Traumatic shock

August 12, 2017 17:51 | Paramedic

Traumatic shock develops as a result of traumatic damage to various organs and body parts, accompanied by pain, blood loss, which appear in severe mechanical damage, poisoning due to absorption of the products of decay of ischemic tissues.Contributing to the development of shock and aggravated it during factors are hypothermia or hyperthermia, intoxication, starvation, overwork.

Serious injuries are the third leading cause of death among the adult population after cardiovascular diseases and malignant neoplasms.The reasons that cause injury are road accidents, injuries after falling from a height, rail injury.Medical statistics show that in recent years polytrauma frequently recorded - injury with damage to several areas.They are characterized by severe impairment of vital body functions, and first of all disorders of blood circulation and respiration.

in the pathogenesis of traumatic shock important place belongs to Blood and plasma, which are accompanied by almost all traumatic injuries.As a result

of damage to vascular injury occurs and increased vascular permeability membranes, which leads to the accumulation of large amounts of blood and plasma in the region of injury.And the severity of the condition of the victim depends not only on the volume of lost blood, but the bleeding rate.Thus, blood pressure is retained at the values ​​of the former to injury when bleeding occurs at a slow rate and volume of blood is then decreased by 20%.At high bleeding rate of circulating blood loss by 30% may result in death of the victim.The reduction in circulating blood volume - hypovolemia - increases the production of adrenaline and noradrenaline, have a direct effect on the capillary circulation.As a result, their impact closed precapillary sphincters and postcapillary expand.Impaired microcirculation causes failures during metabolism, resulting in a large number of selection occurring lactic acid and its accumulation in the blood.Significantly higher amount of unoxidized products leads to the development of acidosis, which in turn contributes to the development of new circulatory disorders and further reduction of the circulating blood volume.Low blood volume can not provide an adequate supply of blood to vital organs, which include primarily the brain, liver, kidneys and brain.Their functions are limited, resulting in irreversible morphological changes develop.

During traumatic shock can be traced to two phases:

• erectile, which comes immediately after the injury.During this period, the consciousness of the victim, or the patient is maintained, marked motor and verbal stimulation, the absence of a critical attitude towards themselves and their surroundings;skin and mucous membranes pale, sweating strengthened, dilated pupils, and respond well to light;blood pressure is normal or is stored may increase, the pulse quickens.Duration erectile shock phase is 10-20 minutes, during which time the patient's condition deteriorates and proceeds to the second phase;

• During the torpid phase of traumatic shock is characterized by a decrease in blood pressure and the development of severe retardation.Changing the status of the victim or patient occurs gradually.In order to assess the patient's condition during the torpid phase of shock it is accepted to focus on the systolic blood pressure level of performance.

I degree - 90-100 m Hg.Article .;while the state of the victim or patient is relatively satisfactory and is characterized by pale skin and visible mucous membranes, muscle tremor;victim consciousness is maintained or slightly inhibited;heart rate to 100 beats per minute, the number of breaths per minute to 25.

II degree - 85-75 mm Hg.Article .;condition of the victim is characterized by clearly pronounced inhibition of consciousness;marked pale skin, cold clammy sweat, drop in body temperature;pulse speeded - up to 110-120 beats per minute, breathing is shallow - up to 30 times per minute.

III degree - pressure below 70 mm Hg.Art., often develops in multiple serious traumatic injuries.Consciousness is affected strongly inhibited, he remains indifferent to the environment and their condition;It does not respond to pain;skin and mucous membranes pale with a grayish tinge;cold sweat;Pulse - 150 beats per minute, breathing is shallow, rapid or, on the contrary, rare;consciousness darkened, pulse and blood pressure are not defined, respiration rare, superficial, diaphragmatic.

