinguished.

1. Not expressed - no clinical data, blood pressure level is normal. The volume of blood loss is up to 10% (500 ml).

2. Weak – minimal tachycardia, slight decrease blood pressure, some signs of peripheral vasoconstriction (cold hands and feet). The volume of blood loss ranges from 15 to 25% (750-1200 ml).

3. Moderate - tachycardia up to 100-120 beats per minute, decreased pulse pressure, systolic pressure 90-100 mm Hg. Art., anxiety, sweating, pallor, oliguria. The volume of blood loss ranges from 25 to 35% (1250–1750 ml).

4. Severe - tachycardia more than 120 beats per minute, systolic pressure below 60 mm Hg. Art., often not detected by a tonometer, stupor, extreme pallor, cold extremities, anuria. The volume of blood loss is more than 35% (more than 1750 ml). Laboratory in general analysis blood decrease in the level of hemoglobin, red blood cells and hematocrit. The ECG reveals nonspecific changes in the ST segment and T wave, which are caused by insufficient coronary circulation.

Treatment hemorrhagic shock involves stopping bleeding, using infusion therapy to restore blood volume, using vasoconstrictors or vasodilators depending on the situation. Infusion therapy involves intravenous administration of fluid and electrolytes in a volume of 4 liters ( saline, glucose, albumin, polyglucin). In case of bleeding, transfusion of same-group blood and plasma is indicated in a total volume of at least 4 doses (1 dose is 250 ml). Introduction shown hormonal drugs, such as membrane stabilizers (prednisolone 90-120 mg). Depending on the etiology, specific therapy is carried out.

Septic shock– this is the penetration of an infectious agent from its original focus into the blood system and its spread throughout the body. The causative agents can be: staphylococcal, streptococcal, pneumococcal, meningococcal and enterococcal bacteria, as well as Escherichia, Salmonella and Pseudomonas aeruginosa, etc. Septic shock is accompanied by dysfunction of the pulmonary, hepatic and renal systems, a violation of the blood coagulation system, which leads to the occurrence of thrombohemorrhagic syndrome ( Machabeli syndrome), which develops in all cases of sepsis. The course of sepsis is influenced by the type of pathogen, this is especially important when modern methods treatment. Laboratory findings indicate progressive anemia (due to hemolysis and inhibition of hematopoiesis). Leukocytosis up to 12,109/l, however, in severe cases, since a sharp depression of the hematopoietic organs develops, leukopenia can also be observed.

Clinical symptoms of bacterial shock: chills, heat, hypotension, dry warm skin - at first, and later - cold and moist, pallor, cyanosis, impaired mental status, vomiting, diarrhea, oliguria. Neutrophilia with shift is characteristic leukocyte formula to the left up to the myelocytes; ESR increases to 30–60 mm/h or more. The level of bilirubin in the blood is increased (up to 35–85 µmol/l), which also applies to the content of residual nitrogen in the blood. Blood clotting and prothrombin index reduced (up to 50–70%), reduced calcium and chloride content. Total protein blood is reduced, which occurs due to albumin, and the level of globulins (alpha-globulins and b-globulins) increases. The urine contains protein, leukocytes, red blood cells and casts. The level of chloride in the urine is reduced, and the level of urea and uric acid is increased.

Treatment is primarily etiological in nature, therefore, before prescribing antibacterial therapy it is necessary to determine the pathogen and its sensitivity to antibiotics. Antimicrobial agents should be used in maximum doses. To treat septic shock, it is necessary to use antibiotics that cover the entire spectrum of gram-negative microorganisms. The most rational is the combination of ceftazidime and impinem, which have proven effective against Pseudomonas aeruginosa. Drugs such as clindamycin, metronidazole, ticarcillin or imipinem are used as the drugs of choice when a resistant pathogen occurs. If staphylococci are cultured from the blood, it is imperative to begin treatment with penicillin drugs. Treatment of hypotension consists in the first stage of treatment in the adequacy of the volume of intravascular fluid. Use crystalloid solutions (isotonic sodium chloride solution, Ringer lactate) or colloids (albumin, dextran, polyvinylpyrrolidone). The advantage of colloids is that when they are introduced, the results are most quickly achieved. necessary indicators filling pressure and remain so for a long time. If there is no effect, then inotropic support and (or) vasoactive drugs are used. Dopamine is the drug of choice because it is a cardioselective beta-agonist. Corticosteroids reduce the overall response to endotoxins, help reduce fever, and have a positive hemodynamic effect. Prednisolone at a dose of 60k 90 mg per day.

