Antishock therapy. Anti-shock first aid kit

/. Elimination of central nervous system disorders (neuroleptanalgesia (NLA), central analgesics, diazepines, etc.

2. Oxygen therapy.

3. Artificial ventilation, chest compressions.

4. Elimination of tissue hypoxia: (hyperbaric oxygenation (HBO) according to
possibilities), anabolic hormones, aspartic acid, glutamic
acid, etc.

5. Plasma substitutes (according to indications).

6. Administration of erythromass (indications).

7. Increased contractile function of the myocardium (cardiac glycosides, nitrates,
kortiko steroid s).

8. Improving the rheological properties of blood (anticoagulants, antiplatelet agents,
rheopolyglucins, etc.).

9. Elimination of acidosis and normalization of water and electrolyte balance (soda
solutions, solutions of potassium, calcium, glucose-insulin, hemodialysis, etc.).

10. Detoxification measures (forced diuresis, hemosorption,
peritoneal dialysis).

11. Treatment of hepatic and renal failure.

12. Hourly diuresis.

Test questions for the lecture.

1. What is included in the concept of “shock”?

2. List the main reasons leading to shock states.

3. Describe the clinical signs of anaphylactic shock, variants of its course.

4. What is the sequence of therapeutic measures for this shock?

5. Give the clinical picture of traumatic shock.

6. What should be the scope of assistance for severe mechanical damage with
the purpose of preventing the development of a state of shock?

7. What position should be given to the patient in an unconscious state during
transportation?

8. What is your treatment strategy for cardiogenic shock?

9. Depending on the trigger mechanism, what types of shock conditions do you experience?

Homework.

1.V. A. Mikhelson pp. 139-149. + reference book.

2.Handbook of emergency care, sections: cardiogenic, anaphylactic,

burn and traumatic shocks.

3. “Patient care”, techniques for carrying out the following activities:

technique of noniroleptanalgesia, technique of applying arterial and

venous tourniquets, catheterization.

Self-control tasks:

1. The erectile phase of traumatic shock is characterized by:
A). A sharp drop in blood pressure.

b). Motor excitement. V). Lethargy. G). Speech excitement.

2. Torpid phase:

A). Sharp pallor of the skin. b). Sudden loss of consciousness, c). Progressive drop in blood pressure. G). Lethargy.

d). Progressive increase in heart rate, thread-like pulse. 2. Sequence of first aid for traumatic shock: a). Place the patient to bed, b). Anesthesia, c). Stop bleeding. G). Improve oxygen access. d). Cardiac glycosides.

e). Replenishment of circulating blood volume (CBV). and). Transport immobilization. h). Vasoconstrictor and vascular drugs. And). Give ammonia.

Task No. 1.

A 30-year-old man was injured in a car accident. There is no consciousness. The pulse in the carotid arteries is not palpable. There is no breathing. The victim has a wide leather belt at waist level. What actions need to be taken?

1. Immediately begin artificial ventilation of the lungs, indirect
heart massage without wasting time removing the belt.

2. Carry out artificial ventilation and chest compressions after
release from the belt to avoid rupture of the liver and spleen.

3. Turn the victim onto his right side.

4, Do not touch the victim until the traffic police arrive.

Task No. 2.

You work at a medical center. A 38-year-old woman, K., contacted you; her surgeon recommended a course of penicillin intramuscularly for a boil on the left shoulder. After the injection of penicillin, the patient felt a sharp general weakness, itching, a feeling of heat throughout the body, chills, anxiety, agitation, headache, difficulty breathing, then loss of consciousness, and convulsions appeared.

1. What happened to the patient?

2. What is the emergency care of a paramedic?

3. What do you think was the paramedic’s mistake in this situation?

4. Further tactics for the paramedic? Forecast?

Topic 8; Intensive therapy for acute poisoning.

Purpose of studying the topic:

Know the clinical manifestations of acute poisoning and the principles of treatment
emergency care, taking into account the table of poisons and antidotes;

Be able to provide first aid in case of acute poisoning.

Plan.

1. Basics of toxicology: definition of this branch of medicine, types of poisoning, nature of the action of poisons, ways of penetration of poisons into the body, diagnosis of acute poisoning. The main clinical symptoms observed in acute poisoning. Table of poisons and antidotes.

Shock- hypocirculation syndrome with impaired tissue perfusion that occurs in response to mechanical damage and other pathological influences, as well as their immediate complications, leading to decompensation of vital functions.

The volume and nature of anti-shock measures when providing various types of medical care.

In case of shock injury, active anti-shock therapy should be started even in the absence of pronounced clinical manifestations of shock in the first hours.

In some cases, pathogenetic and symptomatic therapy is combined (for example, intravenous infusions to correct blood volume and the administration of vasopressors when blood pressure drops below a critical level).

Stop bleeding.

Continued bleeding leads to an alarming increase in the deficit of blood volume, which cannot be replenished without complete hemostasis. When providing each type of medical care, within the available capabilities, hemostatic measures must be performed as quickly and fully as possible, without which all anti-shock therapy cannot be effective.

Anesthesia.

Afferent pain impulses are one of the most important links in the pathogenesis of the development of shock. Adequate pain relief, eliminating one of the main causes of shock, creates the prerequisites for successful correction of homeostasis in the event of developed shock, and performed in the early stages after injury - for its prevention.

Immobilization of injuries.

Maintaining mobility in the area of injury leads to an increase in both pain and bleeding from damaged tissues, which, of course, can cause shock or aggravate its course. In addition to direct fixation of the damaged area, the purpose of immobilization is also careful transportation during the evacuation of victims.

Maintaining respiratory and cardiac function.

Correction of disturbed homeostasis during shock requires some time, but a critical drop in blood pressure and depression of respiratory function, characteristic of decompensated shock, can quickly lead to death. And therapy directly aimed at maintaining breathing and cardiac activity, being essentially symptomatic, allows you to gain time for pathogenetic treatment.

Elimination of the direct impact of the shockogenic factor.

This group of measures includes the release of victims from the rubble, extinguishing the flame, stopping the effects of electric current and other similar actions that do not require separate decoding and justification of their necessity.

However, with massive injuries and destruction of the extremities, blood circulation often cannot be normalized until the crushed segment is amputated, the wound is treated, the bleeding is stopped, and a protective aseptic bandage and immobilizing splint are applied to the treated wound.

Toxic amines (histamine, serotonin), polypeptides (bradykinin, kallidin), prostaglandins, lysosomal enzymes, tissue metabolites (lactic acid, electrolytes, adenyl compounds, ferritin) were found in substances circulating in the blood that have intoxicating properties. All of these substances have a direct inhibitory effect on hemodynamics and gas exchange and thereby aggravate the clinical manifestations of shock.

