Shock

General information

Shock is a response of an organism to action of external aggressive irritants which can be followed by disturbances of blood circulation, a metabolism, nervous system, breath, other vital functions of an organism.

There are such reasons of shock:

1. The injuries got owing to mechanical or chemical influence: burns, gaps, disturbance of fabrics, separations of extremities, influence of current (traumatic shock);

2. The loss of blood accompanying an injury in large numbers (hemorrhagic shock);

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

4. Hit of allergens on sensibilized Wednesday (acute anaphylaxis);

5. Necrosis extensive liver, intestines, kidneys, heart; ischemia.

It is possible to diagnose shock for the person who transferred a shock or an injury proceeding from the following signs:

• concern;
• the obscured consciousness with tachycardia;
• reduced arterial pressure;
• the broken breath
• the reduced volume of the emitted urine;
• integuments cold and wet, marble or it is pale - cyanochroic color

Clinical picture of shock

The clinical picture of shock differs depending on weight of influence of external irritants. For the correct assessment of a condition of the person who transferred shock and assistance at shock, it is necessary to distinguish several stages of this state:

1. Shock of 1 degree. At the person consciousness remains, he makes contact though reactions are slowed slightly down. Pulse indicators – 90-100 blows, systolic pressure – 90 mm;

2. Shock 2 degrees. Reactions at the person are slowed also down, but he in consciousness, correctly answers the asked questions, talks a vocal murmur. The speeded-up shallow breathing, frequent pulse (140 beats per minute), pressure is observed arterial it is lowered to 90-80 mm hg. The forecast at such shock serious, a state demands urgent holding antishock procedures;

3. Shock 3 degrees. At the person reactions are slowed down, he does not feel pain and is adynamic. The patient slowly and in a whisper talks, can not answer questions in general, or is terse. Consciousness can be absent completely. Integuments are pale, with the expressed Crocq's disease, are covered then. Pulse at the victim hardly noticeable, is probed only on femoral and sleepy arteries (usually 130-180 уд. / mines). Also shallow and frequent breathing is observed. Venous central pressure can be below zero or zero, and systolic pressure – lower than 70 mm hg.

4. Shock 4 degrees is the terminal state of an organism which is expressed often in irreversible pathological changes – a hypoxia of fabrics, acidosis, intoxication. A condition of the patient at such form of shock extremely heavy and the forecast practically always negative. At the victim heart is not listened, he unconscious also breathes superficially with whimpers and spasms. There is no reaction to pain, pupils are expanded. At the same time arterial pressure – 50 mm hg, can also not be defined in general. Pulse is also hardly noticeable and is felt only on the main arteries. Integuments of the person - gray, with the characteristic marble drawing and spots similar on cadaveric, pointing to the general decrease in a krovenapolneniye.

Types of shock

The depressed case is classified depending on shock origins. So, it is possible to allocate:

- Vascular shock (septic, neurogenic, acute anaphylaxis);

- Hypovolemic (angidremichesky and hemorrhagic shock);

- Cardiogenic shock;

- Painful shock (burn, traumatic shock).

Vascular shock is the shock caused by vasodepression. Its subspecies: the septic, neurogenic, acute anaphylaxis is states with a different pathogeny. Septic shock arises owing to infection of the person with a bacterial infection (sepsis, peritonitis, a sphacelism). Neurogenic shock is most often shown after an injury back or a myelencephalon. The acute anaphylaxis is the allergic reaction proceeding in a severe form which arises within the first 2-25 min. after hit of allergen in an organism. The substances capable to cause an acute anaphylaxis are drugs of plasma and plasma proteins, X-ray contrast and anesthetics, other medicines.

Hypovolemic shock is caused by acute shortage of the circulating blood, secondary decrease in emission of heart, decrease in venous return to heart. There is this depressed case at dehydration, plasma loss (angidremichesky shock) and a loss of blood - hemorrhagic shock.

Cardiogenic shock – the critical condition of heart and vessels which is characterized by high mortality (from 50 to 90%), and coming owing to serious violation of blood circulation. At cardiogenic shock the brain due to the lack of blood supply (the broken cardiac performance, the expanded vessels incapable to hold blood), suffers a sharp shortage of oxygen. Therefore the person who is in a condition of cardiogenic shock faints and most often dies.

Painful shock, as well as cardiogenic, acute anaphylaxis – the widespread depressed case arising at acute reaction on traumatized (traumatic shock) or a burn. And it is important to understand that burn and traumatic shock is kinds of shock hypovolemic, loss of a large amount of plasma or blood (hemorrhagic shock) is their reason. It can be internal and outside bleedings, and also exudation of plasma liquid through the burned sites of skin at burns.

The help at shock

Giving help at shock it is important to understand that often wrong transportation of the victim and first-aid treatment is the reason of overdue depressed cases at shock therefore holding elementary rescue procedures before arrival of an ambulance crew is very important.

The help at shock, consists in the following events:

1. To remove the shock cause, for example, to stop bleeding, to release the jammed extremities, to extinguish the clothes burning on the victim;

2. To check existence of foreign objects in a mouth and the victim's nose, if necessary to remove them;

3. To check existence of breath, pulse, and if necessary to carry out a cardiac massage, an artificial respiration;

4. To track that the victim lay the head sideways, so he will not choke with own emetic masses, at him language will not sink down;

5. To establish whether there is a victim in consciousness and to give it anesthetic. It is desirable to give to the patient hot tea, but to exclude before it stomach wound;

6. To weaken clothes on a belt, a breast, the victim's neck;

7. The patient needs to be warmed or cooled depending on a season;

8. The victim it is impossible to leave one, he cannot smoke. Also it is impossible to put a hot-water bottle to the injured places – it can provoke outflow of blood from vital bodies.