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General information

This is a serious condition when the cardiovascular system cannot cope with the blood supply to the body, usually due to low blood pressure and cell or tissue damage.

Causes of shock

Shock can be caused by a condition in the body when blood circulation is dangerously reduced, for example, with cardiovascular disease (heart attack or heart failure), with large loss of blood (severe bleeding), with dehydration, with severe allergic reactions or blood poisoning (sepsis).

Shock classification includes:

cardiogenic shock (associated with cardiovascular problems),
hypovolemic shock (caused by low blood volume),
anaphylactic shock (caused by allergic reactions),
septic shock(caused by infections)
neurogenic shock(violations by nervous system).

Shock is a life-threatening condition and requires immediate medical treatment; emergency care is not excluded. The patient's condition in shock can quickly deteriorate; be prepared for initial resuscitation efforts.

Symptoms of shock

Symptoms of shock may include feelings of fear or agitation, bluish lips and nails, chest pain, confusion, cold clammy skin, decreased or stopping urination, dizziness, fainting, low blood pressure, pallor, excessive sweating, rapid pulse, shallow breathing, unconsciousness, weakness.

First aid for shock

Check the victim's airway and, if necessary, artificial respiration.

If the patient is conscious and has no injuries to the head, limbs, or back, lay him on his back, with his legs raised 30 cm; don't raise your head. If the patient has suffered an injury in which raised legs cause pain, then there is no need to raise them. If the patient received severe damage spine, leave it in the position in which you found it, without turning it over, and provide first aid, treating wounds and cuts (if any).

Man gotta stay warm, loosen up tight clothes, do not give the patient anything to eat or drink. If the patient is vomiting or drooling, turn the patient's head to the side to allow the vomit to drain (only if there is no suspicion of spinal injury). If there is still a suspicion of spinal injury and the patient is vomiting, it is necessary to turn him over, fixing his neck and back.

Call ambulance and continue to monitor vital signs (temperature, pulse, respiratory rate, blood pressure) until help arrives.

Preventive measures

Preventing shock is easier than treating it. Fast and timely treatment underlying causes will reduce the risk of developing severe shock. First aid will help control the state of shock.

Shock is general reaction the body to extremely strong, for example painful, irritation. It is characterized by severe disorders of the functions of vital organs, nervous and endocrine systems. Shock is accompanied by severe disturbances in blood circulation, breathing and metabolism. There are a number of classifications of shock.

Types of shock.

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

– hypovolemic (with blood loss);
– cardiogenic (with severe impairment of cardiac function);
– redistribution (in case of circulatory disorders);
– pain (in case of injury, myocardial infarction).

Shock is also determined by the reasons that provoked its development:

– traumatic (due to extensive injuries or burns, the leading causative factor is pain);
– anaphylactic, which is the most severe allergic reaction on certain substances in contact with the body;
– cardiogenic (develops as one of the most severe complications of myocardial infarction);
– hypovolemic (for infectious diseases with repeated vomiting and diarrhea, overheating, blood loss);
– septic, or infectious toxic (for severe infectious diseases);
– combined (combines several causal factors and development mechanisms).

Pain shock.

Pain shock is caused by pain that exceeds the individual pain threshold in strength. It is more often observed with multiple traumatic injuries or extensive burns. Symptoms of shock are divided into phases and stages. In the initial phase (erectile) of traumatic shock, the victim experiences agitation, pale facial skin, a restless look, and an inadequate assessment of the severity of his condition.

There is also an increased physical activity: he jumps up, tries to go somewhere, and it can be quite difficult to hold him. Then, as the second phase of shock (torpid) sets in, depressed consciousness develops against the background of preserved consciousness. mental condition, complete indifference to the environment, decreased or complete absence pain reaction. The face remains pale, its features become sharper, the skin of the entire body is cold to the touch and covered with sticky sweat. The patient's breathing quickens significantly and becomes shallow, the victim feels thirsty, and vomiting often occurs. With different types of shock, the torpid phase differs mainly in duration. It can be roughly divided into 4 stages.