They violate antimicrobial barriers and contribute to the formation of irreversible consequences of shock. Considering this circumstance, indications for amputation of a limb in some cases are set, despite the presence of shock, and are considered as an element of anti-shock measures.

Therapy aimed at normalizing blood volume and correcting metabolic disorders:

Infusion-transfusion therapy.

Modern transfusiology is characterized by scientifically based restriction of blood transfusion. In order to correct BCC, crystalloid and colloid solutions are widely used, as well as blood components, which are available in large quantities in the arsenal of modern medicine. In this case, the goal is not only to compensate for the volume of blood volume, but also to combat generalized tissue dehydration and correct disturbed water and electrolyte balances.

In conditions of decompensation, it is usually necessary to control the acid-base state of the blood (pH and alkaline reserve), since instead of the expected metabolic acidosis Metabolic symptoms are common in shock alkalosis, especially 6-8 hours after injury. In this case, alkalosis occurs more often, the later the BCC deficiency is replenished.

Correction of vascular tone.

The need to correct vascular tone is due to the fact that its value largely determines not only the parameters of the systemic circulation (for example, cardiac output and blood pressure), but also the distribution of blood flows along the nutritional and shunt pathways, which significantly changes the degree of tissue oxygenation.

With prolonged spasm of peripheral vessels and the introduction of significant volumes of fluid, the use of drugs that actively reduce total peripheral resistance, reduce the return of venous blood to the heart and thereby facilitate its work is indicated.

Hormone therapy.

The administration of large doses (hydrocortisone - 500-1000 mg) of glucocorticoids, especially in the first minutes of treatment, has a positive inotropic effect on the heart, reduces renal vascular spasm and capillary permeability; eliminates the adhesive properties of blood cells; restores reduced osmolarity of intra- and extracellular fluid spaces.

Pathogenesis

The triggering mechanisms of shock can be different, but common to all forms of shock is a critical decrease in tissue perfusion, leading to impaired cell function, and in advanced cases, to their death.

The most important pathophysiological link of shock is a disorder of capillary circulation, leading to tissue hypoxia, acidosis and ultimately to an irreversible condition.

sharp decrease in BCC;

stages of shock:

compensated

decompensated

irreversible

Shock classification

hypovolemic:

hemorrhagic-

nonhemorrhagic -

Ø burns;

cardiogenic: low

Ø ventricular aneurysm;

Ø septic -

Ø anaphylactic -

Ø neurogenic -

obstructive

Ø cardiac tamponade;

Ø atrial myxoma.

General diagnostics

Shock criteria:

Hemorrhagic shock

Clinical picture:

. There may be no clinical signs of blood loss. The patient, who is in a horizontal position, has no symptoms of blood loss. The only sign may be an increase in heart rate of at least 20 per minute when getting out of bed. Blood pressure is within normal limits or slightly reduced (90 – 100 mm Hg); CVP 40 – 60 mm. water st; Ht 0.38 – 0.32; skin is dry, pale, cold; diuresis >

. Pulse > 130 beats/min; HELL< 70мм.рт.ст.; ЦВД 0мм.вод.ст.;ЧД 30 – 40 в мин.; шоковый индекс > <70 г/л; Ht <0,22; ступор, резкая бледность, пульс часто не определяется.

< 50мм.рт.ст (по методу Короткова почти не определяется); пульс (на магистральных артериях) >150 or< 40 в мин.; ЦВД – 0мм.вод.ст. или отрицательный.

Action algorithm
with hemorrhagic shock:

Diagnostics.

Ø prevention of RDS,

Ø prevention of DIC syndrome,

Ø prevention of acute renal failure.

1. Diagnostics.

BCC deficiency from 40 to 70%

Clinical symptoms:

1. Consciousness:

Ø confusion to the point of coma - BCC deficit > 40%

Pulse > 120 - 140.

Blood pressure< 80 мм рт. ст.

Pulse pressure is low.

Respiratory rate - > 30 - 35 per minute.

Diuresis< 0.5 мл/кг - час.

Shock index > 1.

Treatment of septic shock

reliable elimination of the main etiological factor or disease that triggered and maintained the pathological process.

correction of critical states of disorders: hemodynamics, gas exchange, hemorheological disorders, hemocoagulation, water-electrolyte shifts, metabolic insufficiency, etc.

direct impact on the function of the affected organ, up to temporary prosthetics, should begin early, before the development of irreversible changes.

antibacterial therapy, immunocorrection and adequate surgical treatment of septic shock.

When treating patients with a septic focus within the abdominal cavity or pelvis, you can resort to a combination of gentamicin and ampicillin (50 mg/kg per day) or lincomycin.

If a gram-positive infection is suspected, vancomycin (vancocin) up to 2 g/day is often used.

When determining sensitivity to antibiotics, therapy may be changed. In cases where it was possible to identify the microflora, the choice of antimicrobial drug becomes straightforward. It is possible to use monotherapy with antibiotics that have a narrow spectrum of action.

In some cases, along with antibiotics, powerful antiseptics can be included in the antibacterial combination of drugs: dioxidin up to 0.7 g/day, metronidazole (Flagyl) up to 1.5 g/day, solafur (Furagin) up to 0.3–0, 5 g/day.

γ-globulin or polyglobulin, specific antitoxic serums (antistaphylococcal, antipseudomonas).

rheological infusion media (reopoliglkzhin, plasmasteril, HAES-steril, reogluman), as well as chimes, complamin, trental.

It is advisable to use antioxidants (tocopherol, ubiquinone) as protectors of damage to cellular structures.

for inhibition of blood proteases - antienzyme drugs (Gordox - 300,000-500,000 IU, Contrical - 80,000-150,000 IU, Trasylol - 125,000-200,000 IU).

the use of drugs that weaken the effect of humoral factors of septic shock - antihistamines (suprastin, tavegil) in the maximum dose.

Pathogenesis

The most important pathophysiological link of shock is a disorder of capillary circulation, leading to tissue hypoxia, acidosis and ultimately to an irreversible condition.

The most important mechanisms of shock development:

sharp decrease in BCC;

violation of vascular regulation.

decrease in heart performance;

stages of shock:

compensated - perfusion of vital organs is maintained due to
compensatory mechanisms; as a rule, no pronounced hypotension is observed
sia due to an increase in general vascular resistance;

decompensated - compensatory mechanisms are unable to maintain sufficient perfusion, all pathogenetic mechanisms of shock development are triggered and progress;

irreversible - the damage is irreversible, massive cell death and multiple organ failure develop.

