It's called a state of shock. General pathogenesis and manifestations of shock conditions

Shock is a form of a critical state of the body, manifested by multiple organ dysfunction, which cascades on the basis of a generalized circulation crisis and, as a rule, ends in death without treatment.

A shock factor is any effect on the body that exceeds adaptive mechanisms in strength. In shock, the functions of respiration, the cardiovascular system, and kidneys change, the processes of microcirculation of organs and tissues and metabolic processes are disturbed.

Etiology and pathogenesis

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

1. traumatic shock:

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

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

3) under the influence of 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 violation water balance dehydration occurs.

3. Septic (bacterial-toxic) shock (generalized purulent processes caused by gram-negative or gram-positive bacteria).

4. Anaphylactic shock.

5. Cardiogenic shock(myocardial infarction, acute heart failure). Considered in 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 volume of circulating blood (BCC) decreases, as there are various factors: blood loss, redistribution of fluid between the blood and tissues, or a discrepancy between the normal volume of blood and the increasing capacity of the vascular bed. The resulting discrepancy between the BCC 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 it is here that the main function of blood circulation is carried out - the exchange of substances and oxygen between the cell and the blood. There comes a thickening of the blood, an increase in its viscosity and intracapillary microthrombosis. Subsequently, cell functions are disrupted up to their death. The tissues begin to predominate anaerobic processes over aerobic, which leads to the development of metabolic acidosis. 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, the nutrition of the cells is disrupted, which leads to a decrease in the supply of oxygen to the cells.

In anaphylactic shock under the influence of histamine and other biologically active substances capillaries and veins lose their tone, while the peripheral vascular bed expands, its capacity increases, which leads to a pathological redistribution of blood. Blood begins to accumulate in the capillaries and venules, causing a violation of cardiac activity. The BCC formed at the same time does not correspond to the capacity of the vascular bed, and the minute volume of the heart (cardiac output) decreases accordingly. The resulting stagnation of blood in the microcirculatory bed leads to a breakdown in metabolism and oxygen between the cell and 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 exacerbates hypoxia in severe stages of shock development. Violated detoxification, protein-forming, glycogen-forming and other functions of the liver. Disorder of the main, regional blood flow and microcirculation in renal tissue contributes to the violation of both the filtration and concentration functions of the kidneys with a decrease in diuresis from oliguria up to anuria, which leads to the accumulation of nitrogenous slags in the patient's body, such as urea, creatinine, and other toxic metabolic products. The functions of the adrenal cortex are impaired, the synthesis of corticosteroids (glucocorticoids, mineralocorticoids, androgenic hormones) is reduced, which aggravates the ongoing processes. Circulatory disorder in the lungs explains the violation external respiration, alveolar gas exchange decreases, blood shunting occurs, microthrombosis is formed, and as a result, the development respiratory failure which exacerbates tissue hypoxia.

Clinic

Hemorrhagic shock is the reaction of the body to the resulting blood loss (loss of 25-30% of the BCC leads to severe shock).

In occurrence burn shock the predominant 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, pallor of the skin, cold sticky sweat, the pulse becomes small and frequent, arterial pressure remains within the normal range or slightly reduced, but slightly, urination decreases.

With uncompensated reversible shock, the skin and mucous membranes become cyanotic, 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, the ECG shows a violation of myocardial oxygen supply. With an irreversible course of shock, consciousness is absent, blood pressure drops to critical numbers and may not be detected, skin marble color, anuria develops - cessation of urination. The Algover index is high.

To assess the severity hemorrhagic shock great importance has a definition of BCC, the 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 Map

Table 5

Evaluation of results by total points

The shock index, or Algover index, is the ratio of heart rate to systolic pressure. With shock of the first degree, the Algover index does not exceed 1. With the 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 is a complex of various allergic reactions immediate type reaching extreme gravity.

Distinguish the following forms anaphylactic shock:

1) cardiovascular form, in which it develops acute insufficiency blood circulation, manifested by tachycardia, often with a violation of the rhythm of heart contractions, fibrillation of the ventricles and auricles, a decrease in blood pressure;

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

3) cerebral form due to hypoxia, impaired microcirculation and cerebral edema.

According to the severity of the course, 4 degrees of anaphylactic shock are distinguished.

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

II degree (moderate severity) - Quincke's edema, tachycardia, lowering of arterial pressure, increase of the Algover index join the previously indicated symptoms.

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

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

Treatment. Treatment is carried out according to general principles shock treatment: restoration of hemodynamics, capillary blood flow, application 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 adrenaline infusion until hemodynamic stabilization. You can use dopmin 10-15 mcg / kg / min, and with symptoms of bronchospasm and b-agonists: alupent, brikanil intravenous drip.

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 bcc and hemodynamics.