Shock I degree (mild).

The general condition of the victim is satisfactory, accompanied by mild lethargy. The pulse rate is 90–100 beats per minute, its filling is satisfactory. Systolic (maximum) blood pressure is 95–100 mmHg. Art. or a little higher. Body temperature remains within normal limits or is slightly reduced.

Shock II degree (moderate).

The victim's lethargy is clearly expressed, the skin is pale, and the body temperature decreases. Systolic (maximum) blood pressure is 90–75 mm Hg. Art., and the pulse is 110–130 beats per minute (weak filling and tension, varying). Breathing is shallow and rapid.

Shock III degree (severe).

Systolic (maximum) blood pressure is below 75 mm Hg. Art., pulse – 120–160 beats per minute, thread-like, weak filling. This stage of shock is considered critical.

IV degree shock (called preagonal state).

Blood pressure is not determined, and the pulse can only be detected in large vessels ( carotid arteries). The patient's breathing is very rare and shallow.

Cardiogenic shock.

Cardiogenic shock is one of the most serious and life-threatening complications of myocardial infarction and severe violations heart rate and conductivity. This type shock can develop during a period of severe pain in the heart area and is characterized at first by extremely sudden weakness, pallor of the skin and cyanosis of the lips. In addition, the patient experiences coldness in the extremities, cold sticky sweat covering the entire body, and often loss of consciousness. Systolic blood pressure drops below 90 mm Hg. Art., a pulse pressure– below 20 mm Hg. 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 ventricles of the heart, a decrease in the stroke volume of the heart and, as a result, a significant decrease in cardiac blood output. In some cases, the victim is helped by “switching on” a compensatory mechanism such as increased heart rate. Enough common cause The development of hypovolemic shock is significant blood loss as a result of extensive trauma 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 vital importance belongs to the significant blood loss itself, which leads to sharp fall blood pressure. Compensatory processes, such as spasm of small blood vessels, aggravate pathological process, since they inevitably lead to impaired microcirculation and, as a consequence, to systemic oxygen deficiency and acidosis.

The accumulation of under-oxidized substances in various organs and tissues causes intoxication of the body. Repeated vomiting and diarrhea due to infectious diseases also lead to a decrease in circulating blood volume and a drop in blood pressure. Factors predisposing to the development of shock are: significant blood loss, hypothermia, physical fatigue, mental trauma, starvation, hypovitaminosis.

Infectious toxic shock.

This type of shock is the most severe complication of infectious diseases and a direct consequence of the effect of the pathogenic toxin on the body. There is a pronounced centralization of blood circulation, due to which most of the blood turns out to be practically unused and accumulates in peripheral tissues. The result of this is a violation of microcirculation and tissue oxygen starvation. Another feature of infectious toxic shock– a significant deterioration in the blood supply to the myocardium, which soon leads to a pronounced decrease in blood pressure. This type of shock is characterized by appearance patient – microcirculation disorders give the skin “marbling”.

General principles of emergency care for shock.

The basis of all anti-shock measures is timely provision medical care at all stages of the victim’s movement: at the scene of the incident, on the way to the hospital, directly in it. The main principles of anti-shock measures at the scene of an incident are to carry out an extensive set of actions, the order of which depends on the specific situation, namely:

1) elimination of the action of the traumatic agent;
2) stopping bleeding;
3) carefully shifting the victim;
4) giving it a position that alleviates the condition or prevents additional injuries;
5) release from constricting clothing;
6) closing wounds with aseptic dressings;
7) pain relief;
8) use of sedatives;
9) improving the functioning of the respiratory and circulatory organs.

In emergency care for shock, the priorities are bleeding control and pain relief. It should be remembered that the repositioning of victims, as well as their transportation, must be careful. Patients should be placed in ambulance transport taking into account the convenience of resuscitation measures. Pain relief for shock is achieved by administering neurotropic drugs and analgesics. The earlier it starts, the weaker it is pain syndrome, which, in turn, increases the effectiveness of antishock therapy. Therefore, after stopping massive bleeding, before immobilization, dressing the wound and positioning the victim, it is necessary to provide anesthesia.

