Depressed cases of various genesis

Description:

Shock (from English shock — blow, a shock) — the pathological process which is developing in response to influence of extraordinary irritants and followed by progressive disturbance of the vital functions of a nervous system, blood circulation, breath, a metabolism and some other functions. In fact, it is failure of compensatory reactions of an organism in response to damage.

Symptoms of Depressed cases of various genesis:

Criteria of diagnosis:
The diagnosis "shock" is made in the presence at the patient of the following signs of shock:

    * a lowering of arterial pressure and tachycardia (at a torpid phase);
    * concern (an erectile phase across Pirogov) or a black-out (a torpid phase across Pirogov);
    * breath disturbance;
    * reduction of volume of the emitted urine;
    * cold, wet skin with pale cyanochroic or marble coloring.
As circulator disturbances classification provides the following types of shock:

    * hypovolemic;
    * cardiogenic;
    * redistribution (distributive);
    * obstructive.

Clinical classification subdivides shock into four degrees on degree of its weight.

    * Shock of the I degree. Condition of the victim compensated. Consciousness is kept, clear, the patient контактен, is slowed slightly down. The systolic arterial pressure (AP) exceeds 90 mm of a mercury column, pulse is speeded up, 90–100 beats per minute. The forecast is favorable.
    * Shock of the II degree. The victim is slowed down, the integument is pale, cardiac sounds are muffled, pulse frequent – to 140 beats per minute, weak filling, maximum is lowered by the ABP to 90–80 mm of mercury. The shallow breathing which is speeded up consciousness is kept. The victim answers questions correctly, speaks slowly, a low voice. The forecast is serious. Rescue of life requires holding antishock actions.
    * Shock of the III degree. The patient is adynamic, slowed down, does not react to pain, answers questions in monosyllables and extremely slowly or at all does not answer, speaks deaf hardly audible whisper. The consciousness confused or is absent at all. Skin is pale, it is covered cold then, the Crocq's disease is expressed. Cardiac sounds are deaf. Pulse threadlike – 130–180 beats per minute, is defined only on large arteries (sleepy, femoral). Breath is superficial, frequent. Systolic the ABP is lower than 70 mm of a mercury column, the central venous pressure (CVP) is equal to zero or negative. The anury (lack of urine) is observed. The forecast is very serious.
    * Shock of the IV degree is shown clinically as one of terminal states. Cardiac sounds are not listened, the unconscious victim, an integument of gray color acquires the marble drawing with congestive spots of type cadaveric (a sign of decrease in a krovenapolneniye and stagnation of blood in small vessels), lips cyanotic, arterial pressure are lower than 50 mm of mercury., often is not defined at all. Pulse is hardly notable on the central arteries, an anury. Breath is superficial, rare (sobbing, convulsive), scarcely noticeable, pupils are expanded, there are no reflexes and reactions to pain stimulation. The forecast is almost always adverse.

Approximately weight of shock can be determined by Algover's index, that is by the pulse attitude towards value of the systolic ABP. A normal index — 0,54; 1,0 — transition state; 1,5 — heavy shock.

Reasons of Depressed cases of various genesis:

From the modern point of view shock develops according to the theory of a stress of G. Selye. According to this theory, excessive impact on an organism causes in it specific and nonspecific reactions. The first depend on the nature of impact on an organism. The second — only at most influences. Nonspecific reactions at influences of a superstrong irritant received the name of the general adaptation syndrome. The general adaptation syndrome proceeds always the same, in three stages:

  1. the stage of mobilization (alarm) caused by primary damage and reaction to it;
  2. resistance stage which is characterized by the maximum tension of protective mechanisms;
  3. an exhaustion stage, that is disturbance of the adaptive mechanisms leading to development of "adaptation disease".

Thus, shock, on the Selye, is manifestation of nonspecific reaction of an organism to excessive influence.

N. I. Pirogov in the middle of the 19th century defined in a pathogeny of shock of a concept erectile (excitement) and torpid (slackness, catalepsy) phases.

A number of sources  gives classification of shock according to the main pathogenetic mechanisms.

This classification subdivides shock on:

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

Treatment of Depressed cases of various genesis:

Treatment of shock consists of several moments:

  1. elimination of the reasons which caused development of shock;
  2. compensation of deficit of the volume of the circulating blood (VCB), with care at cardiogenic shock;
  3. oxygenotherapy (oxygen inhalation);
  4. therapy of acidosis;
  5. therapy by vegetotropny drugs with the purpose to cause a positive inotropic effect.

In addition apply steroid hormones, heparin and Streptokinasa to prevention of microthrombosis, diuretics for recovery of function of kidneys at the normal ABP, artificial ventilation of the lungs.