First aid at shock

Shock is called the pathological reaction of an organism coming in response to the irritation caused by the injuring factor (or set of factors) the excessive force with which the organism is not able to cope. Shock represents disturbance of the vital functions of an organism and is direct threat of human life.

Types of shock

Depressed case various factors, both external (injury) and internal can cause (disease). Depending on a disturbing factor distinguish several types of shock, the following is basic of which:

• Cardiogenic – develops as a result of disturbance of cordial activity. Can develop at a myocardial infarction, a stenocardia attack, arrhythmias, etc.;
• Hypovolemic – is connected with critical reduction of volume of the blood circulating in a blood channel. Is caused most often by massive blood loss, is more rare – severe dehydration;
• Traumatic – is caused by the injury which is followed by considerable damages of bodies and fabrics. Multiple or just heavy fractures (a change of a basin, a backbone), gunshot wounds, craniocereberal injuries, the combined injury, etc. can be such injury;
• Infectious and toxic – is caused by hit in an organism of excessive amount of the toxins produced by pathogenic microorganisms (bacteria and viruses);
• Septic – is connected with heavy infectious inflammatory process as a result of which the fabric hypoxia – insufficient supply of fabrics with oxygen develops that leads to dysfunction of many vitals at once, so-called multiorgan insufficiency develops;
• Anaphylactic – extreme extent of allergic reaction of immediate type, usually in response to administration of medicine. Is caused by food allergy or hit in a poison organism less often (for example, at stings of insects).

Some researchers also allocate psychogenic shock which results from a heavy mental shock (a grief, horror, despair, etc.).

Most often in practice it is necessary to face cardiogenic and traumatic shock, is more rare – with psychogenic. Shock can be and combined – for example, the depressed case at extensive burns is caused by several factors at once.

There are also other classifications on which we will not stop as they have no relation to first-aid treatment. Let's note only that quite often speak about painful shock. Under this definition traumatic shock most often gets though the megalgia can be caused not only by an injury, but also heart attack (cardiogenic shock at stenocardia), and the getting wound (hypovolemic shock), and acute pathology of internals (a perforation of the ulcer, renal colic, intestinal impassability, etc.).

Degrees of shock and their signs. Shock index

For the correct first-aid treatment at shock it is necessary to define its degree. In total in a depressed case allocate four degrees, but as the last is terminal, i.e. in fact, death of an organism, usually speak about three:

• The I degree - compensation. The victim is in consciousness, is adequate, makes contact, reactions are slowed down, or, on the contrary, overexcitation is noted (can shout, swear). Person pale or red. The upper indicator of pressure (systolic pressure) is higher than 90 mm Hg, pulse of 90-100 blows/min. The forecast at this stage is favorable, all phenomena are reversible, and measures of first aid it can appear enough to normalize the victim. Nevertheless, medical examination is necessary not to be mistaken in definition of degree of shock;
• The II degree – subcompensation. The victim in consciousness, shallow breathing, pulse becomes frequent up to 140 blows/min., weak, the systolic pressure of 80-90 mm Hg. Pallor of integuments, cold sweat, a fever is noted. Reactions are slowed down, but the contact remains, the person answers questions, the speech silent and weak. It is a dangerous stage of shock which demands medical assistance as at an adverse current it can develop in the following stage;
• The III degree – a decompensation. The victim can be both in consciousness, and without it. It is slow-moving if in consciousness, then answers questions with whisper, slowly, in monosyllables, or does not answer at all. Integuments are pale, sometimes with a cyanotic shade, are covered with a cold perspiration, breath frequent, superficial. Systolic pressure of 70 mm Hg and below. The pulse of very weak filling which is speeded up – can reach up to 180 blows/min., is defined only on large arteries (sleepy or femoral). At this stage the emergency medical assistance and resuscitation actions in the conditions of a hospital is necessary for the patient;
• The IV degree – irreversible. A terminal state at which the patient is unconscious integuments of white or gray color, sometimes get a mramornost (uneven tone, coherent with disturbance of blood circulation in capillaries), lips and a nasolabial triangle blue, upper pressure less than 50 mm Hg or is not defined at all, pulse is defined as threadlike and only on large arteries, or is absent. Breath is superficial, uneven, pupils are expanded, reflexes are absent. At this stage the forecast adverse even in the presence of medical care. Despite it, first aid at shock of the IV degree, as well as medical, all the same has to appear as so far the person is living chance of recovery, though small, nevertheless is.

It is not always possible to determine shock degree by external signs therefore for convenience doctors use a so-called index of Algover, or a shock index. It is easy to calculate it in the presence of a tonometer. Algover's index is defined by the pulse relation to an upper (systolic) indicator of arterial pressure. For example, if pulse of 80 blows/min., and systolic the ABP of 120 mm Hg, then Algover's index is defined as 80: 120 = 0,66. The normal indicator is considered 0,5 – 0,7, the indicator 1 is shock of the I degree, an indicator 1,5 – shock of the II degree, an indicator 2 – shock of the III degree. Shock in the IV degree usually does not cause difficulties in definition.

First-aid treatment at shock

The depressed case constitutes serious health hazard, and to truly estimate this danger to the nonspecialist very difficult. Therefore if the victim is shocked or there are bases shock to suspect, it is necessary to call the ambulance immediately. The following signs can form the basis for suspicions:

• Pallor of integuments, cold sweat;
• Pulse of weak fullness, is speeded up, breath differs from normal (can be superficial or on the contrary, forced);
• Faintness, weakness, overexcitation or opposite, block;
• The glassy look, can be focused in one point or slowly move.

It is especially dangerous if such symptoms are observed at the person who had an injury or heart attack.

Waiting for medical assistance as measures of first aid it is necessary to make the following:

1. To terminate the injuring factor if there is bleeding, to try to stop it;
2. To lay the victim so that his legs were a little above the head. It will provide inflow of blood to a brain;
3. As much as possible to facilitate breath. To remove what can prevent breath, weaken hard fasteners, provide inflow of fresh air to the room;
4. To warm the victim, having covered with a blanket;
5. If the person is unconscious, and also in cases when there is a stomatorrhagia or a nose, vomiting or emetic desires, it is necessary to lay the victim on one side or at least to turn on one side his head and to watch that it remained in such situation. It is necessary that the victim did not choke;
6. Before arrival of ambulance not to leave the person of one, to watch his state. In case of the termination of breath or cordial activity immediately to start resuscitation actions (breath of companies - in - a mouth, a mouth - in - a nose, an indirect cardiac massage) and to see them to arrival of the doctor or before recovery of breath and pulse.

What should not be done within first-aid treatment at a depressed case?

Not to aggravate a condition of the victim, giving first aid at shock, it is not necessary to give to the victim of medicine. It concerns any medicines, including anesthetics and drugs supporting cordial activity. Even the most useful of them can distort a clinical picture, without having allowed the doctor adequately to estimate the patient's condition.

It is forbidden to allow to the victim to drink when:

• There was a craniocereberal injury;
• The area of a stomach is injured;
• There is bleeding or suspicion of internal bleeding;
• There is a heartache.

In other cases of the injured person it is possible to give to drink, avoiding at the same time any alcohol-containing and tonics.