Shock classification

hypovolemic:

hemorrhagic- shock from bleeding, which can occur due to injury, pathology of the digestive canal, during surgery, etc.

nonhemorrhagic - occurs due to dehydration caused by:

Ø burns;

Ø polyuria (diabetes insipidus, polyuric stage of acute kidney failure);

Ø insufficiency of the adrenal cortex;

Ø loss of fluid into the “third space” (peritonitis, intestinal obstruction, ascites);

Ø pathology of the digestive system: vomiting, diarrhea, loss through a probe in the digestive canal, fistulas, pancreatitis;

cardiogenic: low Tissue perfusion during cardiogenic shock is caused by a decrease in cardiac output due to a sharp disruption of the pumping function of the heart due to:

Ø a sharp decrease in myocardial contractility (acute myocardial infarction, affecting up to 40-50% of the heart muscle, acute myocarditis of various etiologies, myocardial contusion, end-stage cardiomyopathies);

Ø damage to the valvular apparatus of the heart, papillary muscles;

Ø ventricular aneurysm;

Ø pharmacological/toxic myocardial depression ((β-6 locators, calcium channel blockers, tricyclic antidepressants);

distributive/vasoperipheral (this type of shock is based on the redistribution of fluid in the body, usually from the intravascular sector to the extravascular):

Ø septic - shock in response to septicemia and bacterial toxins;

Ø anaphylactic - a type of immediate allergic reaction that occurs upon repeated introduction of an allergen into the body and is accompanied by disorders of the central nervous system, arterial hypotension, increased permeability of the vascular endothelium, spasm of smooth muscles, in particular the development of bronchiolospasm;

Ø neurogenic - occurs as a result of impaired vasomotor function of the sympathetic autonomic nervous system, which leads to peripheral vasodilation and movement of blood to peripheral areas;

obstructive - occurs due to external compression or internal obstruction of a large vessel or heart:

Ø bending of the great vessels (tension pneumothorax, etc.);

Ø massive embolism of the pulmonary circulation;

Ø compression of the main vessel from the outside (tumor, hematoma, aortocaval compression by the pregnant uterus);

Ø cardiac tamponade;

Ø blockage of the main vessel (thrombosis);

Ø atrial myxoma.

General diagnostics

Shock criteria:

Ø a) symptoms of a critical violation of the capillary circulation of the affected organs (pale, cyanotic, marbled appearance, cold, moist skin, a symptom of a “pale spot” of the nail bed, impaired pulmonary function, central nervous system, oliguria);

Ø b) symptoms of impaired central circulation (small and frequent pulse, sometimes bradycardia, decreased systolic blood pressure and decreased amplitude of the latter).

Hemorrhagic shock

Clinical picture:

Loss of 15% of blood volume or less (compensated severity) . There may be no clinical signs of blood loss. The patient, who is in a horizontal position, has no symptoms of blood loss. The only sign may be an increase in heart rate of at least 20 per minute when getting out of bed. Blood pressure is within normal limits or slightly reduced (90 – 100 mm Hg); CVP 40 – 60 mm. water st; Ht 0.38 – 0.32; skin is dry, pale, cold; diuresis > 30 ml/hour. The white spot symptom is positive.

Loss of 20 to 25% of bcc (subcompensated degree) . The main symptom is orthostatic hypotension - a decrease in systolic blood pressure by at least 15 mm Hg. In the supine position, blood pressure is usually maintained, but may be slightly reduced. Pulse 110 - 120 beats/min; Blood pressure 70 – 80 mmHg; CVP 30 – 40mm Hg; pallor, anxiety, cold sweat, oliguria up to 25 - 30 ml/hour; RR up to 30/min; shock index 1 – 1.7; Нb 70 – 80 g/l; Ht 0.22 – 0.3.

Loss of 30 to 40% of blood volume (decompensated degree) . Pulse > 130 beats/min; HELL< 70мм.рт.ст.; ЦВД 0мм.вод.ст.;ЧД 30 – 40 в мин.; шоковый индекс >2; oliguria (diuresis 5 -15 ml/hour); Hb<70 г/л; Ht <0,22; ступор, резкая бледность, пульс часто не определяется.

Loss of more than 40% of blood volume (irreversible severity).Terminal state: coma, gray skin, shallow, arrhythmic breathing, bradypnea; HELL< 50мм.рт.ст (по методу Короткова почти не определяется); пульс (на магистральных артериях) >150 or< 40 в мин.; ЦВД – 0мм.вод.ст. или отрицательный.

Action algorithm
with hemorrhagic shock:

Diagnostics.

Carrying out emergency anti-shock intensive therapy.

Ensuring optimal anesthesia during surgery that eliminates the source of bleeding.

Prevention of multiple organ failure as a complication of shock and intensive care:

Ø prevention of RDS,

Ø prevention of DIC syndrome,

Ø prevention of acute renal failure.

Protective therapy in the hypercatabolic phase.

1. Diagnostics.
Decompensated hemorrhagic shock.

BCC deficiency from 40 to 70%

Blood loss from 2 to 3.5 liters.

Clinical symptoms:

1. Consciousness:

Ø anxiety or confusion - BCC deficiency - 30 - 40%,

Ø confusion to the point of coma - BCC deficit > 40%

Pulse > 120 - 140.

Blood pressure< 80 мм рт. ст.

Pulse pressure is low.

Respiratory rate - > 30 - 35 per minute.

Diuresis< 0.5 мл/кг - час.

Shock index > 1.

emergency antishock therapy

Venous access is adequate for rapid administration of large volumes of media: cava - catheterization one- or two-way, cubital veins one or two.

NB! In a critical condition, the anesthesiologist must choose the method of venous access that he knows flawlessly; this can be cava catheterization using the Seldinger method, venesection v. Bazilicae, cubital veins, etc.

Immediate jet injection of 7.5% sodium chloride solution at a dose of 4 ml/kg, followed by jet injection of 400 ml of colloidal solution (reopolyglucin, refortan, stabizol).

Switch to jet administration of crystalloid or colloid solutions until systolic blood pressure stabilizes at 80 - 90 mm Hg. Art. The total dose of crystalloids is up to 20 ml/kg body weight, colloids - 8 - 10 ml/kg body weight. STABLE blood pressure numbers already allow for surgical intervention aimed at stopping bleeding.