For this purpose, the victim is injected intravenously with 1–2 ml of a 1% solution of promedol, diluted in 20 ml of a 0.5% solution of novocaine, or 0.5 ml of a 0.005% solution of fentanyl, diluted in 20 ml of a 0.5% solution of novocaine or 20 ml 5% glucose solution. Analgesics are administered intramuscularly without a solvent (1–2 ml of 1% promedol solution, 1–2 ml of tramal). The use of other narcotic analgesics is contraindicated, as they cause depression of the respiratory and vasomotor centers. Also, for abdominal injuries with suspected damage to internal organs, the administration of fentanyl is contraindicated.

The use of alcohol-containing liquids in emergency care for shock is not allowed, as they can cause increased bleeding, which will lead to a decrease in blood pressure and depression of the functions of the central nervous system. It is always necessary to remember that during shock conditions, spasm of peripheral blood vessels occurs, therefore, medications are administered intravenously, and if there is no access to a vein, intramuscularly.

Local anesthesia and cooling of the damaged part of the body have a good analgesic effect. Local anesthesia is carried out with a solution of novocaine, which is injected into the area of damage or wound (within intact tissue). With extensive crushing of tissues, bleeding from internal organs, increasing swelling of tissues local anesthesia it is advisable to supplement local influence dry cold. Cooling not only enhances the analgesic effect of novocaine, but also has a pronounced bacteriostatic and bactericidal effect.

In order to relieve agitation and enhance the analgesic effect, it is advisable to use antihistamines, such as diphenhydramine and promethazine. To stimulate the function of breathing and blood circulation, the victim is given respiratory analeptic– 25% solution of cordiamine in a volume of 1 ml. At the time of injury, the victim may be in a state of clinical death. Therefore, when cardiac activity and breathing stop, regardless of the reasons that caused them, they immediately begin resuscitation measures - artificial ventilation and cardiac massage. Resuscitation measures are considered effective only if the victim begins to breathe independently and has a heartbeat.

When providing emergency care at the transportation stage, the patient is given intravenous infusions of large molecular plasma substitutes that do not require special conditions for storage. Polyglucin and other large molecular solutions due to their osmotic properties cause rapid blood flow tissue fluid and thereby increase the mass of blood circulating in the body. At large blood loss It is possible to transfuse blood plasma to the victim.

Upon admission of the victim to medical institution check the correctness of immobilization and timing of application of a hemostatic tourniquet. If such victims are received, the first step is to carry out final stop bleeding. For injuries of the extremities, a case blockade according to Vishnevsky, carried out above the site of injury, is advisable. Re-introduction Promedol is permissible only 5 hours after its initial administration. At the same time, they begin to inhale oxygen to the victim.

Good effect in antishock treatment involves inhaling a mixture of nitrous oxide and oxygen in a 1:1 or 2:1 ratio using anesthesia machines. In addition, to achieve a good neurotropic effect, cardiac drugs should be used: cordiamine and caffeine. Caffeine stimulates the function of the respiratory and vasomotor centers of the brain and thereby increases and enhances myocardial contractions, improves coronary and cerebral circulation, increases blood pressure. Contraindications to the use of caffeine are only uncontrolled bleeding, severe spasm peripheral vessels and increased heart rate.

Cordiamine improves the activity of the central nervous system, stimulates breathing and blood circulation. In optimal dosages, it helps to increase blood pressure and enhance heart function. In severe injuries, when severe disturbances in external respiration and progressive oxygen starvation (respiratory hypoxia) occur, these phenomena are aggravated by circulatory disturbances and blood loss characteristic of shock - circulatory and anemic hypoxia develop.

In case of mild respiratory failure, antihypoxic measures can be limited to freeing the victim from constricting clothing and supplying a clean air stream or a moistened mixture of oxygen with air for inhalation. These activities are necessarily combined with stimulation of blood circulation. In cases of acute respiratory failure, tracheostomy is indicated if necessary. It consists of creating an artificial fistula, which allows air to enter the trachea through an opening on the surface of the neck. A tracheostomy tube is inserted into it. In emergency situations, it can be replaced by any hollow object.

