Shock states of various origins. Traumatic shock: classification, degrees, first aid algorithm stage - erectile

Shock is a pathological process that occurs as a response of the human body to exposure to extreme stimuli. In this case, shock is accompanied by impaired blood circulation, metabolism, breathing, and nervous system functions.

The state of shock was first described by Hippocrates. The term "shock" was coined by Le Dran in 1737.

Shock classification

There are several classifications of the state of shock.

According to the type of circulatory disorders, the following types of shock are distinguished:

cardiogenic shock, which occurs due to circulatory disorders. In the case of cardiogenic shock due to lack of blood flow (impaired cardiac activity, dilation of blood vessels that cannot hold blood), the brain experiences a lack of oxygen. In this regard, in a state of cardiogenic shock, a person loses consciousness and, as a rule, dies;
hypovolemic shock is a condition caused by a secondary decrease in cardiac output, acute deficiency of circulating blood, and a decrease in venous return to the heart. Hypovolemic shock occurs when there is loss of plasma (anhydremic shock), dehydration, or loss of blood (hemorrhagic shock). Hemorrhagic shock can occur when a large vessel is damaged. As a result, blood pressure quickly drops to almost zero. Hemorrhagic shock occurs when the pulmonary trunk, inferior or superior veins, or aorta rupture;
redistributive - it occurs due to a decrease in peripheral vascular resistance with increased or normal cardiac output. It can be caused by sepsis, drug overdose, anaphylaxis.

According to severity, shock is divided into:

shock of the first degree or compensated - the person’s consciousness is clear, he is communicative, but a little inhibited. Systolic pressure is more than 90 mm Hg, pulse is 90-100 beats per minute;
shock of the second degree or subcompensated - the person is inhibited, the heart sounds are muffled, the skin is pale, the pulse is up to 140 beats per minute, the pressure is reduced to 90-80 mm Hg. Art. Breathing is rapid, shallow, consciousness remains. The victim answers correctly, but speaks quietly and slowly. Antishock therapy is required;
shock of the third degree or decompensated - the patient is inhibited, adynamic, does not respond to pain, answers questions in monosyllables and slowly or does not answer, speaks in a whisper. Consciousness may be confused or absent. The skin is covered with cold sweat, pale, and acrocyanosis is pronounced. The pulse is threadlike. Heart sounds are muffled. Breathing is frequent and shallow. Systolic blood pressure less than 70 mm Hg. Art. Anuria is present;
shock of the fourth degree or irreversible - terminal condition. The person is unconscious, heart sounds cannot be heard, the skin is gray with a marbled pattern and congestive spots, the lips are bluish, the pressure is less than 50 mm Hg. Art., anuria, pulse is barely noticeable, breathing is rare, there are no reflexes or reactions to pain, the pupils are dilated.

According to the pathogenetic mechanism, the following types of shock are distinguished:

hypovolemic shock;
neurogenic shock is a condition that develops due to damage to the spinal cord. The main signs are bradycardia and arterial hypotension;
traumatic shock is a pathological condition that threatens human life. Traumatic shock occurs with fractures of the pelvic bones, traumatic brain injuries, severe gunshot wounds, abdominal injuries, large blood loss, and operations. The main factors determining the development of traumatic shock include: loss of a large amount of blood, severe pain irritation;
infectious-toxic shock - a condition caused by exotoxins of viruses and bacteria;
septic shock is a complication of severe infections, which is characterized by a decrease in tissue perfusion, which leads to impaired delivery of oxygen and other substances. Most often develops in children, the elderly and patients with immunodeficiency;
cardiogenic shock;
anaphylactic shock is an immediate allergic reaction, which is a state of high sensitivity of the body that occurs upon repeated exposure to an allergen. The rate of development of anaphylactic shock ranges from a few seconds to five hours from the moment of contact with the allergen. At the same time, in the development of anaphylactic shock, neither the method of contact with the allergen nor the time matter;
combined.

Help with shock

When providing first aid for shock before the ambulance arrives, it must be borne in mind that improper transportation and first aid can cause a delayed state of shock.

Before the ambulance arrives, you must:

if possible, try to eliminate the cause of shock, for example, free trapped limbs, stop bleeding, extinguish clothes that are burning on a person;
check the victim’s nose and mouth for the presence of foreign objects and remove them;
check the victim’s pulse and breathing; if such a need arises, perform artificial respiration and cardiac massage;
turn the victim's head to the side so that he cannot choke on the vomit and suffocate;
find out whether the victim is conscious and give him an analgesic. Having ruled out an abdominal injury, you can give the victim hot tea;
loosen the victim’s clothing around the neck, chest, and waist;
warm or cool the victim depending on the season.