Preparation for transfusion of erythrocyte-containing media (packed red blood cells, fresh blood) in full compliance with all the rules of blood transfusion:

Ø determination of the patient's blood group,

Ø determination of donor blood group,

Ø compatibility tests according to the ABO system and Rh factor.

Transfusion of erythrocyte-containing media should be carried out after stabilization of systolic blood pressure at 80 - 90 mm Hg. Art.

Blood transfusion should be performed urgently when Ht decreases below 25%.

Transfusion of crystalloid and colloid solutions should always be accompanied by inotropic support and the administration of glucocorticoids.

Dose of glucocorticoids: hydrocortisone - 40 mg/kg,

prednisolone, (methylprednisolone) - 8 - 10 mg/kg (acceptable up to 30 mg/kg)

dexamethasone - 1 mg/kg.

Inotropic support is provided by the following adrenomimetic drugs:

dopamine - 2 - 5 mcg/kg - min.
norepinephrine - 2 - 16 mcg/min.
dobutrex - 2 - 20 mcg/min

General principles of antishock therapy:

Stopping bleeding (temporary, final; if necessary, surgical hemostasis, which should be performed as quickly as possible).

Warming the patient.

Creation of strained blood volume (SCV).

Pharmacological inotropic support.

Dobutrex (dobutamine), bolus – 5 mcg/kg, maintenance – 5 – 10 mcg/kg×min. Dopamine bolus – 5 mcg/kg; maintaining 5 – 8 mcg/kg×min. Dopamine and dobutamine always cause tachycardia in the absence of NOC.

Vasopressor support. In the absence of NOC and with systolic blood pressure below 70 mm Hg. Art. for vasopressor support, norepinephrine is used at a rate of 0.12 - 0.24 mcg/kg x min.

Use of glucocorticoids and insulin.

Ø If, during the restoration of NOC during the use of dopamine, signs of a refractory course of shock are revealed, glucocorticoids (15 mg/kg prednisolone) in combination with insulin (at the rate of 1 unit per 5 mg of prednisolone) must be included in the anti-shock IT complex. The entire dose of glucocorticoids is administered almost immediately and insulin is administered in fractional doses over 1-2 hours under glucose level control, avoiding hypoglycemia.

Maintaining NOC.

Ø After the appearance of a tense volume, an infusion is carried out to stabilize the NOC at the rate of: (20 ml + pathological losses + diuresis) in 10 minutes. For every 100 ml of crystalloids, it is advisable to use an additional 10 ml of 6% HES.

Ø The total amount of crystalloids used for prophylactic plasma volume replacement adds up to: (120 ml + pathological losses + diuresis) per hour.

In case of inadequate breathing and the need for general anesthesia, use tracheal intubation and artificial normocarbonatemic ventilation with a respiratory rate of 7–12 per minute. and alveolar ventilation in the range of 4.8–5.2 l/min with FiO 2 no more than 0.4; with RDS and pulmonary edema, FiO 2 increases until arterial hypoxemia is eliminated.

In conditions of severe metabolic acidosis(pH< 7,1; ВЕ < - 10 ммоль/л) – необходимо применение ощелачивающих растворов (натрия гидрокарбонат).

If pain relief is needed, use only drugs that do not cause cardio- and vascular-depressive effects.

To ensure effective levels of total protein and colloid-oncotic pressure, 5-10% albumin solution, native plasma, 6-10% leaded starch solution or 8% gelatin solution (gelatinol) are used. The concentration of total protein in the blood plasma should be considered critical if it is less than 55 g/l.

To restore effective Hb levels and O2 transport washed red blood cells, leukocyte-depleted red blood cells, and, as an exception, regular red blood cells are used.

Before analyzing the algorithm for providing medical emergency care for anaphylactic shock in adults and children, let’s consider the concept of “anaphylaxis”.

Anaphylaxis is a pathological process that develops when an antigen (foreign protein) is introduced and manifests itself in the form of increased sensitivity upon repeated contact with this allergen. This condition is a manifestation of hypersensitivity immediate type, in which the reaction between antigen and antibodies occurs on the surface of cells.

Reasons

The most important condition for the occurrence of anaphylaxis is state increased sensitivity of the body (sensitization) to the repeated introduction of a foreign protein.

Etiology. In every living organism, when a foreign protein (antigen) is introduced into it, antibodies begin to be produced. They are strictly specific formations and act only against one antigen.

When a reaction occurs between an antigen and antibodies in a living organism, large amounts of histamine and serotonin are released, which explains the active reaction that occurs.

Anaphylactic shock reactions

Anaphylactic reactions proceed violently, with the involvement of the vascular apparatus and smooth muscle organs. They are divided into two types:

generalized(anaphylactic shock);
localized(edema, urticaria, bronchial asthma).

A special form is the so-called whey a disease that gradually - during the period when the production of antibodies against the introduced antigen begins (from one to several days) - develops after a single injection of a large dose of foreign serum.

Anaphylactic shock

Repeated introduction of a foreign protein into a sensitized body can lead to a serious condition - anaphylactic shock.

Clinic

The clinical presentation of anaphylactic shock varies between individuals and can vary widely. Anaphylactic shock can occur in a mild form and manifest itself with mild general symptoms (urticaria, bronchospasm, shortness of breath).

Much more often, the picture of shock looks more menacing and, if help is not provided in a timely manner, can result in the death of the patient.

In the first minutes of anaphylactic shock, blood pressure rises sharply, then begins to decline and eventually drops to zero. There may be severe itching of the skin followed by urticaria, swelling of the face and upper extremities. Paroxysmal abdominal pain, nausea, vomiting, and diarrhea appear. The patient's consciousness is confused, convulsions occur, a sharp increase in body temperature, and involuntary bowel movements and urination may occur.

In the absence of urgent help, death occurs from suffocation and cardiac dysfunction.

Main symptoms

Anaphylactic shock is characterized by the following main symptoms: soon after contact with the allergen (sometimes within a few seconds), the patient becomes:

restless
pale,
complains of a throbbing headache,
dizziness,
tinnitus.

His body is covered with cold sweat, he experiences fear of death.

First emergency aid for anaphylactic shock

Stop administering medications.
Inject injection site with Adrenaline 0.15-0.75 ml of 0.1% solution in 2-3 ml of isotonic sodium chloride solution.
Give the patient's body a horizontal position, apply heating pads to the legs, turn the head to the side, extend the lower jaw, fix the tongue, and, if possible, start oxygen supply.
Immediately enter:

Adrenalin 0.1% – 5 ml intravenous bolus;
Prednisolone 0.5–1 ml per 1 kg of weight, 40–60 ml hydrocortisone or 2.5 ml dexomethasone(corticosteroids block the antigen-antibody reaction);
Cordiamine 2.5% – 2 ml;
Caffeine 10% – 2.0 (injections of Adrenaline and Caffeine, repeat every 10 minutes until blood pressure increases);
for tachycardia 0.05% solution Strophantina or 0.06% solution Korglucona;
antihistamines: Suprastin 2% – 20 ml, Diphenhydramine 1% – 5.0 ml, Pipolfen 2.5% – 2.0 ml. After 20 minutes, repeat the injection.

