Inhibited state after shock 5. Traumatic shock: classification, degrees, first aid algorithm. Symptoms, signs and phases

What is shock? This question can baffle many. The often-sounding phrase "I'm in shock" does not even come close to this state. 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 is formed 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 inflicted on the body and the speed of response to them. There are two phases of shock: erectile, torpid.

Phases of shock

erectile

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

Speech and motor excitation.
Consciousness is preserved, but the victim cannot assess the severity of the condition.
Increased tendon reflexes.
The skin is pale.
Slightly increased blood pressure, breathing is frequent.
Oxygen starvation develops.

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

The torpid phase is characterized by:

Violation of the central nervous system and other vital organs.
Increased tachycardia.
Falling venous and arterial pressure.
Metabolic disorders and a decrease in body temperature.
Failure of the kidneys.

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

Clinical picture

Depends on the severity of exposure to stimuli. 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:

The first degree - the person is conscious, answers questions, the reaction is slightly inhibited.
The second degree - all reactions are inhibited. Injured in consciousness, gives the correct answers to all questions, but speaks barely audibly. Breathing is rapid, there is a frequent 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 the terminal state. Irreversible pathological changes may occur. No reaction to pain, pupils dilated. Arterial pressure may not be heard, breathing with sobs. The skin is gray with marble spots.

The occurrence of pathology

What is the pathogenesis of shock? Let's look at this in more detail. For the development of the body's response, the presence of:

Time period.
Disorders of cellular metabolism.
Decrease in 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 former 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 the mechanisms of adaptation.

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

In the middle of the 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. Arterial pressure is lowered.
Irreversible. Damaged organs and systems of the body.

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

hypovolemic shock

It develops as a result of a decrease in the amount of blood, low fluid intake, diabetes mellitus. The reasons for its appearance can also be attributed to incomplete replenishment of fluid losses. This situation occurs due to acute cardiovascular insufficiency.

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

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

The volume of circulating blood fell by fifteen percent. A person in a supine position feels normal. In a standing position, the heart rate increases.
With a loss of blood by twenty percent. Blood pressure and pulse become lower. In the supine position, the pressure is normal.
BCC decreased by thirty percent. The pallor of the skin is diagnosed, the pressure reaches a figure of one hundred millimeters of mercury. Such symptoms appear if a person is in a supine position.

The loss of circulating blood is over forty percent. To all the signs listed above, the marbled color of the skin 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, it is necessary 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 starts dropping. 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.
Thrombus in the heart.

Disease grades:

The duration of the shock is up to five hours. Symptoms are mild, rapid heart rate, systolic pressure - at least ninety units.
Duration shock - from five to ten hours. All symptoms are pronounced. The pressure is greatly reduced, 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 condition of a person causes this pathological process. In the veins, arteries, capillaries, the blood flow is weakened. Lots of blood is shed. The pain syndrome is pronounced. There are two phases of traumatic shock:

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

Light. The person is conscious, there is a slight lethargy, shortness of breath. Slightly reduced reflexes. The pulse is quickened, the skin is pale.
Average. Lethargy and lethargy are pronounced. The pulse is fast.
Heavy. The victim is conscious, but does not perceive what is happening. The skin is earthy gray in color. The tips of the fingers and nose are cyanotic. The pulse is fast.
state of prejudice. 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 view as septic. This is a severe manifestation of sepsis that occurs with infectious, surgical, gynecological, urological diseases. There is a violation of systemic hemodynamics and severe hypotension appears. The state of shock sets in sharply. Most often, it provokes surgical intervention or manipulations carried out in the focus 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; a decrease in blood flow to the brain tissues causes constant thirst; respiration and heart rate increased. Blood pressure is low, consciousness is clouded.

Anaphylactic

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

Skin, mucous membranes are affected. Itching, redness, angioedema appear.
Violation of the nervous system. In this case, the symptoms are as follows: headaches, nausea, loss of consciousness, impaired sensitivity.
Deviation in the work of the respiratory system. Appears suffocation, asphyxia, swelling of the small bronchi and larynx.
Damage to the heart muscle causes myocardial infarction.