If tracheostomy and toilet respiratory tract do not eliminate acute respiratory failure, therapeutic measures supplemented with artificial ventilation. The latter not only helps to reduce or eliminate respiratory hypoxia, but also eliminates congestion in the pulmonary circulation and at the same time stimulates respiratory center brain.

Emerging violations metabolic processes most pronounced in severe shock. Therefore, the complex of anti-shock therapy and resuscitation, regardless of the reasons for the serious condition of the victim, includes medications metabolic action, which primarily includes water-soluble vitamins (B1, B6, C, PP), 40% glucose solution, insulin, hydrocortisone or its analogue prednisolone.

As a result of metabolic disorders in the body, redox processes are disrupted, requiring the inclusion of blood alkalizing agents in anti-shock therapy and resuscitation. It is most convenient to use 4–5% solutions of sodium bicarbonate or bicarbonate, which are administered intravenously in a dose of up to 300 ml. Transfusions of blood, plasma and some plasma substitutes are an integral part of antishock therapy.

Based on materials from the book " Quick help in emergency situations."
Kashin S.P.

Pain shock is manifested by a reaction to pain, which primarily affects the nervous, cardiovascular and respiratory systems.

It occurs gradually and has different stages.

If immediate action is not taken, this situation can result in a dangerous outcome, including death.

It is important to have time to provide first aid to the victim before the medical team arrives.

Pain shock is a rapidly developing and life threatening the body's reaction to excessive painful effect, accompanied by serious disruptions to the activity of all systems and organs.

Its main feature, besides acute pain, – pressure decrease.

Causes

The main cause of shock is blood flow injury caused by a painful stimulus, which can be:

cold;
burn;
mechanical influences;
electric shock;
fractures;
knife or bullet wounds;
complications of diseases (food bolus getting stuck in the esophagus, uterine rupture, ectopic pregnancy, colic in the liver and kidneys, heart attack, perforated ulcer stomach, stroke).

Trauma disrupts the integrity of blood vessels and is accompanied by blood loss. As a result, the volume of circulating fluid decreases, organs are not fed with blood, lose the ability to perform functions and die.

In order to maintain the blood supply to vital organs (brain, heart, lungs, liver, kidneys) at the proper level, compensatory mechanisms come into play: blood leaves other organs (intestines, skin) and arrives at these. Those. distribution (centralization) of blood flow occurs.

But this is only enough for a while.

The next compensatory mechanism is tachycardia - an increase in the strength and frequency of heart contractions. It increases blood flow through organs.

Since the body works for wear and tear, after a certain period of time the compensation mechanisms become pathological. The tone of the microcirculatory bed (capillaries, venules, arterioles) decreases, blood stagnates in the veins. This causes the body to experience another shock, because... the total area of the venules is enormous and blood does not circulate through the organs. The brain receives a signal about repeated blood loss.

Second to lose muscle tone capillaries. Blood is deposited in them, causing blood clots and obstruction to occur there. The blood clotting process is disrupted because plasma flows out of it, and another portion enters the same place with a new flow shaped elements. Due to the fact that capillary tone is not restored, this phase of shock is irreversible and final, heart failure occurs.

Due to poor blood supply in other organs, their secondary failure appears.

The central nervous system cannot perform complex reflex acts; disturbances in its work progress as ischemia (death of tissue) of the brain develops.

Changes also affect the respiratory system: hypoxia occurs, breathing becomes more frequent and shallow, or, conversely, hyperventilation occurs. This negatively affects the non-respiratory functions of the lungs: fighting toxins, purifying incoming air from impurities, shock absorption of the heart, vocal function, and blood deposition. Blood circulation in the alveoli suffers, which leads to edema.

Because the kidneys are very sensitive to the lack of oxygen, urine production decreases, and then acute renal failure occurs.

This is the mechanism of the stress reaction of the gradual involvement of all organs.

Damage spinal cord resulting injury leads to spinal shock. This condition is dangerous to life and health, so it is important to provide first aid correctly and on time. Follow the link for more details on treatment tactics.

Symptoms, signs and phases

First phase painful shock- excitation, the second - inhibition. Each of them has its own symptoms.