When providing first aid for shock, you need to know that you should not leave the victim alone, let him smoke, or apply a heating pad to the injury sites so as not to cause blood flow from vital organs.

Prehospital emergency care for shock includes:

stopping bleeding;
ensuring adequate ventilation of the lungs and airway patency;
anesthesia;
transfusion replacement therapy;
in case of fractures - immobilization;
gentle transportation of the patient.

As a rule, severe traumatic shock is accompanied by improper ventilation of the lungs. An airway or Z-shaped tube may be inserted into the victim.

External bleeding must be stopped by applying a tight bandage, tourniquet, clamp to the bleeding vessel, or clamping the damaged vessel. If there are signs of internal bleeding, the patient needs to be taken to the hospital as quickly as possible for emergency surgery.

Medical care for shock must meet the requirements of emergency treatment. This means that those agents that produce an effect immediately after their administration to the patient should be immediately used.

If you do not provide assistance to such a patient in time, this can lead to severe disturbances in microcirculation, irreversible changes in tissues and cause the death of a person.

Since the mechanism of shock development is associated with a decrease in vascular tone and a decrease in blood flow to the heart, therapeutic measures, first of all, should be aimed at increasing arterial and venous tone, as well as increasing the volume of fluid in the bloodstream.

Since shock can be caused by various reasons, measures must be taken to eliminate the causes of this condition and against the development of pathogenetic mechanisms of collapse.

What is shock? This question can confuse many. The often heard phrase “I’m in shock” does not even come close to reminiscent of this condition. It should be said right away that shock is not a symptom. This is a natural chain of changes in the human body. A pathological process that forms under the influence of unexpected stimuli. It involves the circulatory, respiratory, nervous, endocrine systems and metabolism.

Symptoms of pathology depend on the severity of the damage caused to the body and the speed of response to it. There are two phases of shock: erectile and torpid.

Shock phases

Erectile

Occurs immediately after exposure to a stimulus. It develops very quickly. For this reason it remains invisible. Signs include:

Speech and motor stimulation.
Consciousness is preserved, but the victim cannot assess the severity of the condition.
Increased tendon reflexes.
The skin is pale.
Blood pressure is slightly increased, breathing is rapid.
Oxygen starvation develops.

During the transition from the erectile phase to the torpid phase, an increase in tachycardia and a drop in pressure are observed.

The torpid phase is characterized by:

Disruption of the central nervous system and other vital organs.
Increased tachycardia.
A drop in venous and blood pressure.
Metabolic disorders and decreased body temperature.
Malfunction of the kidneys.

The torpid phase can enter a terminal state, which in turn causes cardiac arrest.

Clinical picture

Depends on the severity of exposure to irritants. In order to properly provide assistance, it is necessary to assess the patient's condition. The classifications of shock according to the severity of manifestation are as follows:

First degree - the person is conscious, answers questions, the reaction is slightly inhibited.
Second degree - all reactions are inhibited. Traumatized in consciousness, he gives the correct answers to all questions, but speaks barely audibly. Breathing is rapid, there is a rapid pulse and low blood pressure.
The third degree of shock - a person does not feel pain, his reactions are inhibited. His conversation is slow and quiet. Does not answer questions at all, or answers in one word. The skin is pale, covered with perspiration. Consciousness may be absent. The pulse is barely palpable, breathing is frequent and shallow.
The fourth degree of shock is a terminal state. Irreversible pathological changes may occur. No reaction to pain, dilated pupils. Blood pressure may not be audible, breathing with sobs. The skin is gray with marbled spots.

The occurrence of pathology

What is the pathogenesis of shock? Let's look at this in more detail. To develop a response, the body must have:

Time period.
Disorders of cellular metabolism.
Reducing the amount of circulating blood.
Damage incompatible with life.

Under the influence of negative factors, reactions begin to develop in the body:

Specific - depend on the nature of the impact.
Nonspecific - depend on the strength of the impact.

The first ones are called the general adaptation syndrome, which always proceeds in the same way and has three stages:

Anxiety is a reaction to damage.
Resistance is a manifestation of defense mechanisms.
Exhaustion is a violation of adaptation mechanisms.

Thus, based on the above arguments, shock is a nonspecific reaction of the body to a strong impact.

In the mid-nineteenth century, N.I. Pirogov added that the pathogenesis of shock includes three phases. Their duration depends on the patient's response and duration of exposure.

Compensated shock. The pressure is within normal limits.
Decompensated. Blood pressure is reduced.
Irreversible. Organs and systems of the body are damaged.

Now let's take a closer look at the etiopathogenetic classification of shock.

