Traumatic shock - heavy, life-threatening condition of the patient, which occurs when heavy injuries, operations, which are accompanied by large blood loss.
The main causes and mechanisms of traumatic shock
Distributed domestic expression "painful shock""The death of shock." However, in reality there is no "painful shock" does not exist, and to die from the pain alone - even very strong - a person can not. The true cause of traumatic shock is the rapid loss of a large volume of blood. Moreover, this loss can not be required in the form of an explicit (external) or hidden (internal) bleeding, shock and can cause a massive loss of blood plasma through the burnt skin surface for burns.
The importance for the development of traumatic shockIt is not so much the absolute value of the blood loss, as the rate of blood loss. A quick blood loss the body has less time to adjust and adapt, and the development of shock is more likely, that is why the shock of injury is more likely to major arteries, such as the femur.
Of Powerful pain and neuro-psychological stress associated with injury undoubtedly play a role of shock (although not its main cause) in the development and exacerbate the severity of the shock.
The factors leading to the development of traumaticshock or exacerbate it, are also injury with damage to vital organs (eg, shot in the chest, broken ribs have a breach of respiratory function, traumatic brain injury). In such cases, the severity of the shock is not determined by the quantity of blood loss and the intensity of pain and the nature of the injury and the degree of preservation of function of vital organs.
Quick and massive bleeding or plazmopoteryalead to a sharp decrease in circulating blood volume. As a result, quickly and strongly decreases the blood pressure, worsening the supply of tissues with oxygen and nutrients, growing tissue anoxia. Due to the shortfall in the tissues of oxygen in them accumulate toxic oxidized products of metabolism, toxicity develops. Shortfall tissue glucose and other nutrients leads to their transition to "self" - enhanced lipolysis (fat breakdown).
The organism is trying to cope with the loss of blood andstabilize blood pressure in the blood ejection reacts different vasoconstrictive substances (in particular, epinephrine, norepinephrine, dopamine, cortisol) and peripheral vascular spasm. This may temporarily stabilize the blood pressure on a relatively "acceptable" level, but at the same time further worsen the situation with the supply of peripheral tissues with oxygen and nutrients.
The end result of severe shock without treatment usually agony and death. In the case of relatively netyazhёlogo or moderate shock, in principle, possible self-healing.
Symptoms of traumatic shock
Traumatic shock is usually held in hisdevelopment of two phases, the so-called "erectile" phase of the shock and "torpid" phase. Patients with low body's compensatory capacity erectile phase of shock may be absent or very short (measured in minutes) and shock begins to develop immediately a torpid phase.
In the first, erectile, shock phase the patient is excited, scared, anxious. He can rush, screaming in pain, moan, cry, complain of pain, ask or require analgesic drugs.
In this phase, the body's compensatory potential has not been exhausted, and your blood pressure is often even increased compared with the norm (as a reaction to pain and stress).
In torpid phase of shock, the patient ceases to scream,moan, cry, rush of pain, is not asking for anything, it does not require. He slowed down, sluggish, apathetic, sleepy, depressed, can be in complete prostration or lose consciousness. Blood pressure is reduced, sometimes to a critically low numbers or not is determined by measuring on peripheral vessels. The eyes of the patient with torpid shock fade, lose their luster, sunken look. Pupils dilated. Body temperature may be normal, increased (accession of wound infection) or slightly decreased to 35.0-36.0? C ( «energy depletion" fabrics). Noteworthy is the sharp pallor patients, cyanosis (cyanotic) lips and other mucous membranes.
The phenomena of intoxication - lips dry, parched, heavily coated tongue, the patient tormented constant thirst, nausea. Vomiting may occur.
Therapeutic measures in traumatic shock
It should try as best you can and fullerstop the bleeding, it is necessary to press a finger bleeding largest vessel above the injury site, apply a pressure bandage (venous or capillary bleeding) or harness (with arterial bleeding), zatamponirovat open wound swabs with 3% hydrogen peroxide (exerting hemostatic effect). If there is a hemostatic sponge or other means to stop bleeding fast, suitable for use by non-specialist - to use them.
We should not, as a layman, to try to retrieve the knife, splinter, etc. -.. Manipulation of this kind can cause heavy bleeding, pain and aggravate shock.
In cold weather, the patient with shock should be warmshelter and as soon as possible to bring in a warm room or car interior heated (patients with shock are very sensitive to hypothermia). It is important to generously (often, but small portions - swallow to vomit or increased nausea) to water the patient. Moreover, it is necessary to drink more than the patient himself wants or asks (as much as he physically can drink). To begin it is necessary to drink before thirst and development of signs of intoxication such as dry lips and coated tongue. Thus it is better not to drink plain water and special water-salt solution containing all the necessary body salts (the way otpaivat with diarrhea - type rehydron or Ringer's solution). You can drink sweet tea, juice, fruit drinks, mineral water or a salt to a concentration of saline normal water. You can give a little bit of alcohol (provided that the patient previously "familiar" with alcohol and carries it properly - otherwise, and half a glass of vodka can sometimes kill).
Fractures, dislocations need to be carefully immobilized on the tires (any suitable boards), to relieve pain and prevent blood from entering the tiny pieces of tissue (bone marrow, adipose tissue).
Patients with shock should be transported inthe nearest hospital as quickly as possible, but at the same time to comply with reasonable care and try not to shake the car down the road, so as not to increase the pain, not to provoke a resumption of bleeding and worsen shock.
If possible, provide affordablelayman anesthesia - sprinkle "freeze" or to apply to the wound cold (ice pack or cold water) to 1-2 tablets of any available handy non-narcotic analgesics such as dipyrone, aspirin, ketorolac (provided that the patient is not allergic to them ) or that it is better to inject non-narcotic analgesic. It is preferred to give a non-narcotic analgesic powerful example ketorol.