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

4. Bronchodilators: eufillin 240–480 mg, noshpa 2 ml, alupent (brikanil) 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 U, contrical 100 thousand U.

traumatic shock is pathological and critical condition an organism that has arisen in response to an injury, in which the functions of vital systems and organs are impaired and inhibited. During trauma 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 phase of occurrence. 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 pressure and pulse can remain normal for some time. The duration of this phase is from several minutes and hours to several days. But in most cases it is short.

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

Table 6

Assessment of the extent of injury severity

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

Notes

1. In the presence of injuries that are not specified in the list of the volume and severity of the injury, the number of points is awarded according to the type of injury, according to the severity corresponding to one of the listed ones.

2. Subject to availability somatic diseases that reduce the adaptive functions of the organism, 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. The main directions in treatment.

1. Elimination of the action of the traumatic agent.

2. Elimination of hypovolemia.

3. Elimination of hypoxia.

Anesthesia is carried out by the introduction of analgesics and drugs, the implementation of blockades. Oxygen therapy, if necessary, tracheal intubation. Compensation for 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. Fight against vitamin deficiency (vitamins of group B, vitamin C).

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

Stimulation of vascular tone (mezaton, norepinephrine), but only with a replenished volume of circulating blood. Antihistamines (diphenhydramine, sibazon) are also involved in anti-shock therapy.

Hemorrhagic shock is a state of acute cardiovascular insufficiency, which develops after the 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 the tube or ectopic pregnancy, the presence of placental lobules in the uterus, etc.

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

1. Not expressed - there are no clinical data, the level of blood pressure 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 is from 15 to 25% (750-1200 ml).

3. Moderate - tachycardia up to 100-120 beats per 1 min, decrease in pulse pressure, systolic pressure 90-100 mm Hg. Art., anxiety, sweating, pallor, oliguria. The volume of blood loss is 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 determined by the 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 hemoglobin, erythrocytes and hematocrit. The ECG shows nonspecific changes in the ST segment and the T wave, which are due to insufficient coronary circulation.

Treatment hemorrhagic shock involves stopping bleeding, the use of infusion therapy to restore BCC, the use of 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 single-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 the infectious agent from its initial 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 thrombohemorrhagic syndrome ( Machabeli syndrome), which develops in all cases of sepsis. The course of sepsis is affected by the type of pathogen, this is especially important when modern methods treatment. Laboratory progressing anemia is noted (due to hemolysis and oppression of hematopoiesis). Leukocytosis up to 12 109 / l, however, in severe cases, as a sharp depression of the hematopoietic organs is formed, leukopenia can also be observed.

Clinical symptoms of bacterial shock: chills, heat, hypotension, dry warm skin - at first, and later - cold and wet, pallor, cyanosis, mental status disorder, vomiting, diarrhea, oliguria. neutrophilia with shift leukocyte formula to the left up to myelocytes; ESR increases to 30–60 mm/h or more. The level of blood bilirubin 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 lowered (up to 50–70%), the content of calcium and chlorides is reduced. total protein blood is reduced, which occurs due to albumin, and the level of globulins (alpha-globulins and b-globulins) increases. In the urine, protein, leukocytes, erythrocytes and cylinders. The level of chlorides in the urine is reduced, and urea and uric acid are elevated.

Treatment is primarily etiological in nature, therefore, before the appointment antibiotic therapy it is necessary to determine the pathogen and its sensitivity to antibiotics. Antimicrobial agents should be used at maximum doses. For the treatment of 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 the drugs of choice when a resistant pathogen occurs. If staphylococci are sown from the blood, it is necessary to begin treatment with drugs of the penicillin group. Treatment of hypotension is at the first stage of treatment in the adequacy of the volume of intravascular fluid. Use crystalloid solutions (isotonic sodium chloride solution, Ringer's lactate) or colloids (albumin, dextran, polyvinylpyrrolidone). The advantage of colloids is that when they are introduced, the most quickly achieved the right 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 β-agonist. Corticosteroids reduce the overall response to endotoxins, help to reduce fever and give a positive hemodynamic effect. Prednisolone at a dose of 60 to 90 mg per day.

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General information

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

Causes of shock

Shock can be caused by a condition in the body where blood circulation is dangerously reduced, such as heart disease (heart attack or heart failure), large blood loss (hemorrhage), dehydration, 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, and emergency care is not ruled out. The patient's condition in shock can deteriorate rapidly, be prepared for primary resuscitation.

Shock Symptoms

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

First aid for shock

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

If the patient is conscious and has no injuries to the head, limbs, back, lay him on his back, while the legs should be raised by 30 cm; keep your head down. If the patient has received an injury in which the raised legs cause a feeling of pain, then do not raise them. If the patient received severe damage of the spine, leave it in the position in which it was found, without turning it over, and provide first aid by treating wounds and cuts (if any).