Hypovolemic shock

Develops as a result of decreased blood volume, low fluid intake, and diabetes. The reasons for its appearance can also be attributed to incomplete replenishment of fluid losses. This situation occurs due to acute cardiovascular failure.

The hypovolemic type includes anhydremic and hemorrhagic shock. Hemorrhagic is diagnosed with large loss of blood, and anhydremic - with loss of plasma.

Signs of hypovolemic shock depend on the amount of blood or plasma lost by the body. Depending on this factor, they are divided into several groups:

Circulating blood volume dropped by fifteen percent. A person in a supine position feels fine. When standing, your heart rate increases.
With a twenty percent blood loss. Blood pressure and pulse become lower. In the supine position, the pressure is normal.
BCC decreased by thirty percent. Pallor of the skin is diagnosed, the pressure reaches one hundred millimeters of mercury. Such symptoms appear if a person is in a lying position.

The loss of circulating blood is more than forty percent. To all the signs listed above, a marbled skin color is added, the pulse is almost not palpable, the person may be unconscious or in a coma.

Cardiogenic

In order to understand what shock is and how to provide first aid to the victim, you need to know the classification of this pathological process. We continue to consider the types of shock.

The next one is cardiogenic. Most often it occurs after a heart attack. The pressure begins to drop significantly. The problem is that this process is difficult to control. In addition, the causes of cardiogenic shock can be:

Damage to the structure of the left ventricle.
Arrhythmia.
Blood clot in the heart.

Degrees of the disease:

The duration of shock is up to five hours. The symptoms are mild, rapid heart rate, systolic pressure - at least ninety units.
The duration of the shock is from five to ten hours. All symptoms are pronounced. The pressure drops significantly, the pulse increases.
The duration of the pathological process is more than ten hours. Most often this condition leads to death. The pressure drops to a critical point, the heart rate is more than one hundred and twenty beats.

Traumatic

Now let's talk about what traumatic shock is. Wounds, cuts, severe burns, concussions - everything that is accompanied by a serious human condition causes this pathological process. Blood flow in veins, arteries, and capillaries is weakened. A large amount of blood is lost. The pain syndrome is pronounced. There are two phases of traumatic shock:

The second phase, in turn, is divided into the following degrees:

Easy. The person is conscious, there is slight lethargy and shortness of breath. Reflexes are slightly reduced. The pulse is rapid, the skin is pale.
Average. Lethargy and lethargy are clearly expressed. The pulse is increased.
Heavy. The victim is conscious, but does not perceive what is happening. The skin has an earthy gray color. The tips of the fingers and nose are bluish. The pulse is increased.
State of pre-agony. The person has no consciousness. It is almost impossible to determine the pulse.

Septic

Speaking about the classification of shock, one cannot ignore such a type as septic. This is a severe manifestation of sepsis, which occurs in infectious, surgical, gynecological, and urological diseases. Systemic hemodynamics are disrupted and severe hypotension occurs. The state of shock occurs acutely. Most often it is provoked by surgical intervention or manipulations carried out at the site of infection.

The initial stage of shock is characterized by: a decrease in the amount of urine excreted by the body, increased body temperature, chills, nausea, vomiting, diarrhea, and weakness.
The late stage of shock is manifested by the following symptoms: restlessness and anxiety; decreased blood flow to brain tissue causes constant thirst; breathing and heart rate are increased. Blood pressure is low, consciousness is foggy.

Anaphylactic

Now let's talk about what anaphylactic shock is. This is a severe allergic reaction caused by repeated exposure to an allergen. The amount of the latter may be very small. But the higher the dose, the longer the shock. The body's anaphylactic reaction can occur in several forms.

Skin and mucous membranes are affected. Itching, redness, and Quincke's edema appear.
Disruption of the nervous system. In this case, the symptoms are as follows: headaches, nausea, loss of consciousness, sensory disturbance.
Deviation in the functioning of the respiratory system. Choking, asphyxia, and swelling of the small bronchi and larynx appear.
Damage to the heart muscle provokes myocardial infarction.

In order to more thoroughly study what anaphylactic shock is, you need to know its classification by severity and symptoms.

Mild degrees last from a few minutes to two hours and are characterized by: itching and sneezing; discharge from the sinuses; redness of the skin; sore throat and dizziness; tachycardia and decreased blood pressure.
Average. Signs of the appearance of this degree of severity are as follows: conjunctivitis, stomatitis; weakness and dizziness; fear and inhibition; noise in the ears and head; the appearance of blisters on the skin; nausea, vomiting, abdominal pain; urinary disturbance.
Severe degree. Symptoms appear instantly: a sharp decrease in pressure, blue skin, almost no pulse, lack of response to any irritants, cessation of breathing and cardiac activity.