For bronchospasm and ischemic pain - 2.4% - 10.0 ml of Eufillin with 10-20 ml of 40% glucose or intramuscularly 2.4% - 3 ml;
with a significant decrease in blood pressure, carefully, slowly - Mezaton 1% - 1.0 ml;
for symptoms of heart failure and pulmonary edema - intramuscularly 0.5% - 0.5 ml of Strophanthin with 10 ml of 40% glucose or with 10 ml of saline 2.4-10.0 ml, Lasix can be administered intravenously 1% - 4.8 ampoules;
for edema, when there is no cardiovascular insufficiency, fast-acting diuretics are used: 2% Furasemide solution intravenously, 0.03–0.05 ml per 1 kg of weight;
for convulsions and severe agitation: Droperidol 2% - 2.0 ml or Seduxen 0.5-3.5 ml;
in case of respiratory failure - intravenously Lobelin 1% - 0.5–1 ml;
in case of cardiac arrest, Adrenaline 0.1% - 1.0 ml or calcium chloride 10% - 1.0 ml is administered intracardially. Closed heart massage and artificial respiration are performed.

Treatment bronchial asthma Children must be complex. The first thing the attending physician must achieve is the restoration of bronchial patency.

Algorithm for providing emergency care for anaphylactic shock

Anaphylactic shock often develops:

in response to parenteral administration of drugs such as penicillin, sulfonamides, serums, vaccines, protein preparations, radiocontrast agents, etc.;
when conducting provocative tests with pollen and, less commonly, food allergens;
Anaphylactic shock may occur from insect bites.

Symptoms of anaphylaxis shock

The clinical picture of anaphylactic shock always develops quickly. Development time: a few seconds or minutes after contact with the allergen:

depression of consciousness
drop in blood pressure,
convulsions appear
involuntary urination.

The fulminant course of anaphylactic shock ends in death. In most patients, the disease begins with the appearance of:

feelings of heat,
skin hyperemia,
fear of death,
excitement or, conversely, depression,
headache,
chest pain,
suffocation.

Sometimes it develops:

swelling of the larynx similar to Quincke's edema with stridor breathing,
skin itching appears,
urticarial rashes,
rhinorrhea,
dry hacking cough.

Blood pressure drops sharply,
the pulse becomes threadlike,
there may be a hemorrhagic syndrome with petechial rashes.

Death can occur from:

acute respiratory failure due to bronchospasm and pulmonary edema,
acute cardiovascular failure with the development of hypovolemia
or cerebral edema.

Emergency care algorithm and first actions of a nurse!

Discontinue administration of medications or other allergens and apply a tourniquet proximal to the allergen injection site.
Assistance should be provided on the spot: for this purpose, it is necessary to lay the patient down and fix the tongue to prevent asphyxia.
Inject 0.5 ml of 0.1% solution adrenaline subcutaneously at the site of allergen injection (or at the site of the bite) and intravenously drip 1 ml of 0.1% adrenaline solution. If blood pressure remains low, the injection of adrenaline solution should be repeated after 10-15 minutes.
Corticosteroids are of great importance for removing patients from anaphylactic shock. Prednisolone should be administered into a vein in a dose of 75-150 mg or more; dexamethasone– 4-20 mg; hydrocortisone– 150-300 mg; If it is not possible to administer corticosteroids into a vein, they can be administered intramuscularly.
Administer antihistamines: pipolfen– 2-4 ml of 2.5% solution subcutaneously, suprastin– 2-4 ml of 2% solution or diphenhydramine– 5 ml of 1% solution.
For asphyxia and suffocation, administer 10-20 ml of 2.4% solution aminophylline intravenously, alupent– 1-2 ml of 0.05% solution, isadrin– 2 ml of 0.5% solution subcutaneously.
If signs of heart failure appear, administer korglykon– 1 ml of 0.06 solution in isotonic solution sodium chloride, lasix(furosemide) 40-60 mg intravenously in a rapid stream in an isotonic solution sodium chloride.
If an allergic reaction has developed to the introduction penicillin , enter 1000000 units penicillinase in 2 ml of isotonic solution sodium chloride.
Introduction sodium bicarbonate– 200 ml of 4% solution and anti-shock liquids.

If necessary, resuscitation measures are carried out, including closed cardiac massage, artificial respiration, and bronchial intubation. For swelling of the larynx - tracheostomy.

After the patient has recovered from anaphylactic shock, the administration of desensitizing drugs and corticosteroids should be continued. detoxification, dehydration agents for 7-10 days.

Algorithm and standard of emergency care for anaphylactic shock with a step-by-step description

An ordinary person, without medical education and without the availability of special medications, will not be able to provide full assistance. This is due to the fact that emergency care requires a clear algorithm of actions and a clear sequence of administration of certain medications. This complete algorithm of actions can only be carried out by a resuscitator or an ambulance team member.

First aid

First aid, which can be carried out by a person without appropriate training, should begin with calling a doctor to provide qualified assistance.

In case of anaphylactic shock, the usual set of first aid measures should also be carried out, which will be aimed at checking the patency of the airways and ensuring the flow of fresh air A (airway) and B (Breathing).

A. You can, for example, lay the person on his side, turn his head to the side, remove dentures to avoid vomit and tongue.
IN. In case of cramps, you need to support your head and prevent injury to your tongue.

Other stages ( C– Circulation and bleeding, D– Disability, E– Expose/environment) is difficult to do without a medical education.

Algorithm of medical care

The algorithm of actions implies not only a certain set of medications, but their strict sequence. In any critical condition, arbitrary, untimely or incorrect administration of medications can worsen the person’s condition. First of all, medications should be used that will restore vital functions of the body, such as breathing, blood pressure and heartbeat.

In case of anaphylactic shock, medications are administered intravenously, then intramuscularly, and only then orally. Intravenous administration of drugs allows you to achieve quick results.

Adrenaline injection

Emergency care should begin with intramuscular injection of adrenaline solution.