Man gotta stay warm, loosen up tight clothes Do not let the patient eat or drink. If the patient is vomiting or drooling, turn his head to the side to ensure the outflow of vomit (only if there is no suspicion of spinal cord injury). If, nevertheless, there is a suspicion of damage to the spine and the patient is vomiting, it is necessary to turn it over, fixing the neck and back.

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

Preventive measures

Shock is easier to prevent than to treat. fast and timely treatment underlying causes will reduce the risk of severe shock. First aid will help control the state of shock.

Shock is general reaction body to superstrong, 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 disorders of blood circulation, respiration 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 a pronounced violation of cardiac function);
- redistributive (in case of circulatory disorders);
Pain (with trauma, 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 (with severe infectious diseases);
- combined (combines several causative factors and development mechanisms).

Pain shock.

Pain shock is caused by pain that exceeds the individual pain threshold in strength. It is more commonly seen in 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 has agitation, pallor of the skin of the face, a restless look and an inadequate assessment of the severity of his condition.

There is also an increased physical activity: he jumps up, tends to go somewhere, and it can be quite difficult to keep him. Then, as the second phase of shock (torpid) sets in, against the background of preserved consciousness, depressed mental condition, complete indifference to the environment, a decrease or complete absence pain reaction. The face remains pale, its features are sharpened, the skin of the whole body is cold to the touch and covered with sticky sweat. The patient's breathing becomes much faster and becomes shallow, the victim is 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 (light).

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 mm Hg. Art. or a little higher. Body temperature remains within the normal range or slightly reduced.

Shock II degree (moderate severity).

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

Shock III degree (severe).

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

IV degree shock (it is called a preagonal state).

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

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 region of the heart and is initially characterized by an exceptionally sharp weakness, pallor of the skin and cyanosis of the lips. In addition, the patient has cold extremities, cold sticky sweat covering the entire body, and often loss of consciousness. Systolic blood pressure falls 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, to a significant decrease in cardiac output. In some cases, the victim is helped by the "switching on" of such a compensatory mechanism as increased heart rate. Enough common cause The development of hypovolemic shock is a 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 essential belongs to the actual significant blood loss, which leads to sharp drop blood pressure. Compensatory processes, such as spasm of small blood vessels, exacerbate pathological process, because they inevitably lead to a violation of microcirculation and, as a result, to systemic oxygen deficiency and acidosis.

The accumulation of underoxidized substances in various organs and tissues causes intoxication of the body. Repeated vomiting and diarrhea in 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 impact of the pathogen's toxin on the body. There is a pronounced centralization of blood circulation, and therefore most of the blood is practically unused, accumulates in peripheral tissues. The result of this is a violation of microcirculation and tissue oxygen starvation. Another characteristic 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 appearance patient - microcirculation disorders give the skin "marbling".

General principles of emergency care for shock.

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

1) elimination of the action of the traumatic agent;
2) stop bleeding;
3) careful shifting of the victim;
4) giving it a position that alleviates the condition or prevents additional injuries;
5) release from constricting clothing;
6) closure of wounds with aseptic dressings;
7) anesthesia;
8) the use of sedatives;
9) improvement of the activity of the respiratory and circulatory organs.

In emergency care for shock, bleeding control and pain management are priorities. It should be remembered that the transfer of the victims, as well as their transportation, must be careful. It is necessary to place patients in sanitary transport taking into account the convenience of resuscitation. Pain relief in shock is achieved by the introduction of neurotropic drugs and analgesics. The sooner it starts, the weaker pain syndrome, which, in turn, increases the effectiveness of anti-shock therapy. Therefore, after stopping massive bleeding, before immobilization, wound dressing and laying the victim, it is necessary to perform 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 in 20 ml 5% glucose solution. Intramuscularly, analgesics are administered without a solvent (1-2 ml of a 1% solution of promedol, 1-2 ml of tramal). The use of other narcotic analgesics is contraindicated, as they cause depression of the respiratory and vasomotor centers. Also, in case of abdominal injuries with suspected damage to internal organs, the administration of fentanyl is contraindicated.

It is not allowed to use alcohol-containing liquids in emergency care for shock, 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 must always be remembered that in shock conditions, a spasm of peripheral blood vessels occurs, therefore, the administration of drugs is carried out intravenously, and in the absence of 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 \u200b\u200bdamage or wound (within intact tissues). With extensive crushing of tissues, bleeding from internal organs, increasing tissue edema local anesthesia it is desirable to supplement local impact dry cold. Cooling not only enhances the analgesic effect of novocaine, but also has a pronounced bacteriostatic and bactericidal effect.

In order to relieve excitement and enhance the analgesic effect, it is advisable to use antihistamines, such as diphenhydramine and promethazine. To stimulate the function of respiration and blood circulation, the victim is administered respiratory analeptic- 25% cordiamine solution 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 of the lungs and heart massage. Resuscitation measures are considered effective only if the victim has spontaneous breathing and heartbeat.