Painful

Painful shock - what is it? This is a condition that is caused by severe pain. Typically this situation occurs when: a fall or injury. If heavy blood loss is added to the pain syndrome, then death cannot be ruled out.

Depending on the reasons that caused this condition, the body’s reaction can be exogenous or endogenous.

The exogenous type develops as a result of burns, injuries, surgeries and electric shocks.
Endogenous. The reason for its appearance is hidden in the human body. Provokes a response: heart attack, hepatic and renal colic, rupture of internal organs, stomach ulcers and others.

There are two phases of pain shock:

Initial. It doesn't last long. During this period, the patient screams and rushes about. He is agitated and irritable. Breathing and pulse are increased, blood pressure is increased.
Torpidnaya. Has three degrees:

First, the central nervous system is inhibited. The pressure drops, moderate tachycardia is observed, reflexes are reduced.
The second - the pulse quickens, breathing is shallow.
The third one is hard. The pressure has been reduced to critical levels. The patient is pale and cannot speak. Death may occur.

First aid

What is shock in medicine? You figured it out a little. But this is not enough. You should know how to support the victim. The faster help is provided, the greater the likelihood that everything will end well. That is why now we will talk about the types of shocks and emergency care that needs to be provided to the patient.

If a person receives a shock, it is necessary:

Eliminate the cause.
Stop the bleeding and cover the wound with an aseptic napkin.
Raise your legs above your head. In this case, blood circulation in the brain improves. The exception is cardiogenic shock.
In case of traumatic or painful shock, it is not recommended to move the patient.
Give the person warm water to drink.
Bow your head to the side.
In case of severe pain, you can give the victim an analgesic.
The patient should not be left alone.

General principles of shock therapy:

The sooner treatment measures are started, the better the prognosis.
Getting rid of the disease depends on the cause, severity, and degree of shock.
Treatment should be comprehensive and differentiated.

Conclusion

Let's summarize all of the above. So, what is shock? This is a pathological condition of the body caused by irritants. Shock is a disruption of the body's adaptive reactions that should occur in the event of damage.

is a pathological condition that occurs as a result of blood loss and pain during injury and poses a serious threat to the patient’s life. Regardless of the cause of development, it always manifests itself with the same symptoms. Pathology is diagnosed based on clinical signs. Urgent stop of bleeding, pain relief and immediate delivery of the patient to the hospital are necessary. Treatment of traumatic shock is carried out in an intensive care unit and includes a set of measures to compensate for the resulting disorders. The prognosis depends on the severity and phase of shock, as well as the severity of the injury that caused it.

ICD-10

T79.4

General information

Traumatic shock is a serious condition that is the body’s reaction to acute injury, accompanied by severe blood loss and intense pain. It usually develops immediately after injury and is an immediate reaction to damage, but under certain conditions (additional trauma) it can occur after some time (4-36 hours). It is a condition that poses a threat to the patient’s life and requires urgent treatment in an intensive care unit.

Reasons

Traumatic shock develops with all types of severe injuries, regardless of their cause, location and mechanism of injury. Its cause can be knife and gunshot wounds, falls from heights, car accidents, man-made and natural disasters, industrial accidents, etc. In addition to extensive wounds with damage to soft tissue and blood vessels, as well as open and closed fractures of large bones ( especially multiple and accompanied by damage to the arteries), traumatic shock can cause extensive burns and frostbite, which are accompanied by significant loss of plasma.

The development of traumatic shock is based on massive blood loss, severe pain, dysfunction of vital organs and mental stress caused by acute injury. In this case, blood loss plays a leading role, and the influence of other factors can vary significantly. Thus, if sensitive areas (perineum and neck) are damaged, the influence of the pain factor increases, and if the chest is injured, the patient’s condition is aggravated by impaired breathing and oxygen supply to the body.

Pathogenesis

The triggering mechanism of traumatic shock is largely associated with the centralization of blood circulation - a state when the body directs blood to vital organs (lungs, heart, liver, brain, etc.), diverting it from less important organs and tissues (muscles, skin, fatty tissue). The brain receives signals about a lack of blood and reacts to them by stimulating the adrenal glands to release adrenaline and norepinephrine. These hormones act on peripheral blood vessels, causing them to constrict. As a result, blood flows away from the extremities and there is enough of it for the functioning of vital organs.

After some time, the mechanism begins to malfunction. Due to the lack of oxygen, peripheral vessels dilate, causing blood to flow away from vital organs. At the same time, due to disturbances in tissue metabolism, the walls of peripheral vessels stop responding to signals from the nervous system and the action of hormones, so re-narrowing of blood vessels does not occur, and the “periphery” turns into a blood depot. Due to insufficient blood volume, the heart's function is impaired, which further aggravates circulatory problems. Blood pressure drops. With a significant decrease in blood pressure, the normal functioning of the kidneys is disrupted, and a little later - the liver and intestinal wall. Toxins are released from the intestinal wall into the blood. The situation is aggravated due to the occurrence of numerous foci of dead tissue without oxygen and severe metabolic disorders.

