Traumatic shock: classification, degrees, first aid algorithm. Dangerous shock states Inhibited state after shock 5

General information

Shock is the body's response to the action of external aggressive stimuli, which may be accompanied by circulatory, metabolic, nervous system, respiration, and other vital functions of the body.

There are such causes of shock:

1. Injuries resulting from mechanical or chemical exposure: burns, ruptures, tissue damage, limb avulsions, current exposure (traumatic shock);

2. Concomitant trauma loss of blood in large quantities (hemorrhagic shock);

3. Transfusion to the patient incompatible blood in large volume;

4. Entry of allergens into a sensitized environment (anaphylactic shock);

5. Extensive necrosis of the liver, intestines, kidneys, heart; ischemia.

Diagnosis of shock in a person who has suffered a shock or injury can be based on the following signs:

• anxiety;
• blurred consciousness with tachycardia;
• reduced blood pressure;
• disturbed breathing
• reduced volume of urine;
• skin is cold and moist, marbled or pale cyanotic

Clinical picture of shock

The clinical picture of shock differs depending on the severity of the impact. external stimuli. To correctly assess the condition of a person who has undergone shock, and to provide assistance for shock, several stages of this condition should be distinguished:

1. Shock 1 degree. A person retains consciousness, he makes contact, although the reactions are slightly inhibited. Pulse indicators - 90-100 beats, systolic pressure - 90 mm;

2. Shock 2 degrees. A person's reactions are also inhibited, but he is conscious, correctly answers the questions asked, and speaks in a muffled voice. There is rapid shallow breathing, frequent pulse (140 beats per minute), arterial pressure is reduced to 90-80 mm Hg. The prognosis for such a shock is serious, the condition requires urgent anti-shock procedures;

3. Shock 3 degrees. A person has inhibited reactions, he does not feel pain and is adynamic. The patient speaks slowly and in a whisper, may not answer questions at all, or in monosyllables. Consciousness may be completely absent. The skin is pale, with pronounced acrocyanosis, covered with sweat. The victim's pulse is barely noticeable, palpable only on the femoral and carotid arteries (usually 130-180 bpm). There is also shallow and frequent breathing. Venous central pressure may be below zero or zero, and systolic pressure may be below 70 mmHg.

4. Shock of the 4th degree is a terminal state of the body, often expressed in irreversible pathological changes - tissue hypoxia, acidosis, intoxication. The patient's condition with this form of shock is extremely severe and the prognosis is almost always negative. The victim does not listen to the heart, he is unconscious and breathes shallowly with sobs and convulsions. There is no reaction to pain, the pupils are dilated. In this case, blood pressure is 50 mm Hg, and may not be determined at all. The pulse is also hardly noticeable and is felt only on the main arteries. The skin of a person is gray, with a characteristic marble pattern and cadaver-like spots, indicating a general decrease in blood supply.

Types of shock

The state of shock is classified depending on the causes of shock. So, we can distinguish:

Vascular shock (septic, neurogenic, anaphylactic shock);

Hypovolemic (angidremic and hemorrhagic shock);

Cardiogenic shock;

Pain shock (burn, traumatic shock).

Vascular shock is a shock caused by a decrease in vascular tone. Its subspecies: septic, neurogenic, anaphylactic shock are conditions with different pathogenesis. Septic shock occurs as a result of human infection bacterial infection(sepsis, peritonitis, gangrenous process). Neurogenic shock most often occurs after injury to the spinal cord or medulla oblongata. Anaphylactic shock is a severe form of allergic reaction, which occurs during the first 2-25 minutes. after the allergen enters the body. Substances that can cause anaphylactic shock are plasma and plasma protein preparations, radiopaque and anesthetics, other medicines.

Hypovolemic shock is caused by an acute deficiency of circulating blood, a secondary decrease in cardiac output, and a decrease in venous return to the heart. This shock condition occurs with dehydration, loss of plasma (angidremic shock) and loss of blood - hemorrhagic shock.