Without providing timely and qualified medical care torpid phase ends with a terminal condition, which completes the process of severe traumatic shock, and usually leads to death of the victim.

main clinical signs. Traumatic shock is characterized by inhibited consciousness;pale with a bluish tint color of the skin;circulatory disorders, in which the nail bed becomes cyanotic, pressing a finger blood flow is not restored for a long time;neck and extremities veins are filled and sometimes become invisible;quickens and respiratory rate becomes more than 20 times per minute;It quickens the pulse rate up to 100 beats per minute or higher;systolic blood pressure falls to the level of 100 mm Hg.Art.and lower;There is a sharp cold extremities.All these symptoms are a sign that the body is a redistribution of blood flow, which leads to disruption of homeostasis and metabolic changes, it becomes a threat to the life of the patient or victim.The probability of recovery of disturbed functions depends on the duration and severity of shock.

Shock is a dynamic process, and without treatment or in case of late delivery of health care of its milder forms turn into heavy and even in the category of very serious in the development of irreversible changes.Therefore, the main principle of successful treatment of traumatic shock in victims is to assist in the complex, which includes the identification of violations of the vital functions of the body affected and the implementation of measures which aim to eliminate life-threatening conditions.

Emergency care in the prehospital phase includes the following steps.

• Airway.When providing first aid to the victim, be aware that the most common cause, leading to the deterioration of the affected state is acute respiratory failure resulting from aspiration of vomitus, foreign bodies, blood and cerebrospinal fluid.Head injuries are almost always accompanied by aspiration.Acute respiratory failure develops with multiple fractures of the ribs as a result of gemopnevmotoraksa and severe pain syndrome.In this case the victim develop hypercapnia and hypoxia, which exacerbate the phenomenon of shock, sometimes become a cause of death due to suffocation.Therefore, the first task is assisting the airway.

Respiratory failure, which appeared as a result of suffocation during a severe language zapadenii aspiration, due to the general concern of the victim, sudden cyanosis, sweating, retraction of the chest and neck muscles during inspiration, hoarse and arrhythmic breathing.In this case, providing assistance to the victim should ensure patency of the upper airway.At the same time, it should discard the victim's head back, bring the lower jaw forward and aspirate the contents of the vat of the upper respiratory tract.

• Intravenous infusions of plasma-solutions as possible are carried out simultaneously with the implementation of measures to restore normal ventilation, while depending on the size and volume of blood loss, trauma produce a puncture of one or two veins and begin intravenous infusion solutions.The goal of fluid therapy is to replace blood volume deficit.Indications to top plasma-infusion solutions is to reduce systolic blood pressure below 90 mm Hg.Art.In this case, to replenish blood volume is usually used obemzameschayuschie following solutions: synthetic colloids - polyglukin, polidez, zhelatinol, reopoligljukin;crystalloid - Ringer's solution, laktasol, isotonic sodium chloride solution;salt-free solutions - 5% glucose solution.

In case of inability to use infusion therapy in the prehospital hemorrhage when the victim is placed in a supine position with a lowered head end;in the absence of injuries of upper and lower limbs give him an upright position, which will contribute to an increase in central blood volume.In critical situations, when there is no possibility of infusion therapy, administration of vasoconstrictors shown to increase blood pressure.

• Stop external bleeding, which overlay a tight bandage, hemostat or harness, swabbing the wound, and others. Stop the bleeding contributes to more efficient conduct of infusion therapy.Fast hospitalization is necessary if the victim of internal bleeding, signs of which are pale skin, covered in a cold sweat: a rapid pulse and low blood pressure.

• Pain relief should be performed before removing the victim from under heavy objects, shifting on a stretcher, before applying the transport immobilization and take place only after the implementation of measures to restore vital functions, which include airway reorganization, administration of solutions with large blood loss,stop bleeding.

Provided rapid (1 h) the mask anesthesia used transportation via the AP-1 devices, "Trintal" and the use of local anesthetic methoxyflurane and novocaine and trimecaine.

When transporting long (more than 1 hour) used narcotic and non-narcotic analgesics, as they are used in cases of an accurate diagnosis (such as amputation).As in the acute period of severe trauma absorption from the tissues violated drugs analgesic action are administered intravenously, slowly, under the control of breathing and hemodynamics.

• Immobilization: transportation and removal (removal) of the victim from the scene as quickly as possible and hospitalization.

