Inhibited state after shock 5. Shock states of various origins. stage - torpid

Shock conditions are acute severe pathological processes, which can be caused by trauma, infection, poisoning. They are designed to support life, but if rescue is not started in time, they can cause irreversible, lethal damage.

general description

The most famous doctor - N. Burdenko - described shock, not as a stage of dying, but as a struggle of an organism striving to survive. Indeed, in this state, the metabolism slows down, brain activity decreases, arterial pressure, temperature. All forces are directed to maintaining the life of the most important organs: brain, liver, lungs.

However, unfortunately, human body not adapted for a long stay in a state of shock. The redistribution of blood flow and the resulting lack of nutrition and respiration of peripheral tissues inevitably cause cell death.

The task of a person who finds himself next to a patient who develops shock is call immediately ambulance . The sooner resuscitation begins, the more chances the patient has to survive and restore health.

Causes of shocks

Doctors distinguish the following types of shock conditions:

• Hypovolemic shock - with a sharp loss of a large volume of fluid;
• Traumatic - in case of injury, burns, electric shock, and so on;
• Painful endogenous - with acute pain associated with pathologies internal organs(nephrogenic, cardiogenic, and so on);
• Infectious-toxic - with acute poisoning substances released by microorganisms;
• Anaphylactic - when substances that cause an acute and powerful allergic reaction enter the body;
• Post-transfusion - after an injection.

It is easy to see that in each case, the shock may have several causes. For example, with an extensive burn, both acute loss of fluid and unbearable pain are observed, and intoxication develops.

It is more important for us to know how the state of shock develops, what are its external signs- symptoms.

Stages of shock

Excitation stage

This period usually goes unnoticed. It is characterized by an increase in the patient's activity, increased breathing, and an accelerated heartbeat. In this state, the patient can make some efforts to save his life. But the duration of this stage is short.

Deceleration stage

It is this state that becomes noticeable to others. The mechanisms of its development are as follows:

Activity slows down various departments brain. The victim becomes lethargic, sleepy, loses consciousness.

The circulating blood is redistributed - its main volume flows to the internal organs. At the same time, the heartbeat increases, but the strength of myocardial contractions decreases. blood vessels constrict to maintain normal pressure. But such a state is replaced by an overstrain of the vascular wall - at some point, the vessels relax, and the pressure drops critically. In parallel, the human blood thickens (DIC). On the late stage the reverse state may occur - critical inhibition of coagulation. The skin of a person becomes pale, marble, the limbs become cold, the lips turn blue. Breathing shallow, weak. Rapid but weak pulse. Convulsions are possible.

terminal stage

Stop normal metabolic processes leads to tissue damage and dysfunction of internal organs. The more systems damaged, the less hope for saving lives and restoring health.

hypovolemic shock

Associated with sudden loss of body fluids. In this regard, the volume of circulating blood decreases, the water-salt (electrolyte) balance is disturbed. It can occur not only with bleeding (injuries, internal bleeding), but also severe vomiting, profuse diarrhea, excessive sweating, overheating.

Hypovolemia - the most common state of shock in children of the first years of life (especially infants). Often, parents do not realize that a few episodes of vomiting or diarrhea, even when in a hot and stuffy room, the baby can lose a significant amount of fluid. And this state can lead to shock and the most tragic consequences.

You need to understand that when vomiting, loose stool, increased sweating removes important trace elements from the body: potassium, sodium, calcium. And this affects all systems - the tone of the muscles (including those that ensure the functioning of internal organs) and the transmission of nerve impulses are disturbed.

The rate of fluid loss plays an important role in the development of shock. In infants, even a single dose (about 200 ml) can cause severe hypovolemia.

Symptoms of hypovolemia are: pallor and cyanosis of the integument, dryness of the mucous membranes (tongue, like a brush), cold hands and feet, superficial breathing and palpitations, low blood pressure, apathy, lethargy, lack of reactions, convulsions.

Parents should always monitor the drinking regimen of the child. Especially during periods of illness, in hot weather. If the baby has diarrhea or vomiting, you should immediately consult a doctor. It's best to call an ambulance. The fastest and most complete lost fluid is restored with intravenous administration.

burn shock

Has its characteristics. initial stage excitation lasts noticeably longer. At the same time, blood pressure remains normal or even elevated. This is due to a significant concentration of adrenaline, which is released into the blood during stress and due to severe pain.