Cardiogenic shock is an extremely serious condition of the heart and blood vessels, characterized by high mortality (from 50 to 90%), and occurring as a result of a serious circulatory disorder. With cardiogenic shock, the brain experiences a sharp lack of oxygen due to a lack of blood supply (impaired heart function, dilated vessels that are unable to hold blood). Therefore, a person in a state of cardiogenic shock loses consciousness and most often dies.

Pain shock, like cardiogenic, anaphylactic shock, is a common shock condition that occurs with an acute reaction to an injury (traumatic shock) or a burn. Moreover, it is important to understand that burn and traumatic shock are varieties of hypovolemic shock, because their cause is the loss a large number plasma or blood (hemorrhagic shock). These can be internal and external bleeding, as well as exudation of plasma fluid through burned areas of the skin during burns.

Help with shock

When providing assistance in case of shock, it is important to understand that often the cause of belated shock conditions is improper transportation of the victim and first aid in case of shock, so it is very important to carry out elementary rescue procedures before the ambulance arrives.

Help with shock, is the following activities:

1. Eliminate the cause of shock, for example, stop bleeding, release pinched limbs, extinguish burning clothes on the victim;

2. Check for foreign objects in the mouth and nose of the victim, if necessary, remove them;

3. Check for breathing, pulse, and if necessary, perform a heart massage, artificial respiration;

4. Make sure that the victim lies with his head on his side, so he will not choke on his own vomit, his tongue will not sink;

5. Determine if the victim is conscious and give him an anesthetic. It is advisable to give the patient hot tea, but before that, exclude a wound in the abdomen;

6. Loosen clothes on the belt, chest, neck of the victim;

7. The patient must be warmed or cooled depending on the season;

8. The victim must not be left alone, he must not smoke. Also, you can not apply a heating pad to injured places - this can provoke an outflow of blood from vital organs.

Video from YouTube on the topic of the article:

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 system 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 work of the central nervous system and other vital important 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 events may occur pathological changes. 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.

1. compensated shock. The pressure is within normal limits.
2. Decompensated. Arterial pressure is lowered.
3. 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. 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 when big loss blood, and anhydremic - loss of plasma.

Signs of hypovolemic shock depend on the amount of blood or plasma loss from the body. Depending on the 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. Pallor is diagnosed skin, 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:

1. The duration of the shock is up to five hours. Symptoms are mild, rapid heart rate, systolic pressure - at least ninety units.
2. Duration shock - from five to ten hours. All symptoms are pronounced. The pressure is greatly reduced, the pulse increases.
3. 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 serious condition 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 during 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 provoked 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, elevated temperature body, chills, nausea, vomiting, diarrhea, 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. Anaphylactic reaction The organism can proceed 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 work 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 appear immediately: a sharp decline 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 state that is called severe pain. Usually this situation occurs when: a fall, an injury. If to pain syndrome profuse blood loss is added, 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. Provokes a response: heart attack, hepatic and renal colic, rupture internal organs, gastric ulcer and others.

There are two phases of pain shock:

1. 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.
2. 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 to be given 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 strong pain you can give the victim an analgesic.
• The patient must not be left alone.

General principles of shock therapy:

• The sooner they start medical measures, 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 pathological condition organism caused by stimuli. Shock is a disruption of the adaptive reactions of the body, which should occur in case of damage.

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 the reaction of the body to excessive pain, 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;
• disease complications (stuck food bolus in the esophagus, uterine rupture, ectopic pregnancy, colic in the liver and kidneys, heart attack, perforated stomach ulcer, 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 properly maintain the blood supply to vital organs (brain, heart, lungs, liver, kidneys), 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. This increases blood flow through the 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.

The second to lose muscle tone is the 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 kidney failure in acute form.

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

The first phase of pain shock is excitation, the second is inhibition. Each of them has its own symptoms.

On the 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 lethargy, 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

First, 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. It is not permissible to remove foreign objects from the patient's body before the arrival of doctors!

