Traumatic shock – a pathological state which arises owing to blood loss and a pain syndrome at a trauma and poses a serious threat for the patient's life. Develops at the injuries which are followed by big loss of blood or reduction of amount of plasma: craniocereberal trauma, severe wounds of a neck, breast, stomach or extremities, multiple fractures, freezing injuries, burns etc. Regardless of the reason which caused it, traumatic shock always proceeds "according to one scenario", that is, is shown by the same symptoms. The urgent stop of bleeding, anesthesia and immediate delivery of the patient in a hospital is necessary. Treatment of traumatic shock is carried out in the conditions of intensive care unit and includes a package of measures for compensation of the arisen violations. The forecast depends on weight and the phase of shock, and also from weight which caused it injuries.
Traumatic shock – the serious condition representing reaction of an organism to the sharp trauma which is followed by the expressed blood loss and an intensive pain syndrome. Usually develops right after a trauma and is direct reaction to damage, but under certain conditions (an additional travmatization) can arise and after a while (4-36 hours). Is the state posing a threat for the patient's life and demands urgent treatment in the conditions of intensive care unit.Please Help us - click on the advertisement
Classification of traumatic shock
There are several classifications of traumatic shock depending on the reasons of its development. So, in many Russian governments allocate:
- Surgical shock.
- Shock owing to smashing.
- Shock owing to a burn.
- Shock owing to action of a shock air wave.
- Shock owing to imposing of a plait.
- Endotoksinovy shock.
V. K. Kulagin's classification according to which there are following types of traumatic shock is widely used:
- The wound traumatic shock (arising owing to a mechanical trauma). Depending on localization of damage shares on visceral, pulmonalny, cerebral, at an injury of extremities, at a multiple trauma, at a sdavleniye of soft fabrics.
- Operational traumatic shock.
- The hemorrhagic traumatic shock (developing at internal and external bleedings).
- The mixed traumatic shock.
Regardless of the causes traumatic shock proceeds in two phases:
- Erectile – an organism tries to compensate the arisen violations.
- Torpedo – compensation opportunities are exhausted.
Taking into account weight of a condition of the patient in a torpedo phase allocate 4 degrees of traumatic shock:
- I (easy). The patient is pale, is sometimes slowed a little down. Consciousness is clear. Reflexes are lowered. Short wind, pulse to 100 beats/min.
- II (average weight). The patient is sluggish, slowed down. Pulse of about 140 / min.
- III (heavy). Consciousness is kept, the possibility of perception of the world around is lost. Skin is earthy-gray, lips, a nose and finger-tips are cyanotic. Sticky sweat. Pulse about 160 beats/min.
- IV (preagony and agony). Consciousness is absent, pulse is not defined.
Reasons and mechanism of development of traumatic shock
Traumatic shock develops at all types of severe injuries, regardless of their reason, localization and the mechanism of damage. Knife and gunshot wounds, falling from height, car accidents, technogenic and natural disasters, industrial accidents etc. can become its reason.
Except the extensive wounds with damage of soft fabrics and blood vessels and also opened and the closed fractures of large bones (especially multiple and followed by damage arteries) extensive burns and freezing injuries which are followed by considerable loss of plasma can cause traumatic shock.
Massive blood loss, the expressed pain syndrome, dysfunction of vitals and the mental stress caused by a sharp trauma is the cornerstone of development of traumatic shock. At the same time loss of blood plays the leading role, and influence of other factors can significantly differ. So, at damage of sensitive zones (a crotch and a neck) influence of a painful factor increases, and at a thorax injury the condition of the patient is aggravated with malfunction of breath and providing an organism with oxygen.
The trigger of traumatic shock is substantially connected with blood circulation centralization – a state when the organism directs blood to vitals (to lungs, heart, a liver, a brain, etc.), taking away it from less important bodies and fabrics (muscles, skin, fatty cellulose).
The brain receives signals of shortage of blood and reacts to them, stimulating adrenal glands to throw out adrenaline and noradrenaline. These hormones affect peripheral vessels, forcing them to be narrowed. As a result blood flows from extremities and it becomes enough for work of vitals.