Due to spasm and increased blood clotting, some small vessels become clogged with blood clots. This causes the development of DIC syndrome (disseminated intravascular coagulation syndrome), in which blood clotting first slows down and then practically disappears. With DIC, bleeding may resume at the site of injury, pathological bleeding occurs, and multiple small hemorrhages appear in the skin and internal organs. All of the above leads to a progressive deterioration of the patient’s condition and causes death.

Classification

There are several classifications of traumatic shock depending on the causes of its development. Thus, in many Russian manuals on traumatology and orthopedics, surgical shock, endotoxin shock, shock due to crushing, burns, the action of a shock air wave and the application of a tourniquet are distinguished. The classification of V.K. is widely used. Kulagin, according to which there are the following types of traumatic shock:

Wound traumatic shock (arising due to mechanical trauma). Depending on the location of the injury, it is divided into visceral, pulmonary, cerebral, with injury to the extremities, with multiple trauma, with compression of soft tissues.
Operational traumatic shock.
Hemorrhagic traumatic shock (developing with internal and external bleeding).
Mixed traumatic shock.

Regardless of the causes of occurrence, traumatic shock occurs in two phases: erectile (the body tries to compensate for the violations that have arisen) and torpid (compensatory capabilities are depleted). Taking into account the severity of the patient’s condition in the torpid phase, 4 degrees of shock are distinguished:

I (light). The patient is pale and sometimes a little lethargic. Consciousness is clear. Reflexes are reduced. Shortness of breath, pulse up to 100 beats/min.
II (moderate). The patient is lethargic and lethargic. Pulse is about 140 beats/min.
III (severe). Consciousness is preserved, the ability to perceive the surrounding world is lost. The skin is earthy gray, the lips, nose and fingertips are bluish. Sticky sweat. Pulse is about 160 beats/min.
IV (preagonia and agony). There is no consciousness, the pulse is not detected.

Symptoms of traumatic shock

During the erectile phase, the patient is excited, complains of pain, and may scream or moan. He is anxious and scared. Aggression and resistance to examination and treatment are often observed. The skin is pale, blood pressure is slightly elevated. Tachycardia, tachypnea (increased breathing), trembling of the limbs or small twitching of individual muscles are noted. The eyes are shiny, the pupils are dilated, the look is restless. The skin is covered with cold, sticky sweat. The pulse is rhythmic, body temperature is normal or slightly elevated. At this stage, the body is still compensating for the disturbances that have arisen. There are no gross disturbances in the functioning of internal organs, no disseminated intravascular coagulation syndrome.

With the onset of the torpid phase of traumatic shock, the patient becomes apathetic, lethargic, drowsy and depressed. Despite the fact that the pain does not decrease during this period, the patient stops or almost stops signaling about it. He no longer screams or complains; he can lie silently, moaning quietly, or even lose consciousness. There is no reaction even with manipulations in the area of damage. Blood pressure gradually decreases and heart rate increases. The pulse in the peripheral arteries weakens, becomes thread-like, and then becomes undetectable.

The patient's eyes are dull, sunken, the pupils are dilated, the gaze is motionless, there are shadows under the eyes. There is marked pallor of the skin, cyanotic mucous membranes, lips, nose and fingertips. The skin is dry and cold, tissue elasticity is reduced. Facial features are sharpened, nasolabial folds are smoothed. Body temperature is normal or low (temperature may also increase due to wound infection). The patient gets chills even in a warm room. Convulsions and involuntary release of feces and urine are often observed.

Symptoms of intoxication are revealed. The patient suffers from thirst, his tongue is coated, his lips are parched and dry. Nausea and, in severe cases, even vomiting may occur. Due to progressive impairment of kidney function, the amount of urine decreases even with heavy drinking. The urine is dark, concentrated, and in severe shock, anuria (complete absence of urine) is possible.

Diagnostics

Traumatic shock is diagnosed when appropriate symptoms are identified, the presence of a recent injury or another possible cause of this pathology. To assess the condition of the victim, periodic measurements of pulse and blood pressure are performed, and laboratory tests are prescribed. The list of diagnostic procedures is determined by the pathological condition that caused the development of traumatic shock.

Treatment of traumatic shock

At the first aid stage, it is necessary to temporarily stop bleeding (tourniquet, tight bandage), restore airway patency, perform anesthesia and immobilization, and also prevent hypothermia. The patient should be moved very carefully to prevent re-traumatization.