When tissue is damaged high temperature gets into the blood a large number of potassium, which adversely affects nerve conduction and heart rate, the state of the kidneys.

Through the burned integument, a person loses a critical volume of plasma - the blood thickens sharply, blood clots appear that can block the flow of blood to vital organs.

When it comes to children in the first three years of life, any burn is a reason for urgent medical attention. In case of electrical injury, patients of any age are hospitalized.

Percentages are used to estimate the area of ​​the burn - 1% is equal to the area of ​​\u200b\u200bthe palm of the victim. If 3% or more of the body is burned, in order to avoid severe consequences should seek medical attention.

Cardiogenic shock

Associated with acute violation work of the heart. Causes causing similar condition may be different:

• myocardial infarction,
• congenital heart disease,
• trauma and so on.

At the beginning, the patient experiences a lack of air - he begins to cough, tries to take a sitting position (the most comfortable for forced breathing). The skin is covered with cold sweat, the hands and feet become cold. Possible heart pain.

As cardiogenic shock develops, breathing becomes even more difficult (pulmonary edema begins) - it becomes bubbling. Mucus appears. Sharply increasing edema is possible.

Anaphylactic shock

Another common type of shock. Is allergic reaction immediate type that occurs upon contact (often during or immediately after injection) With active substances- medicines, household chemicals, food and so on; or when bitten by an insect (more often, bees, wasps, hornets).

A huge number of compounds are released into the blood, causing inflammatory response. including histamine. Because of this, there is a sharp relaxation vascular walls- the volume of the bloodstream critically increases, despite the fact that the volume of blood does not change. The pressure drops.

An outside observer may notice the appearance of a rash (urticaria), difficulty breathing (due to swelling respiratory tract). Pulse - rapid, weak. Arterial pressure is sharply reduced.

The victim needs immediate resuscitation.

Infectious-toxic shock

It develops in acute poisoning of the body with toxins secreted by microorganisms, and the decay products of the microorganisms themselves. It is especially important for parents of young children to be aware of this condition. After all, in babies, such a shock can also occur when (dangerous toxins are released, diphtheria bacillus and other bacteria).

Children's body is not balanced in comparison with adults. Poisoning quickly leads to disorders of the autonomic vascular system(reflex), cardiovascular activity. It is important to understand that tissues deprived of sufficient nutrition produce their own toxins. These compounds increase poisoning.

Symptoms may vary. In general, it corresponds to other shock states. It is important that parents are aware of the possibility of such a condition and correctly assess increased arousal or lethargy, pallor, cyanosis, marbling of the skin, chills, muscle twitching or convulsions, tachycardia.

What to do with any shock?

In all the above descriptions, the most frequent species shocks, we mentioned the main thing to do: ensure the provision of full medical care.

Nothing to look forward to: call an ambulance immediately or take the victim to the hospital yourself (if it's faster!). When self-transporting, choose a hospital where there is an intensive care unit.

It's okay if you confuse shock with a less dangerous condition. If you simply observe the patient, try to help him on your own, it is possible that irreversible damage and death will occur.

Modern man constantly experiences a state of stress. Sometimes, when the shock is too great, we say that we are in a state of shock. This is of course not true. Our body has a natural ability to deal with stress successfully.

But sometimes there are situations of severe shock when natural compensatory mechanisms cannot cope with stress and simply fail. This causes a breakdown, which is called a shock state (shock).

Very often there is a state of shock after an accident, an accident. In this case, several severe stresses suddenly arise at once, to which the body does not have time to prepare and adapt in time.

Unexpectedly arising stresses after an accident include - the unexpectedness of the incident, pain, the presence of injuries, unpreparedness for such a situation, a feeling of hopelessness of the situation. All these factors provoke a depressed state of the victim. In the body of a person experiencing shock, they begin to produce harmful substances.

In addition, there is an imbalance of all systems, organs, which begin to work in an unstable, stressful mode. First, the body makes attempts to deal with negative environmental factors. If this struggle is not supported in time, it gradually decreases, disappears, and is replaced by a state of shock.

In the event of an accident, this condition is the reaction of the body of the victim to the injury and is great danger, as it provokes even worse deterioration general condition the victim. Shock after an accident can occur immediately after it, or after a few hours.