On initial stage(erectile) patient is excited, he experiences euphoria, increased heart rate, breathing movements, finger trembling, high pressure, the pupils dilate, he is not aware of his condition. A person can shout out sounds and make rough movements. The stage lasts up to 15 minutes.

The first phase of painful shock is replaced by torpid one. Its main symptom is a decrease in pressure, as well as:

lethargy, apathy, lethargy, indifference to what is happening (although there may be excitement and anxiety);
pale skin;
undetectable, frequent, thread-like pulse;
decreased body temperature;
coldness of hands and feet;
loss of sensation;
shallow breathing;
blue lips and nails;
large drops of sweat;
decreased muscle tone.

It is the second phase that manifests itself in acute heart failure and stress response in the form of failure of all other organ systems to such an extent that it is impossible to maintain vital functions.

In this phase, the following degrees of shock are distinguished:

I degree– disturbances in the movement of blood through the vessels are not pronounced, blood pressure and pulse are normal.
II degree - pressure during contraction of the heart muscle decreases to 90-100 mm Hg. Art., there is lethargy, rapid pulse, the skin acquires White color, peripheral veins collapse.
III degree - the patient’s condition is serious, blood pressure drops to 60-80 mm Hg, pulse is weak, 120 beats per minute, skin is pale, freezing sweat appears.
IV degree - the victim’s condition is regarded as very serious, his thoughts are confused, he loses consciousness, his skin and nails turn blue, and a marbled (spotted) pattern appears. Blood pressure – 60 mm Hg. Art., pulse - 140-160 beats per minute, it can only be felt on large vessels.

It is most convenient to calculate blood loss using the value of “upper” blood pressure.

Table. Dependence of blood loss on systolic pressure

If you have low blood pressure or a traumatic brain injury, you should not use analgesics!

First aid for painful shock

First, the patient must be warmed using heating pads, blankets, warm clothes, then drink hot tea. In case of painful shock, the victim is prohibited from giving anything to drink. In the presence of vomiting and wounds abdominal cavity Drinking liquid is prohibited!

A cold object, such as ice, is applied to the injury site. Delete foreign objects It is not permissible to leave the patient’s body until the doctors arrive!

If the painful shock is caused by an injury, it is necessary to stop the bleeding by applying tourniquets, bandages, clamps, tampons, and pressure cotton-gauze bandages.

In case of blood loss, the damaged vessel is clamped with a tourniquet; in case of wounds, fractures and damage to the integrity of soft tissues, a splint is applied. It should extend beyond the joints above and below the damaged area of the bone, and a spacer should be placed between it and the body.

The patient can be transported only after the symptoms of shock have resolved.

Corvalol, Valocordin and Analgin will help relieve an attack of pain at home.

Treatment

Each stage has its own treatment measures, but there are general rules treatment of shock.

Help should be provided as early as possible (the shock lasts about a day).
Therapy is long-term, complex and depends on the cause and severity of the condition.

Medical measures include:

leading to the required level volume of circulating fluid (replenishment of blood loss through intravenous infusion of solutions);
normalization internal environment body;
pain relief with painkillers;
elimination of respiratory problems;
preventive and rehabilitation measures.

In case of shock of I-II degree, plasma or 400-800 ml of Polyglucin is injected intravenously to block pain. This is important when moving the patient over a long distance and preventing shock from worsening.

While the patient is moving, the medications are stopped.

In case of shock of II-III degree, after the administration of Polyglyukin, 500 ml of saline or 5% glucose solution is transfused, later Polyglyukin is again prescribed with the addition of 60-120 ml of Prednisolone or 125-250 ml of adrenal hormones.

In severe cases, infusions are made into both veins.

In addition to injections, local anesthesia with a 0.25-0.5% Novocaine solution is performed at the fracture site.

If the internal organs are not affected, the victim is given 1-2 ml of 2% Promedol, 1-2 ml of 2% Omnopon or 1-2 ml of 1% morphine for pain relief, and also injected with Tramadol, Ketanov or a mixture of Analgin and Diphenhydramine in a ratio of 2 :1.

During shock III-IV degrees anesthesia is carried out only after the appointment of Polyglyukin or Reopoliglyukin, analogues of adrenal hormones are administered: 90-180 ml of Prednisolone, 6-8 ml of Dexamethasone, 250 ml of hydrocortisone.