In the hospital, at the initial stage, resuscitators-anesthesiologists transfuse saline (lactasol, Ringer's solution) and colloid (reopolyglucin, polyglucin, gelatinol, etc.) solutions. After determining the rhesus and blood group, the transfusion of these solutions in combination with blood and plasma is continued. Provide adequate breathing using airways, oxygen therapy, tracheal intubation, or mechanical ventilation. Pain relief is continued. Bladder catheterization is performed to accurately determine the amount of urine.

Surgical interventions are carried out according to vital indications in the amount necessary to preserve vital functions and prevent further aggravation of shock. They stop bleeding and treat wounds, block and immobilize fractures, eliminate pneumothorax, etc. Prescribe hormone therapy and dehydration, use drugs to combat cerebral hypoxia, and correct metabolic disorders.

6804 0

This is an acutely developing and life-threatening condition that occurs as a result of severe trauma, is characterized by a critical decrease in blood flow in tissues (hypoperfusion) and is accompanied by clinically pronounced disturbances in the functioning of all organs and systems.

The leading factor in the pathogenesis of traumatic shock is pain (powerful pain impulses coming from the site of injury to the central nervous system). A complex of neuroendocrine changes during traumatic shock leads to the launch of all subsequent responses of the body.

Redistribution of blood. At the same time, the blood supply to the vessels of the skin, subcutaneous fat, and muscles increases with the formation of areas of stasis in them and the accumulation of red blood cells. Due to the movement of large volumes of blood to the periphery, relative hypovolemia is formed.

Relative hypovolemia leads to a decrease in venous return of blood to the right side of the heart, a decrease in cardiac output, and a decrease in blood pressure. A decrease in blood pressure leads to a compensatory increase in total peripheral resistance and impaired microcirculation. Impaired microcirculation and its progression are accompanied by hypoxia of organs and tissues and the development of acidosis.

Traumatic shock is often combined with internal or external bleeding. Which, naturally, leads to an absolute decrease in the volume of circulating blood. Despite the exceptional importance of blood loss in the pathogenesis of traumatic shock, traumatic and hemorrhagic shocks should not be identified. In case of severe mechanical damage, the pathological effects of blood loss are inevitably accompanied by the negative influence of neuropain impulses, endotoxemia and other factors, which makes the state of traumatic shock always more severe compared to “pure” blood loss in an equivalent volume.

One of the main pathogenetic factors that forms traumatic shock is toxemia. Its influence begins already 15-20 minutes from the moment of injury. The endothelium and, above all, the renal endothelium are exposed to toxic effects. In this connection, multiple organ failure develops quite quickly.

Diagnosis of traumatic shock is based on clinical data: systolic and diastolic blood pressure, pulse, skin color and moisture, and diuresis. In the absence of arrhythmia, the degree and severity of hemodynamic disturbances can be assessed using the shock index (Algovera).

With closed fractures, blood loss is:
. ankles - 300 ml;
. shoulder and shin - up to 500 ml;
. hips - up to 2 l;
. pelvic bones - up to 3 liters.

Depending on the value of systolic blood pressure, there are 4 degrees of severity of traumatic shock:
1. I degree - systolic pressure decreases to 90 mm Hg. Art.;
2. II degree of severity - up to 70 mm Hg. Art.;
3. III degree of severity - up to 50 mm Hg;
4. IV degree of severity - less than 50 mm Hg. Art.

Clinic

With shock degree, clinical manifestations may be scanty. The general condition is moderate. Blood pressure is slightly reduced or normal. Slight lethargy. Pale, cold skin. Positive “white spot” symptom. Heart rate increases to 100 per minute. Rapid breathing. Due to an increase in the content of catecholamines in the blood, there are signs of peripheral vasoconstriction (pale, sometimes “goosey” skin, muscle tremors, cold extremities). Signs of circulatory disorders appear: low central venous pressure, decreased cardiac output, tachycardia.

In the third degree of traumatic shock, the condition of the patients is severe, consciousness is preserved, and lethargy is noted. The skin is pale, with an earthy tint (appears when pallor is combined with hypoxia), cold, often covered with cold, sticky sweat. Blood pressure was stably reduced to 70 mm Hg. Art. or less, pulse increased to 100-120 per minute, weak filling. There is shortness of breath and thirst. Diuresis is sharply reduced (oliguria). IV degree of traumatic shock is characterized by the extremely severe condition of the patients: severe adynamia, indifference, skin and mucous membranes are cold, pale gray, with an earthy tint and a marble pattern. Pointed facial features. Blood pressure is reduced to 50 mm Hg. Art. and less. CVP is close to zero or negative. The pulse is thread-like, more than 120 per minute. Anuria or oliguria is noted. In this case, the state of microcirculation is characterized by paresis of peripheral vessels, as well as disseminated intravascular coagulation syndrome. Clinically, this is manifested by increased tissue bleeding.