It should be remembered that it is advisable to inject small amounts of adrenaline to more quickly produce an effect in different parts of the body. It is this medicinal substance that has a powerful vasoconstrictor effect; its injection prevents further deterioration of cardiac and respiratory activity. After the administration of adrenaline, blood pressure normalizes, breathing and pulse improve.

An additional stimulating effect can be achieved by introducing a solution of caffeine or cordiamine.

Introduction of aminophylline

To restore airway patency and eliminate spasm, aminophylline solution is used. This drug quickly eliminates spasm of the smooth muscles of the bronchial tree.

When the airway is restored, the person feels some improvement.

Administration of steroid hormones

In case of anaphylactic shock, a necessary component is the administration of steroid hormones (prednisolone, dexamethasone). These medications reduce tissue swelling, the amount of pulmonary secretion, as well as manifestations of oxygen deficiency in tissues of the whole body.

In addition, steroid hormones have a pronounced ability to suppress immune reactions, including allergic ones.

To enhance the antiallergic effect itself, antihistamine solutions (tavegil, suprastin, tavegil) are administered.

Eliminating the allergen

The next necessary stage of emergency care after normalizing blood pressure and breathing is eliminating the effect of the allergen.

In the case of anaphylactic shock, this may be from a food product, an inhaled aerosol of a substance, an insect bite, or the administration of a drug. To stop the further development of anaphylactic shock, it is necessary to remove the insect sting from the skin, rinse the stomach if the allergen got in with the food product, and use an oxygen mask if the situation is provoked by an aerosol.

Help in the hospital

It should be understood that after the first emergency measures are taken for anaphylactic shock, the provision of assistance does not end. Further treatment requires the person to be admitted to a hospital to continue treatment.

In a hospital setting, treatment may be prescribed:

massive infusion therapy with crystalloid and colloid solutions;
medications that stabilize cardiac and respiratory activity;
and also, without fail, a course of tableted antiallergic drugs (fexofenadine, desloratadine).

Emergency care can only end when the activity of the respiratory and cardiac systems is completely restored.

The algorithm for further treatment provides for further thorough identification of the cause (specific allergen) that caused the development of the emergency situation, in order to prevent the re-development of anaphylactic shock.

First aid kit for anaphylactic shock and a new order

The first aid kit for anaphylactic shock must be fully equipped in accordance with the new order of the Ministry of Health of the Russian Federation. An emergency first aid kit should always be readily available for possible intended use.

Order No. 291 of November 23, 2000

Order No. 291 sets out in detail all stages of medical care: from the pre-medical stage to the stage of providing qualified medical care in a hospital setting. The algorithm for diagnosing anaphylactic shock and, more importantly, measures for its prevention are described in detail. Order No. 291 describes the step-by-step actions of a person, without special medical skills, in the process of providing assistance at the pre-medical level.

In an anaphylactic state, not only speed is important, but also the order of actions. That is why order No. 291 clearly delineates the algorithm primary And secondary actions of a medical worker. The approximate composition of a first aid kit, which should be available in all medical institutions, is also indicated.

Order No. 626 of 04.09.2006

Order No. 626 clearly regulates medical procedures and the frequency of their use in anaphylactic shock. At the same time, Order No. 626 does not indicate which aspects should be carried out by a doctor and which ones, for example, by a paramedic. This can lead to inconsistency and complicate emergency care. The information presented is a certain standard of action created on the basis of foreign trends. The composition of the first aid kit according to order No. 291 is very approximate and imprecise.

Composition, set and layout of a first aid kit for anaphylactic shock

In 2014, an attempt was made to improve, to a greater extent, the process of preparing for the provision of emergency measures for anaphylactic shock. The composition of the first aid kit is described in detail, indicating not only drugs, but also consumables. The following components are envisaged:

adrenalin- for local injection and intramuscular injection to provide an almost instantaneous vasoconstrictor effect;
glucocorticosteroids(prednisolone) - to create a powerful systemic anti-edematous, anti-allergic and immunosuppressive effect;
antihistamines means in the form of a solution for intravenous administration (first generation, such as tavegil or suprastin) - for the fastest possible antiallergic effect;
second antihistamine ( diphenhydramine) - to enhance the effect of tavegil and suprastin, as well as for sedation (calming) of a person;
aminophylline(bronchodilator) - to eliminate bronchospasm;
consumables: syringes, the volume of which must correspond to the available solutions; cotton wool and gauze; ethanol;
venous(usually cubital or subclavian) catheter- for permanent access to the vein;
saline solution for the use of solutions at the secondary care stage.
medicines.

The composition of the 2014 first aid kit does not include the presence (and subsequent use) of diazepam (a drug that depresses the nervous system) and an oxygen mask. The new order does not regulate medications according to the stages of emergency care.

In case of anaphylactic shock, the above medications should be used immediately. Therefore, any office should have a stocked first aid kit, then anaphylactic shock that suddenly occurs in a person will be successfully stopped. Read also a separate page dedicated to a home first aid kit and a first aid kit for a child (children).

Video: Emergency measures for anaphylactic shock

Eliseev O.M. (compiler). Handbook of emergency and first aid. – St. Petersburg: Publishing house. LLP “Leila”, 1996.
Uzhegov G. N. Official and traditional medicine. The most detailed encyclopedia. – M.: Eksmo Publishing House, 2012.

In modern combat injuries, TS develops in 20-25% of the wounded. Under traumatic shock refers to a severe form of the body’s general reaction to trauma, combat, predominantly gunshot or explosive trauma. TS is one of the fundamental concepts and is an important component of the diagnosis of combat damage, determining the nature of therapeutic and diagnostic measures in the system of staged treatment of the wounded with evacuation as directed.

Pathogenesis:

Acute blood loss: decreased blood volume, decreased IOC, hypotension and decreased tissue perfusion, accompanied by increasing hypoxia. Blood loss exceeding 1000 ml is detected in 50%, and 1500 ml - in 35% of wounded patients arriving in a state of shock. In case of shock of the third degree of severity, massive blood loss exceeding 30% of the blood volume (1500 ml) occurs in 75-90% of the wounded.

Decrease in systolic blood pressure: insufficient. eff. pumping function of the heart, which may be caused by circulatory hypoxia of the heart muscle, cardiac contusion due to closed or open chest trauma, as well as early post-traumatic endotoxemia. A decrease in blood pressure during TS is also associated with a circulatory, vascular factor.

Pathological afferent impulses.

Functional disorders associated with a specific location of damage.