The patient is prescribed medications that increase blood pressure.

It is impossible to achieve a rapid increase in blood pressure. Introducing protein substances that increase blood pressure (mesaton, dopamine, norepinephrine) is strictly prohibited!

For any type of shock, inhalation of oxygen is indicated.

Even after some time after a state of shock, due to impaired blood supply, pathology of internal organs is possible. This is expressed in poor coordination of movements, inflammation peripheral nerves. Without taking anti-shock measures, death occurs from painful shock, so it is important to be able to provide first aid.

Video on the topic

State of shock, or acute shock, sharp violation blood circulation in organs and tissues of the body. Cells do not receive the oxygen necessary for their existence, nutrients. The result is hypoxia. This condition disrupts the vital functions of the body and threatens human life. Therefore, in a state of shock, the victim needs emergency medical care.

The condition of a person in shock can rapidly deteriorate. Therefore, before the ambulance arrives, you need to provide first aid to the victim. Perhaps this will save a person's life. How to distinguish a state of shock in a person, what first aid is needed, what are the symptoms of shock - we will talk to you about this very important topic today:

How does shock manifest in a person? Symptoms of the condition

Let us immediately note that the nature of the shock is always different. For example, anaphylactic - can affect an allergy sufferer from one insect bite. People suffering from heart disease, in particular myocardial infarction, may develop cardiogenic shock. With weakened immune system, from penetration into the body toxic substances, septicemia may develop, and if a serious injury occurs, traumatic shock occurs.

There are several stages of shock. At the initial stage, the person is noticeably excited. This prevents him from adequately assessing his surroundings. Blood pressure does not change significantly.

Excitement gives way to lethargy, depression, and apathy. The patient is conscious, can speak, and answer questions. Breathing becomes shallow, blood pressure decreases. Due to slow blood circulation, the skin and mucous membranes turn pale.

Next, a further decrease in blood pressure occurs, tachycardia appears, and normal function respiratory organs. The skin is cold and pale. The pulse is weak but rapid. Does not exceed 120 beats. min. There is a sharp reduction in urine output.

The most severe condition is shock Stage III. Characterized by the following symptoms: severe pallor, bluishness of the skin, cold sweat, rapid breathing. The pulse is frequent (more than 120 beats per minute), thread-like, palpable only in the largest arteries. Blood pressure drops sharply to 70 mmHg and below.

Due to acute intoxication, when the body begins to be poisoned by its own waste products, characteristic spots appear on the skin. At this stage, the patient may lose consciousness.

In a severe state of shock, the patient does not respond to pain, is unable to move, and cannot answer questions. At this stage, anuria is observed, a condition in which urination is almost completely absent. Dysfunction of some internal organs occurs, in particular the liver and kidneys.

Of course, each case is individual. The state of shock, the symptoms of which we are considering today, can manifest itself in different ways, depending on the type of shock, its severity, age, general condition health of the patient. However, the main signs we discussed above are usually similar.

How is a person’s state of shock corrected? First aid

To help a person, and in some cases save his life, each of us needs to have first aid skills. For example, you need to be able to perform artificial respiration (you can find a description of the technique on our website).

So you can do the following:

First of all, calm down yourself and call an ambulance. When calling, clearly explain what happened and what condition the patient is in.

Then check the patient's breathing and, if necessary, perform artificial respiration.

If a person is conscious, there is no visible injuries head, back or limbs, place him on his back, raising his legs slightly above his body position (30 - 50 cm). You can’t raise your head, so don’t put a pillow on it.

If there is injury to the limbs, there is no need to elevate the legs. This will cause severe pain. If the back is injured, the victim should not be touched. It should be left in the same position. Just bandage wounds and abrasions, if any. This concerns traumatic shock.

For other types of this pathological condition, provide the patient with warmth, unbutton buttons, hooks, and belts on clothing, allowing him to breathe freely. Perform artificial respiration if necessary.

If observed profuse drooling, vomiting, turn the patient's head to the side to prevent him from choking on the vomit.

Monitor vital signs until emergency services arrive. Measure your pulse, breathing rate, and blood pressure.

Further necessary help a team of doctors will be called. If necessary, resuscitation measures will be provided in an ambulance on the way to the hospital.