Degrees of severity of shock conditions

First degree of severity

With this degree, a person is conscious, can communicate with others, although a slight inhibition of reactions and actions is noticeable. Blood pressure may decrease, pulse - from 90 to 100 beats per minute. The first degree of severity of shock usually has a favorable prognosis.

Second degree of severity

The victim is conscious, but there are slow reactions, poor contact with others. A person can correctly answer questions, while the voice is quiet, answers slowly. The skin is pale, especially lips, fingers, nose, auricles. Systolic blood pressure may be 80 mmHg. The prognosis of the condition is dangerous, it is necessary to carry out urgent anti-shock actions.

Third degree of severity

The victim is conscious. However, most often the posture is motionless, there is no contact with others, or they are very inhibited. The person does not respond to pain. The skin of the lips, fingers, earlobes are pale.

Systolic blood pressure is about 70 mm, diastolic may be near zero, or show negative meaning. The pulse is up to 180 beats per minute, and is felt only on large arteries.
The prognosis of the condition is very dangerous. It is necessary to carry out urgent anti-shock measures.

Fourth degree of severity

In this case, the victim is unconscious. The skin is very pale, reactions to pain absent, the skin becomes covered with gray (cadaverous) spots, due to a decrease in the amount of blood in the cells of the body, the brain. In addition, this occurs due to stagnation in the capillary vessels.

The patient's pupils are dilated. Systolic pressure is 50 mmHg diastolic pressure may be near zero or even negative. The pulse is weak, palpable in the large arteries. Breathing is weak, sobbing, convulsive. The prognosis of the condition is very unfavorable.

How to recognize a state of shock and provide the necessary assistance?

It often happens that after an accident, a person has no visible injuries, but he is most likely in a state of shock. How to recognize it?

Usually, being in a state of shock, a person is somewhat inhibited. He may appear unnaturally calm, answering questions addressed to him slowly, with effort, after some time. The skin is pale, the pulse is rapid. These are all signs of first degree shock.

In this state, you need to try to protect the victim from others, take him to a quiet place, provide him with a warm drink (if you are sure that the digestive organs are not damaged), let him warm up, lie down calmly. Inspect the victim for hidden injuries, damage. The fact is that in a state of shock, a person may inadequately assess the situation, not notice his own injuries. In any case, the victim should be taken to the hospital.

In the case of more serious shock conditions, characterized by severe lethargy, a significant drop in blood pressure, loss of consciousness, it is necessary to immediately call an emergency medical team. This must be done even if the victims of the accident do not have visible damage.

In our life full of dangers, each person should be able to correctly assess the situation, learn how to provide first aid to save the life of the victim during an accident. Such skills are an indicator of the psychological, moral, social responsibility of a person. Therefore, do not be indifferent to others and treat yourself responsibly. And, of course, do not violate the rules of an accident, do not get into emergency situations.

- This is a pathological condition that occurs due to blood loss and pain in trauma 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. An urgent stop of bleeding, anesthesia and immediate delivery of the patient to the hospital is necessary. Traumatic shock is treated under conditions intensive care unit and includes a set of measures to compensate for violations that have occurred. The prognosis depends on the severity and phase of the shock, as well as the severity of the trauma that caused it.

ICD-10

T79.4

General information

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

The reasons

Traumatic shock develops in all types severe injuries, regardless of their cause, localization and mechanism of damage. It can be caused by stab and gunshot wounds, falls from a height, car crashes, man-made and natural disasters, industrial accidents, etc. In addition to extensive wounds with damage to soft tissues 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 a significant loss of plasma.

The development of traumatic shock is based on massive blood loss, expressed pain syndrome dysfunction of vital organs and mental stress, conditioned acute injury. In this case, blood loss plays a leading role, and the influence of other factors can vary significantly. So, 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 respiratory function and oxygen supply to the body.

Pathogenesis

The trigger 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.), removing it from less important organs and tissues (muscles, skin, adipose tissue). The brain receives signals about the lack of blood and responds to them by stimulating the adrenal glands to release adrenaline and norepinephrine. These hormones act on peripheral vessels, causing them to constrict. As a result, the blood flows from the limbs and it becomes enough for the functioning of the vital organs.