The main natural compensatory mechanisms can be presented in the following sequence:

An increase in minute volume of blood circulation against the background of a decrease in circulating blood volume due to an increase in heart rate;

Centralization of blood circulation by increasing the tone of peripheral vessels and internal redistribution of limited blood volume in the interests of organs experiencing the greatest functional load in an extreme situation;

Increasing the depth and frequency of external respiration as a mechanism to compensate for developing hypoxia;

Intensification of tissue metabolism in order to mobilize additional energy resources.

Shock severity	Clinical criteria	Forecast
I degree (mild shock)	The damage is of moderate severity, often isolated. The general condition is moderate or severe. Moderate lethargy, pallor. Heart rate = 90-100 per minute, systolic blood pressure not lower than 90 mm Hg. Art. Blood loss up to 1000 ml (20% bcc)	If assistance is provided in a timely manner - favorable
II degree (moderate shock)	The damage is extensive, often multiple or combined. The general condition is serious. Consciousness is preserved. Severe lethargy, pallor. Heart rate 100-120 per minute, systolic blood pressure 90-75 mm Hg. Blood loss up to 1500 ml (30% bcc)	Doubtful
III degree (severe shock)	The injuries are extensive, multiple or combined, often with damage to vital organs. The condition is extremely serious. Stupor or stupor. Severe pallor, adynamia, hyporeflexia. Heart rate 120-160 per minute, weak filling, systolic blood pressure 70 - 50 mm Hg. Art. Anuria is possible. Blood loss 1500-2000 ml (30-40% bcc)	Very serious or unfavorable

In the terminal state, a distinction is made between its preagonal phase, agony and clinical death. The preagonal state is characterized by the absence of a pulse in the peripheral vessels and a decrease in systolic blood pressure below 50 mm Hg. Art., impaired consciousness to the level of stupor or coma, hyporeflexia, agonal breathing. During agony, pulse and blood pressure are not determined, heart sounds are muffled, consciousness is lost (deep coma), breathing is shallow and agonal in nature. Clinical death is recorded from the moment of complete cessation of breathing and cessation of cardiac activity. If it is not possible to restore and stabilize vital functions within 5-7 minutes, the death of the cells of the cerebral cortex that are most sensitive to hypoxia occurs, and then biological death.

Treatment of traumatic shock must be early, comprehensive and adequate. Main objectives of treatment:

1) Elimination of external respiratory distress, achieved by restoring the patency of the upper respiratory tract, eliminating open pneumothorax, draining tension pneumothorax and hemothorax, restoring the bone frame of the chest in case of multiple fractures, oxygen inhalation or transfer to mechanical ventilation.

2) Stopping ongoing external or internal bleeding.

3) Replenishment of blood loss and restoration of blood volume with subsequent elimination of other factors of ineffective hemodynamics. The use of vasoactive and cardiotropic drugs is carried out according to strict indications after replenishment of blood volume or (if necessary) in parallel with its replenishment. Infusion therapy also aims to eliminate disturbances in the acid-base state, osmolar, hormonal and vitamin homeostasis.

4) Termination of pathological afferent impulses from lesions, which is achieved by the use of analgesics or adequate general anesthesia, conduction novocaine blockades, and immobilization of damaged body segments.

5) Performing emergency surgical interventions included in the complex of anti-shock measures and aimed at stopping bleeding, eliminating asphyxia, and damage to vital organs.

6) Elimination of endotoxemia through the use of various methods of extracorporeal and intracorporeal detoxification.

8) Early antibiotic therapy, starting in the advanced stages of medical evacuation. This therapy is especially indicated for patients with penetrating abdominal wounds, open bone fractures and extensive soft tissue damage.

9) Correction of general somatic disorders identified in the dynamics, reflecting the individual characteristics of the body’s general reaction to severe trauma.

First medical aid: wounded arriving in a state of shock, especially with shock of II-III severity, it is necessary to carry out a set of measures to ensure the elimination of the immediate life threat and subsequent transportation to the next stage of evacuation. If there are indications, additional measures are taken to reliably eliminate external respiratory disorders: tracheal intubation, cricoconicotomy or tracheostomy, oxygen inhalation using standard devices, thoracentesis with a valve device for tension pneumothorax. The tourniquet is controlled and, if possible, external bleeding in the wound is temporarily stopped. Transport immobilization is corrected using standard means. Analgesic drugs are reintroduced. In case of combined injuries of the musculoskeletal system, conduction blockades using local anesthetics are indicated. If there are pronounced signs of acute blood loss, perform infusion or infusion-transfusion therapy in a volume of 500-1000 ml. If appropriate conditions exist, infusion therapy continues during further transportation. All wounded are given tetanus toxoid, and broad-spectrum antibiotics are used when indicated.

When providing qualified and specialized medical care anti-shock measures must be carried out in full, which requires sufficiently highly qualified anesthesiologists, surgeons and all medical personnel.

Restoring the function of the respiratory system. An indispensable condition for the effectiveness of measures in this area of anti-shock care is the elimination of mechanical causes of respiratory disorders - mechanical asphyxia, pneumothorax, hemothorax, paradoxical movements of the chest wall during the formation of the costal valve, aspiration of blood or vomit into the tracheobronchial tree.

Along with these measures, depending on specific indications, the following are performed:

Anesthesia by performing segmental paravertebral or vagosympathetic blockade;

Constant inhalation of humidified oxygen;

Tracheal intubation and mechanical ventilation for stage III respiratory failure (respiratory rate of 35 or more per minute, pathological breathing rhythms, cyanosis and sweating, feeling of lack of air).

In case of respiratory failure due to lung contusions, the following is required:

Limiting the volume of intravenous infusion-transfusion therapy to 2-2.5 l with switching the required additional volume to intra-aortic infusions;

Long-term multi-level analgesia through retropleural blockade (administration of 15 ml of 1% lidocaine solution every 3-4 hours through a catheter installed in the retropleural space), central analgesia with intravenous fentanyl 4-6 times a day, 0.1 mg, and neurovegetative blockade with intramuscular injection of droperidol 3 times a day;

The use of rheologically active drugs in hemodilution mode (0.8 l of 5% glucose solution, 0.4 l of rheopolyglucin), disaggregants (trental), direct anticoagulants (up to 20,000 units of heparin per day), aminophylline (10.0 ml of 2.4% solution intravenously 2-3 times a day), saluretics (Lasix 40-100 mg per day up to 50-60 ml of urine per hour), and with sufficient excretory function of the kidneys - osmodiuretics (mannitol 1 g/kg body weight per day) or oncodiuretics ( albumin 1 g/kg body weight per day), as well as glucocorticoids (prednisolone 10 mg/kg body weight) and ascorbic acid 5.0 ml of 5% solution 3-4 times a day.