When providing emergency care at the stage of transportation, 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 big blood loss possible transfusion of blood plasma to the victim.

Upon admission of the victim to medical institution check the correctness of immobilization, the timing of the imposition of a hemostatic tourniquet. In case of admission of such victims, first of all, they are carried out final stop bleeding. In case of injuries of the extremities, a case blockade according to Vishnevsky, carried out above the injury site, is advisable. Re-introduction Promedol is permissible only 5 hours after its initial administration. Simultaneously begin to carry out inhalation of oxygen to the victim.

good effect in antishock treatment provides inhalation of a mixture of nitrous oxide and oxygen in a ratio of 1: 1 or 2: 1 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 speeds up 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.

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

With unexpressed respiratory failure, antihypoxic measures may be limited to releasing 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 the stimulation of blood circulation. In cases of acute respiratory failure, if necessary, a tracheostomy is indicated. It consists in 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 the tracheostomy and toilet respiratory tract do not eliminate acute respiratory failure, medical measures supplemented with artificial lung ventilation. The latter not only contributes to the reduction or elimination 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 form of shock. Therefore, the complex of anti-shock therapy and resuscitation, regardless of the causes of 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 upset, requiring the inclusion of blood alkalization agents in antishock therapy and resuscitation. It is most convenient to use 4–5% solutions of sodium bicarbonate or bicarbonate, which are administered intravenously at a dose of up to 300 ml. Transfusions of blood, plasma and some plasma substitutes are an integral part of anti-shock therapy.

According to 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 proceeds gradually and has different stages.

If you do not take immediate measures, this situation is fraught with a dangerous outcome up to death.

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

Pain shock is a rapidly developing and life threatening body's response to excessive painful effect accompanied by severe violations of the activity of all systems and organs.

Its main feature, besides acute pain, is the decrease in pressure.

Causes

The main cause of shock is a 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 (stuck food bolus 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, the organs do not feed on 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 decreases from 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, compensation mechanisms become pathological. The tone of the microcirculatory bed (capillaries, venules, arterioles) decreases, blood stagnates in the veins. From this, the body experiences another shock, because. the total area of the venules is enormous and the blood does not circulate through the organs. The brain receives a signal about repeated blood loss.

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

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

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

Changes also affect the respiratory system: hypoxia occurs, breathing quickens and becomes superficial, or, conversely, hyperventilation occurs. This negatively affects the non-respiratory functions of the lungs: the fight against toxins, the purification of incoming air from impurities, depreciation of the heart, voice, and blood deposition. In the alveoli, blood circulation suffers, which leads to edema.

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

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

Damage spinal cord as a result of 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.

Symptoms, signs and phases

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

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

The first phase of the pain shock is replaced by a 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;
not traceable, frequent, thready pulse;
decrease in body temperature;
cold 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 reaction in the form of insufficiency of all other organ systems to such an extent that it is impossible to maintain vital activity.

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

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

It is most convenient to calculate blood loss by the value of the "upper" blood pressure.

Table. Dependence of blood loss on systolic pressure

With reduced pressure and traumatic brain injury, analgesics should not be used!

First aid for pain shock

Initially, the patient must be warmed using heating pads, blankets, warm clothes, then drink hot tea. In case of pain shock, the victim is forbidden 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 from the body of the patient before the arrival of doctors is not permissible!

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

In case of loss of blood, the damaged vessel is clamped with a tourniquet; in case of wounds, fractures and violation of the integrity of soft tissues, a splint is applied. It should go beyond the joints above and below the damaged area of \u200b\u200bthe bone, and a gasket must be laid between it and the body.

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

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

Treatment

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

It is necessary to provide assistance as soon as possible (the shock lasts about a day).
Therapy is long, complex and depends on the cause and severity of the condition.

Medical activities include:

reduction to right level volume of circulating fluid (completion of blood loss through intravenous infusion of solutions);
normalization internal environment organism;
relief of pain with painkillers;
elimination of respiratory failures;
preventive and remedial measures.

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

During the movement of the patient, the flow of drugs is stopped.

In case of shock of II-III degree, after the administration of Polyglucin, 500 ml of saline or 5% glucose solution are transfused, later Polyglucin 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 at the fracture site, local anesthesia is performed with a 0.25-0.5% solution of Novocaine.

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

During the shock III-IV degree anesthesia is produced only after the appointment of Polyglucin 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 drugs that increase blood pressure.

You can not achieve a rapid rise in blood pressure. It is strictly forbidden to inject protein substances that increase blood pressure (mezaton, dopamine, noradrenaline)!

In all types of shock, inhalation of oxygen is indicated.

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