After a while the mechanism begins to glitch. Due to the lack of oxygen peripheral vessels extend therefore blood flows from vitals. At the same time because of violations of fabric exchange of a wall of peripheral vessels cease to react to signals of nervous system and effect of hormones therefore repeated narrowing of vessels does not happen, and "periphery" turns into depot of blood.
Because of the insufficient volume of blood work of heart is broken that aggravates blood circulation violations even more. Arterial pressure falls. At considerable decrease HELL is broken normal work of kidneys, and a bit later – a liver and an intestinal wall. Toxins are thrown out of a wall of guts blood. The situation is aggravated because of emergence of the numerous centers of the fabrics which became lifeless without oxygen and gross violation of a metabolism.
Because of a spasm and increase in coagulability of blood a part of small vessels is corked with blood clots. It becomes the reason of development of the DVS-syndrome (a syndrome of disseminirovanny intra vascular folding) at which fibrillation at first is slowed down, and then practically disappears. At the DVS-syndrome bleeding in the place of a trauma can renew, there is pathological bleeding, multiple small hemorrhages in skin and internals develop.
Everything listed leads to the progressing deterioration in a condition of the patient and becomes the reason of a lethal outcome.Please Help us - click on the advertisement
Symptoms of traumatic shock
The patient is excited in an erectile phase of traumatic shock, complains of pain, can shout or groan. It is disturbing and scared. Aggression, resistance to inspection and treatment is quite often observed. Skin is pale, arterial pressure is a little increased. Tachycardia, (breath increase), trembling of extremities or small twitchings of separate muscles is noted. Eyes shine, pupils are expanded, a look uneasy. Skin is covered cold sticky then. Pulse is rhythmical, body temperature normal or a little raised. At this stage the organism still compensates the arisen violations. Gross violations of activity of internals are absent, there is no DVS-syndrome.
With approach of a torpedo phase of traumatic shock the patient becomes apathetic, sluggish, sleepy and depressive. In spite of the fact that pain during this period does not decrease, the patient ceases or almost ceases to signal about it. He does not shout any more and does not complain, can silently lie, quietly postanyvy, or at all faint. Reaction is absent even at manipulations in the field of damage.
Arterial pressure gradually decreases, and heart rate increases. Pulse on peripheral arteries weakens, becomes threadlike, and then ceases to be defined.
The patient's eyes dim, sunk down, pupils expanded, a stone look, under shadow eyes. The expressed pallor of integuments, a tsianotichnost mucous, lips, a nose and finger-tips is noted. Skin dry and cold, elasticity of fabrics is lowered. Features are pointed, nasolabial folds are maleficiated. Body temperature normal or lowered (also temperature increase because of a wound infection is possible). The patient is beaten by a fever even in the warm room. Spasms, involuntary allocation a calla and urine are quite often observed.
Intoxication symptoms come to light. The patient suffers from thirst, language is laid over, the lips baked, dry. Nausea, and in hard cases even vomiting can be observed. Because of the progressing violation of work of kidneys the amount of urine decreases even at plentiful drink. Urine dark, concentrated, at heavy shock is possible an anury (total absence of urine).Please Help us - click on the advertisement
First aid and treatment of traumatic shock
At a stage of first aid it is necessary to carry out a temporary stop of bleeding (a plait, a hard bandage), to restore passability of airways, to execute anesthesia and an immobilization, and also to prevent overcooling. It is necessary to move the patient very carefully not to allow a repeated travmatization.
In a hospital at the initial stage carry out transfusion salt (, Ringer's solution) and colloidal (, , etc.) solutions. After definition of a Rhesus factor and a blood type continue transfusion of the specified solutions in combination with blood and plasma.
Surgeries carry out according to vital indications in the volume necessary for preservation of activity and prevention of further aggravation of shock. Carry out a stop of bleeding and processing of wounds, blockade and an immobilization of changes, elimination of pheumothorax, etc.
Appoint hormonal therapy, and dehydration, apply medicines to fight against a brain hypoxia, correct exchange violations.