In the event of the development of adult respiratory distress syndrome or fat embolism, mechanical ventilation with increased end-expiratory pressure up to 5-10 cmH2O takes on leading importance in the treatment of respiratory disorders. Art. with a “Phase-5” type device against the backdrop of measures recommended for lung contusion. But at the same time, the dose of glucocorticoids is increased to 30 mg/kg of body weight per day.

Restoring the function of the circulatory system. A prerequisite for the effectiveness of intensive care measures is stopping external or internal bleeding, as well as eliminating damage and tamponade of the heart.

Subsequent compensation for blood loss is carried out based on the following principles: for blood loss up to 1 liter - crystalloid and colloid blood replacement solutions with a total volume of 2-2.5 liters per day; for blood loss up to 2 liters - replacement of bcc with red blood cells and blood substitutes in a 1:1 ratio with a total volume of up to 3.5-4 liters per day; with blood loss exceeding 2 liters, the volume of blood volume is replaced mainly by red blood cells in a 2:1 ratio with blood substitutes, and the total volume of injected fluid exceeds 4 liters; when blood loss exceeds 3 liters, replenishment of the bcc is carried out using large doses of red blood cells (in terms of blood - 3 liters or more), blood transfusion is carried out at a rapid pace into two large veins, or into the aorta through the femoral artery. It must be remembered that blood spilled into the body cavity is subject to reinfusion (if there are no contraindications). Replacement of lost blood is most effective in the first two days. Adequate compensation of blood loss is combined with the use of drugs that stimulate peripheral vascular tone: dopmin at a dose of 10-15 mcg/kg per minute or norepinephrine at a dose of 1.0-2.0 ml of a 0.2% solution in 400.0 ml of a 5% glucose solution at a speed of 40-50 drops per minute.

Along with this, in order to stabilize hemodynamics, glucocorticoids, disaggregants and rheologically active drugs are used in the doses specified in subsection 1.

Correction of the blood coagulation system is determined by the severity of disseminated intravascular coagulation syndrome (DIC): for DIC of the first degree (hypercoagulation, isocoagulation), heparin 50 U/kg 4-6 times a day, prednisolone 1.0 mg/kg 2 times a day, trental are used , rheopolyglucin; for stage II DIC (hypocoagulation without activation of fibrinolysis), heparin is used up to 30 U/kg (no more than 5000 U per day), prednisolone 1.5 mg/kg 2 times a day, albumin, plasma, rheopolyglucin, red blood cell mass for no more than 3 days conservation; for DIC of the third degree (hypocoagulation with the beginning activation of fibrinolysis), prednisolone 1.5 mg/kg 2 times a day, contrical 60,000 units per day, albumin, plasma, red blood cell mass for short periods of preservation, fibrinogen, gelatin, dicinone are used; for stage IV DIC (generalized fibrinolysis), prednisolone up to 1.0 g per day, contrical 100,000 units per day, plasma, fibrinogen, albumin, gelatin, dicinone, alkaline solutions are used. In addition, a mixture is injected locally through drainages into the serous cavities for 30 minutes: 5% solution of epsilon-aminocaproic acid 100 ml, 5.0 ml of adroxon, 400-600 units of dry thrombin.

In case of heart failure caused by heart damage, it is necessary to limit intravenous infusion-transfusion therapy to 2-2.5 liters per day (the remaining required volume is injected into the aorta through the femoral artery). In addition, polarizing mixtures are used in the infusion media (400 ml of 10% glucose solution with the addition of 16 units of insulin, 50 ml of 10% potassium chloride solution, 10 ml of 25% magnesium sulfate solution), cardiac glycosides are administered (1 ml 0.06 % korglykon solution or 0.5 ml of 0.05% strophanthin solution 2-3 times a day), and for progressive heart failure, inotropic support is provided with dopamine (10-15 mcg/kg per minute) or dobutrex (2.5-5. 0 mcg/kg per minute), as well as the introduction of nitroglycerin (1 ml of 1% solution 2 times a day, diluted slowly by drip). Heparin is administered subcutaneously at 5000 units 4 times a day.

Restoring the function of the central nervous system. Surgical assistance for wounds and head injuries at the stage of providing qualified medical care is limited to stopping external bleeding from the integumentary tissue and restoring external respiration through tracheal intubation or tracheostomy. Next, preparations are made for the evacuation of the wounded to the hospital base, where surgical intervention is performed at a specialized level in an exhaustive manner.

For encephalopathies of various origins (consequences of hypoxia, compression of the brain) or excessive afferent impulses from multiple lesions, the following intensive care measures are carried out:

Infusion therapy in the mode of moderate dehydration with a total volume of up to 3 liters per day using crystalloid solutions, 30% glucose solution (38 units of insulin per 250 ml with a total volume of 500-1000 ml), rheopolyglucin or reogluman; with the development of cerebral edema, dehydration is carried out due to saluretics (Lasix 60-100 mg), osmodiuretics (mannitol 1 g/kg body weight in the form of a 6-7% solution), oncodiuretics (albumin 1 g/kg body weight);

Complete central analgesia by intramuscular administration of fentanyl 0.1 mg 4-6 times a day, droperidol 5.0 mg 3-4 times a day, intravenous administration of sodium hydroxybutyrate 2.0 g 4 times a day;

Parenteral administration of the following drugs: piracetam 20% 5.0 ml 4 times a day intravenously, sermion (nicerogoline) 4.0 mg 3-4 times a day intramuscularly, solcoseryl 10.0 ml intravenously drip on the first day, 6 days on subsequent days .0-8.0 ml;

Oral administration of glutamic acid 0.5 g 3 times a day;

Constant inhalation of humidified oxygen.

In the case of the development of early multiple organ failure, intensive care measures take on a syndromic character.

The most important component of the treatment of shock is the implementation of emergency and urgent surgical interventions aimed at stopping ongoing external or internal bleeding, eliminating asphyxia, damage to the heart or other vital organs, as well as the hollow organs of the abdomen. In this case, intensive care measures are carried out as preoperative preparation, anesthetic support for the operation itself and continue in the postoperative period.

Adequate treatment of shock is aimed not only at eliminating this terrible consequence of severe combat trauma. It lays the foundation for treatment in the post-shock period before determining the immediate outcome of the injury. At the same time, the entire pathological process until the wounded person is cured has been considered in recent years from the standpoint of concept of traumatic illness.

The concept of traumatic illness is fully realized at the stage of providing specialized medical care, where the treatment of severe consequences of injury and complications, including rehabilitation of the wounded, is carried out depending on the location of the injuries and their nature until the final outcome.