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

Mild degree lasts from several minutes to two hours and is characterized by: itching and sneezing; discharge from the sinuses; redness of the skin; sore throat and dizziness; tachycardia and hypotension.
Average. Signs of the appearance of this severity are as follows: conjunctivitis, stomatitis; weakness and dizziness; fear and lethargy; noise in the ears and head; the appearance of blisters on the skin; nausea, vomiting, abdominal pain; violation of urination.
Severe degree. Symptoms instantly appear: a sharp decrease in pressure, blue skin, the pulse is almost not palpable, lack of response to any stimuli, respiratory and cardiac arrest.

painful

Pain shock - what is it? This condition is caused by severe pain. Usually this situation occurs when: a fall, an injury. If profuse blood loss is added to the pain syndrome, then a lethal outcome is not excluded.

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

The exogenous form develops as a result of burns, injuries, operations and electric shocks.
Endogenous. The reason for its appearance is hidden in the human body. It 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, rushes about. He is excited and irritable. Breathing and pulse speeded up, pressure increased.
Torpid. It has three degrees:

The first is the inhibition of the central nervous system. 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 is reduced to critical levels. The patient is pale and unable to speak. Death may occur.

First aid

What is a shock in medicine, you figured it out a little. But this is not enough. You should know how to support the victim. The sooner help is provided, the more likely it is 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 has received a shock, you must:

Remove the cause.
Stop bleeding and close the wound with an aseptic napkin.
Raise your legs above your head. In this case, the blood circulation of 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.
Tilt your head to the side.
In case of severe pain, you can give the victim an analgesic.
The patient must not be left alone.

General principles of shock therapy:

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

Conclusion

Let's sum up all of the above. So what is shock anyway? This is a pathological condition of the body caused by irritants. Shock is a disruption of the adaptive reactions of the body, which should occur in case of damage.

A rapidly developing condition against the background of a severe injury, which poses a direct threat to human life, is commonly called traumatic shock. As it already becomes clear from the name itself, the cause of its development is severe mechanical damage, unbearable pain. It is necessary to act in such a situation immediately, since any delay in the provision of first aid can cost the patient's life.

Table of contents:

Causes of traumatic shock

The cause may be injuries of a severe degree of development - fractures of the hip bones, gunshot or stab wounds, rupture of large blood vessels, burns, damage to internal organs. These can be injuries to the most sensitive parts of the human body, such as the neck or perineum, or vital organs. The basis of their occurrence, as a rule, are extreme situations.

note

Very often, pain shock develops when large arteries are injured, where there is a rapid loss of blood, and the body does not have time to adapt to new conditions.

Traumatic shock: pathogenesis

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

With intense, unbearable pain and high blood loss, a signal is sent to our brain, which provokes its strong irritation. The brain abruptly releases a large amount of adrenaline, such an amount is not typical for normal human life, and this disrupts the functioning of various systems.

With severe bleeding there is a spasm of small vessels, for the first time it helps to save part of the blood. Our body cannot maintain such a state for a long time, subsequently the blood vessels expand again and blood loss increases.

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

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

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

In some cases, the recovery of the body with mild and moderate severity of 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 condition in the patient, he can cry, scream, be extremely agitated and even resist assistance. The skin becomes pale, sticky sweat appears, the rhythm of breathing and heartbeat is disturbed.

note

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

Stage 2 - torpid

Has a rapid development. The patient's condition changes dramatically and becomes inhibited, consciousness is lost. However, the patient still feels pain, and first aid manipulations 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 degree of development of pain shock is distinguished.

1 degree

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

2 degree

It is noted by the patient's inhibition, he can answer the question for a long time and does not immediately understand when he is being addressed. The skin is pale, the limbs may become bluish. Arterial pressure is reduced, the pulse is frequent, but weak. Lack of proper assistance can provoke the development of the next degree of shock.

3 degree

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

4 degree

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

Treatment

The main principle of treatment in the development of traumatic shock is immediate action to normalize the patient's state of health.

First aid for traumatic shock should be carried out immediately, take clear and decisive action.

First aid for traumatic shock

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

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

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

Forbidden!

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

Description:

Shock (from the English shock - blow, shock) is a pathological process that develops in response to exposure to extreme stimuli and is accompanied by a progressive violation of the vital functions of the nervous system, blood circulation, respiration, metabolism and some other functions. In fact, this is a breakdown of the body's compensatory reactions in response to damage.