The clinical picture of traumatic shock reflects the specific features of individual types of injuries. Thus, with severe wounds and chest injuries, psychomotor agitation, fear of death, and hypertonicity of skeletal muscles are observed; a short-term rise in blood pressure is replaced by a rapid fall. In cases of traumatic brain injury, there is a pronounced tendency to arterial hypertension, masking the clinical picture of hypocirculation and traumatic shock. With intra-abdominal injuries, the course of traumatic shock is soon superimposed by symptoms of developing

Urgent Care

Treatment of traumatic shock should be comprehensive, pathogenetically substantiated, individual in accordance with the nature and location of the injury.

Ensure patency of the upper respiratory tract using the triple Safar maneuver and assisted ventilation.
. Inhalation of 100% oxygen for 15-20 minutes, followed by a decrease in the oxygen concentration in the inhaled mixture to 50-60%.
. In the presence of tension pneumothorax, drainage of the pleural cavity.
. Stop bleeding by finger pressure, tight bandage, tourniquet, etc.
. Transport immobilization (should be performed as early and reliably as possible).
. Pain relief through the use of all types of local and regional anesthesia. For fractures of large bones, local anesthetics are used in the form of blockades of the immediate fracture zone, nerve trunks, and osteofascial sheaths.
. The following analgesic cocktails are administered parenterally (intravenously): atropine sulfate 0.1% solution 0.5 ml, sibazon 0.5% solution 1-2 ml, tramadol 5% solution 1-2 ml (but not more than 5 ml) or promedol 2 % solution 1 ml.
. Or atropine sulfate 0.1% solution 0.5 ml, sibazon 0.5% solution 1 ml, ketamine 1-2 ml (or at a dose of 0.5-1 mg/kg body weight), tramadol 5% solution 1-2 ml (but not more than 5 ml) or promedol 2% solution 1 ml.

It is possible to use other analgesics in equivalent doses.

The most important task in the treatment of traumatic shock is the fastest possible restoration of blood supply to tissues. With an undetectable level of blood pressure, jet transfusions into two veins (under pressure) are necessary in order to achieve a rise in systolic pressure to a level of at least 70 mm Hg within 10-15 minutes. Art. The infusion rate should be 200500 ml per 1 minute. Due to the significant expansion of the vascular space, it is necessary to administer large volumes of fluid, sometimes 3-4 times greater than the estimated blood loss. The rate of infusion is determined by the dynamics of blood pressure. The jet infusion should be carried out until the blood pressure steadily rises to 100 mm Hg. Art.

Table 8.5. Infusion therapy program during transportation of the victim

Glucocorticosteroids are administered intravenously at an initial dose of 120-150 mg of prednisolone and subsequently at a dose of at least 10 mg/kg. The dose can be increased to 25-30 mg/kg body weight. Treatment of heart failure may require the inclusion of dobutamine in the therapy at a dose of 5-7.5 mcg/kg/min or dopamine 5-10 mcg/kg/min, as well as drugs that improve myocardial metabolism, antihypoxants - Riboxin - 10-20 ml; cytochrome C - 10 mg, Actovegin 10-20 ml. If a terminal condition develops or it is impossible to provide emergency infusion therapy, dopamine is administered intravenously in 400 ml of a 5% glucose solution or any other solution at a rate of 8-10 drops per minute. In case of internal bleeding, conservative measures should not delay the evacuation of victims, since only emergency surgery can save their life.

The sequence of activities may vary depending on the prevalence of certain violations. The victim is transported to the hospital while intensive care continues.

Sakrut V.N., Kazakov V.N.

A rapidly developing condition against the background of a severe injury, which poses a direct threat to a person’s life, is commonly called traumatic shock. As is already clear from the name itself, the cause of its development is severe mechanical damage and unbearable pain. In such a situation, you should act immediately, since any delay in providing first aid can cost the patient’s life.

Table of contents:

Causes of traumatic shock

The cause may be severe injuries - hip fractures, gunshot or knife wounds, rupture of large blood vessels, burns, damage to internal organs. This may include injuries to the most sensitive areas of the human body, such as the neck or perineum, or to vital organs. The basis for their occurrence, as a rule, is extreme situations.

Please note

Very often, painful shock develops when large arteries are injured, where rapid blood loss occurs, and the body does not have time to adapt to new conditions.

Traumatic shock: pathogenesis

The principle of the development of this pathology is a chain reaction of traumatic conditions that have serious consequences for the patient’s health and are aggravated one after another in stages.