After a while, the mechanism starts to fail. Due to the lack of oxygen, peripheral vessels dilate, so blood flows away from vital organs. At the same time, due to violations of tissue metabolism, the walls of peripheral vessels cease to respond to signals nervous system and the action of hormones, so there is no re-constriction of blood vessels, and the "periphery" turns into a blood depot. Due to insufficient blood volume, the work of the heart is disrupted, which further exacerbates circulatory disorders. The blood pressure drops. With a significant decrease in blood pressure, the normal work kidneys, 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 tissues that have become dead without oxygen and a gross metabolic disorder.

Due to spasm and increased blood clotting, some of the small vessels are clogged with blood clots. This causes the development of DIC (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 lethal outcome.

Classification

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

• Wound traumatic shock (resulting from mechanical trauma). Depending on the location of the damage, it is divided into visceral, pulmonary, cerebral, with an injury to the limbs, 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 disorders 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 (easy). The patient is pale, 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 about 140 beats / min.
• III (severe). Consciousness is preserved, the possibility of perception of the surrounding world is lost. The skin is earthy gray, the lips, nose and fingertips are cyanotic. Sticky sweat. The pulse is about 160 beats / min.
• IV (pre-agony and agony). Consciousness is absent, the pulse is not determined.

Symptoms of traumatic shock

In the erectile phase, the patient is agitated, complains of pain, and may scream or moan. He is anxious and scared. Often there is aggression, resistance to examination and treatment. The skin is pale, blood pressure is slightly elevated. There is tachycardia, tachypnea (increased breathing), trembling of the limbs or small twitches individual muscles. The eyes are shining, the pupils are dilated, the look is restless. The skin is covered with cold clammy sweat. The pulse is rhythmic, body temperature is normal or slightly elevated. At this stage, the body still compensates for the violations that have arisen. There are no gross violations of the activity of internal organs, there is no DIC.

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 ceases or almost ceases to signal 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 on the peripheral arteries weakens, becomes thready, and then ceases to be determined.

The patient's eyes are dim, sunken, the pupils are dilated, the gaze is motionless, shadows under the eyes. There is a pronounced pallor of the skin, cyanosis of the mucous membranes, lips, nose and fingertips. The skin is dry and cold, tissue elasticity is reduced. Facial features are sharpened, nasolabial folds are smoothed out. The body temperature is normal or low (it is also possible to increase the temperature due to a wound infection). The patient is chilled even in a warm room. Often there are convulsions, involuntary excretion of feces and urine.

Symptoms of intoxication are revealed. The patient suffers from thirst, the tongue is lined, the lips are parched and dry. Nausea and, in severe cases, even vomiting may occur. Due to the progressive deterioration of the kidneys, the amount of urine decreases even with plentiful drink. Urine dark, concentrated, anuria possible in severe shock ( complete absence urine).

Diagnostics

Traumatic shock is diagnosed when the corresponding symptoms are identified, the presence of a fresh injury or other possible cause occurrence of this pathology. To assess the condition of the victim, periodic measurements of the pulse and blood pressure are performed, prescribe laboratory research. Scroll diagnostic procedures determined pathological condition that caused the development of traumatic shock.

Treatment of traumatic shock

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

In the hospital for initial stage resuscitators-anesthesiologists transfuse saline (lactasol, Ringer's solution) and colloidal (rheopolyglucin, polyglucin, gelatinol, etc.) solutions. After determining the Rh and blood group, the transfusion of these solutions is continued in combination with blood and plasma. Ensure adequate breathing using airways, oxygen therapy, tracheal intubation, or mechanical ventilation. Continue anesthesia. 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 save life and prevent further aggravation of shock. They stop bleeding and treat wounds, blockade and immobilization of fractures, eliminate pneumothorax, etc. Hormone therapy and dehydration are prescribed, drugs are used to combat cerebral hypoxia, and metabolic disorders are corrected.

Description:

Shock (from English shock - blow, shock) - pathological process, developing in response to exposure to extreme stimuli and accompanied by progressive impairment of vital important functions 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 retarded skin covering pale, muffled heart sounds, frequent pulse - up to 140 beats per minute, weak filling, maximum blood pressure 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 heard, the victim is unconscious, skin gray color acquires a marble pattern with stagnant spots of the cadaveric type (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 to cause a positive inotropic effect.

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