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:

• bringing the volume of circulating fluid to the desired level (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 introduction 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 Novocain.

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 :one.

During shock of III-IV degree, anesthesia is performed only after the appointment of Polyglukin 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.

Related video

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

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, they are distinguished the following types shock:

• cardiogenic shock, which occurs due to circulatory disorders. In the case of cardiogenic shock due to the lack of blood flow (disturbance in 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, an acute shortage of circulating blood, a decrease in venous return to the heart. Hypovolemic shock occurs when plasma is lost (angidremic shock), dehydration, blood loss (hemorrhagic shock). Hemorrhagic shock can occur when a large vessel is damaged. As a result, blood pressure quickly drops to almost zero. Hemorrhagic shock is observed when the pulmonary trunk, lower or upper veins, aorta are ruptured;
• 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.

The severity of shock is divided into:

• shock of the first degree or compensated - the person's consciousness is clear, he is contact, but a little slow. Systolic pressure more than 90 mm Hg, pulse 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 is preserved. The victim answers correctly, but speaks quietly and slowly. Requires anti-shock therapy;
• 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, pronounced acrocyanosis. The pulse is thready. 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 - a terminal state. The person is unconscious, heart sounds are not auscultated, skin gray color with a marble pattern and stagnant spots, bluish lips, pressure less than 50 mm Hg. Art., anuria, the pulse is barely perceptible, breathing is rare, there are no reflexes and reactions to pain, the pupils are dilated.

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

• 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 a person's life. Traumatic shock occurs with fractures of the pelvic bones, craniocerebral injuries, severe gunshot wounds, abdominal injuries, large blood loss, and operations. The main factors causing 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 that 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 when repeated exposure to an allergen. Development speed anaphylactic shock ranges from a few seconds to five hours from the moment of coming into 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 matters;
• combined.

Help with shock

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

Before the ambulance arrives:

• if possible, try to eliminate the cause of the shock, for example, release pinched limbs, stop bleeding, extinguish clothes burning on a person;
• check the nose, mouth of the victim for the presence of foreign objects in them, remove them;
• check the pulse, breathing of the victim, if such a need arises, then perform artificial respiration, heart massage;
• turn the head of the victim to one side so that he cannot choke on vomit and suffocate;
• find out if the victim is conscious and give him an analgesic. Excluding a wound in the abdomen, you can give the victim hot tea;
• loosen the clothes of the victim on the neck, chest, belt;
• warm or cool the victim depending on the season.

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

Prehospital Ambulance shock includes:

• stop 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 air duct or a Z-shaped tube may be inserted into the victim.

External bleeding must be stopped by applying a tight bandage, tourniquet, clamp on the bleeding vessel, clamping the damaged vessel. If there are signs internal bleeding, then the patient needs to be taken to the hospital as soon as possible for an urgent operation.

Medical care for shock should meet the requirements of emergency therapy. This means that those drugs that have an effect immediately after their administration to the patient should be applied immediately.

If timely assistance is not provided to such a patient, then this can lead to gross disturbances in microcirculation, irreversible changes in tissues and cause 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 aim to increase arterial and venous tone, as well as increase the volume of fluid in the bloodstream.

Since shock can cause different reasons, then measures should be taken to eliminate the causes of such a state and against the development of pathogenetic mechanisms of collapse.

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 reason for its development is a strong 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.

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 injured large arteries 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 is a chain reaction of traumatic conditions that carry severe consequences for the health of the patient and 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.

When 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 volume 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 medium degree the severity of the 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. received injury and unbearable pain provoke an atypical condition in the patient, he may cry, scream, be extremely agitated and even resist the provision of help. 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 may 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 lethargy, he can respond for a long time to question asked and does not immediately understand when addressed to him. 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. Forecast at given state 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:

The harness is applied when arterial bleeding(blood spouts), 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 intramuscular injection analgesics. AT 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 carried out only when, waiting medical care can take a very long time.

Forbidden!

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