For intense, unbearable pain and high blood loss, a signal is sent to our brain that provokes severe irritation. The brain suddenly releases a large amount of adrenaline, such an amount is not typical for normal human activity, and this disrupts the functioning of various systems.

In case of sudden blood loss A spasm of small vessels occurs, at first this helps to save some of the blood. Our body is unable to maintain this state for a long time; subsequently, the blood vessels dilate again and blood loss increases.

In case of closed injury the mechanism of action is similar. Thanks to the hormones released, the vessels block the outflow of blood and this condition is no longer a defensive reaction, but, on the contrary, is the basis for the development of traumatic shock. Subsequently, a significant amount of blood is retained, and there is a lack of blood supply to the heart, respiratory system, hematopoietic system, brain and others.

Subsequently, intoxication of the body occurs, vital systems fail one after another, and necrosis of the tissue of internal organs occurs due to lack of oxygen. In the absence of first aid, all this leads to death.

The development of traumatic shock against the background of injury with intense blood loss is considered the most severe.

In some cases, recovery of the body with mild to moderate pain shock can occur on its own, although such a patient should also be given first aid.

Symptoms and stages of traumatic shock

Symptoms of traumatic shock are pronounced and depend on the stage.

Stage 1 – erectile

Lasts from 1 to several minutes. The resulting injury and unbearable pain provoke an atypical state in the patient; he may cry, scream, be extremely agitated, and even resist assistance. The skin becomes pale, sticky sweat appears, and the rhythm of breathing and heartbeat is disrupted.

Please note

At this stage, it is already possible to judge the intensity of the pain shock manifested; the brighter it is, the stronger and more rapidly the subsequent stage of shock will manifest itself.

Stage 2 – torpid

Has rapid development. The patient's condition changes sharply and becomes inhibited, consciousness is lost. However, the patient still feels pain, first aid procedures should be carried out with extreme caution.

The skin becomes even paler, cyanosis of the mucous membranes develops, the pressure drops sharply, the pulse is barely palpable. The next stage will be the development of dysfunction of internal organs.

Degrees of development of traumatic shock

Symptoms of the torpid stage can have different intensity and severity, depending on this, the degrees of development of pain shock are distinguished.

1st degree

Satisfactory condition, clear consciousness, the patient clearly understands what is happening and answers questions. Hemodynamic parameters are stable. Slightly increased breathing and heart rate may occur. It often occurs with fractures of large bones. Mild traumatic shock has a favorable prognosis. The patient should be given assistance in accordance with the injury, given analgesics and taken to a hospital for treatment.

2nd degree

The patient is marked by lethargy; he may take a long time to answer the question asked and does not immediately understand when he is addressed. The skin is pale, the limbs may take on a bluish tint. Blood pressure is reduced, pulse is frequent but weak. Lack of proper assistance can provoke the development of the next degree of shock.

3rd degree

The patient is unconscious or in a state of stupor, there is practically no reaction to stimuli, the skin is pale. A sharp drop in blood pressure, the pulse is frequent, but weakly palpable even in large vessels. The prognosis for this condition is unfavorable, especially if the procedures performed do not lead to positive dynamics.

4th degree

Fainting, no pulse, extremely low or no blood pressure. The survival rate for this condition is minimal.

Treatment

The main principle of treatment for the development of traumatic shock is immediate action to normalize the patient’s health status.

First aid for traumatic shock must be provided immediately, with clear and decisive action.

First aid for traumatic shock

What specific actions are necessary is determined by the type of injury and the cause of the development of traumatic shock; the final decision comes based on the actual circumstances. If you witness the development of painful shock in a person, it is recommended to immediately take the following actions:

A tourniquet is used for arterial bleeding (blood spurts out) and is applied above the wound site. It can be used continuously for no more than 40 minutes, then it should be relaxed for 15 minutes. When the tourniquet is applied correctly, the bleeding stops. In other cases of injury, a pressure gauze bandage or tampon is applied.

Provide free access of air. Remove or unfasten constrictive clothing and accessories, remove foreign objects from the respiratory passages. The unconscious patient should be placed on his side.
Warming procedures. As we already know, traumatic shock can manifest itself in the form of paleness and coldness of the extremities, in which case the patient should be covered or additional access to heat should be provided.
Painkillers. The ideal option in this case would be intramuscular injection of analgesics.. In an extreme situation, try to give the patient an analgin tablet sublingually (under the tongue for faster action).
Transportation. Depending on the injuries and their location, it is necessary to determine the method of transporting the patient. Transportation should be carried out only in cases where waiting for medical assistance may take a very long time.

Forbidden!

Disturb and excite the patient, make him move!
Shift or move the patient from