Symptoms:

Diagnosis criteria:
The diagnosis of "shock" is made when the patient has the following signs of shock:

      * decrease in blood pressure and (in the torpid phase);
      * anxiety (erectile phase according to Pirogov) or blackout of consciousness (torpid phase according to Pirogov);
      * respiratory failure;
      * Decreased urine output;
      * Cold, moist skin with a pale cyanotic or marble coloration.
According to the type of circulatory disorders, the classification provides for the following types of shock:

* redistributive (distributive);
* obstructive.

The clinical classification divides shock into four grades according to its severity.

      * I degree shock. The victim's condition is compensated. Consciousness is preserved, clear, the patient is communicative, slightly retarded. Systolic blood pressure (BP) exceeds 90 mm Hg, pulse is rapid, 90-100 beats per minute. The prognosis is favorable.
      * II degree shock. The victim is inhibited, the skin is pale, the heart sounds are muffled, the pulse is frequent - up to 140 beats per minute, weak filling, the maximum blood pressure is reduced to 90-80 mm Hg. Art. Breathing is shallow, rapid, consciousness is preserved. The victim answers questions correctly, speaks slowly, in a low voice. The prognosis is serious. Anti-shock measures are required to save lives.
      * III degree shock. The patient is adynamic, lethargic, does not respond to pain, answers questions in monosyllables and extremely slowly or does not answer at all, speaks in a dull, barely audible whisper. Consciousness is confused or absent altogether. The skin is pale, covered with cold sweat, pronounced. Heart sounds are muffled. The pulse is threadlike - 130-180 beats per minute, is determined only on large arteries (carotid, femoral). Breathing shallow, frequent. Systolic blood pressure is below 70 mmHg, central venous pressure (CVP) is zero or negative. Observed (lack of urine). The prognosis is very serious.
      * IV degree shock manifests itself clinically as one of the terminal states. Heart sounds are not audible, the victim is unconscious, the gray skin acquires a marble pattern with stagnant cadaveric spots (a sign of reduced blood supply and stagnation of blood in small vessels), bluish lips, blood pressure below 50 mm Hg. Art., is often not defined at all. Pulse barely perceptible in the central arteries, anuria. Breathing is superficial, rare (sobbing, convulsive), barely noticeable, the pupils are dilated, there are no reflexes and reactions to pain stimulation. The prognosis is almost always poor.

Roughly, the severity of shock can be determined by the Algover index, that is, by the ratio of the pulse to the value of systolic blood pressure. Normal index - 0.54; 1.0 - transition state; 1.5 - severe shock.

Causes of occurrence:

From a modern point of view, shock develops in accordance with G. Selye's theory of stress. According to this theory, excessive exposure to the body causes specific and non-specific reactions in it. The first depend on the nature of the impact on the body. The second - only on the strength of the impact. Nonspecific reactions under the influence of a superstrong stimulus are called the general adaptation syndrome. The general adaptation syndrome always proceeds in the same way, in three stages:

   1. stage of mobilization (anxiety), due to primary damage and reaction to it;
   2. stage of resistance, characterized by the maximum tension of protective mechanisms;
   3. stage of exhaustion, that is, a violation of adaptive mechanisms leading to the development of "adaptation disease".

Thus, shock, according to Selye, is a manifestation of a non-specific reaction of the body to excessive exposure.

N. I. Pirogov in the middle of the 19th century defined the concepts of erectile (excitation) and torpid (lethargy, numbness) phases in the pathogenesis of shock.

A number of sources give a classification of shock in accordance with the main pathogenetic mechanisms.

This classification divides shock into:

      * hypovolemic;
      * cardiogenic;
      * traumatic;
      * septic or infectious-toxic;
      * anaphylactic;
      * neurogenic;
      * combined (combine elements of different shocks).

Treatment:

For treatment appoint:

Treatment of shock consists of several points:

   1. elimination of the causes that caused the development of shock;
   2. Compensation for the deficiency of circulating blood volume (BCV), with caution in cardiogenic shock;
   3. oxygen therapy (oxygen inhalation);
   4. acidosis therapy;
   5. therapy with vegetotropic drugs in order to cause a positive inotropic effect.

Additionally, steroid hormones, heparin and streptokinase are used to prevent microthrombosis, diuretics to restore kidney function with normal blood pressure, and artificial ventilation of the lungs.