Fixing damaged limbs prevents the appearance of pain enhancing effects of shock, and is shown in all appropriate cases, regardless of the victim state.It pursues the standard transport bus.

laying victim on a stretcher to transport plays an equally important role in his recovery.In this case the victim is laid so as to avoid aspiration of airway vomit, blood, and others. The victim, who is in the mind, should be put on his back.The patient is unconscious, do not lay a pillow under his head, as in a similar position may airway closure tongue with reduced muscle tone.If the patient or the patient is conscious, he laid on his back.Otherwise, it must be remembered that the decrease in muscle tone language closes the airway, so you should not lay a pillow under the head of the victim or other items.Furthermore, in this position, bent neck bend can cause respiratory tract, and in the event of vomiting will vomit freely enter the respiratory tract.When bleeding from the nose or mouth of the victim lying on his back dripping blood and stomach contents will be free to get into the airway lumen and closing them.This is a very important moment in the affected transport, as according to the statistics about a quarter of all victims in accidents die in the first minutes as a result of the aspiration of the respiratory tract and the incorrect position during transport.And if in this case, the victim survives the first few hours, then later in most cases it develops postaspiratsionnaya pneumonia, is difficult to treat.Therefore, to avoid such complications, the victim in such cases it is advisable to lay on your stomach and see to it that his head was turned to one side.Such a provision will facilitate the outflow of blood from the nose and mouth out, moreover, the language will not interfere with the free breathing of the victim.

position of the victim lying on his side with his head turned to the side will also prevent aspiration of the respiratory tract and the tongue.But to the victim is not able to turn back or face down, the leg on which he was lying, should bend the knee: in this position it will serve as a support to the victim.When transporting the victim should be borne in mind that the wound of the chest in order to facilitate better breathing victim lay, raising the upper body;at the turn of the injured ribs should be put on the affected side, and then the weight will act on the type of tire, preventing painful movements of the ribs while breathing.

Catching transporting the injured from the scene, providing assistance must remember that its purpose is to prevent the deepening of the shock, reducing the severity of hemodynamic and respiratory depression, which pose the greatest danger to the life of the victim.

shock - this is a common reaction to emergency action (injury, allergy).Clinical manifestations: acute cardiovascular failure and always - polyorganic failure.

main link in the pathogenesis of traumatic shock are disorders caused by trauma of tissue blood flow.Trauma leads to disruption of the integrity of the blood vessels, blood loss, which is the trigger mechanism of the shock.There is a shortage of blood volume (CBV), bleeding (ischemia) bodies.At the same time, to hold down the level of blood flow in vital organs (brain, heart, lungs, kidneys, liver) at the expense of others (skin, intestine, etc..), Included compensatory mechanisms, ieredistribution of blood flow occurs.This is called centralization of circulation, whereby some time supported the work of vital organs.

Next compensation mechanism - a tachycardia, which increases the flow of blood through the organs.

But after a while the compensatory nature of pathological reactions take.At the level of the microcirculation (arterioles, venules, capillaries) reduces the tone of capillaries, venules, blood is collected (pathologically deposited) in the venules, which is equivalent to re-hemorrhage, since the area is huge venules.Next lose their tone and capillaries, they dorastyagivayutsya, filled with blood, it comes stagnation, why there are massive microthrombuses - the basis of blood coagulation disorders.There is a violation of the capillary wall permeability, plasma leakage, in place of the plasma blood flows again.This is an irreversible, terminal phase of shock, the tone of the capillaries is not restored, progressive heart failure.

in other organs in shock changes due to reduced blood supply (hypoperfusion) are secondary.The functional activity of the central nervous system is maintained, but the complex functions as cerebral ischemia being violated.

shock is accompanied by respiratory failure, because there is hypoperfusion of the lungs with blood.It begins tachypnea, hyperpnoea as a result of hypoxia.Suffer so-called non-respiratory lung function (filtering, detoxification, blood-forming) in the alveoli and blood circulation, a so-called "shock lung" - interstitial edema.In the kidney, there is first a decrease in urine output, then there is acute renal failure, "shock kidney", as the kidney is very sensitive to hypoxia.

thus quickly formed polyorganic failure, and without urgent action antishock death occurs.

Clinic shock.In the initial period is often observed stimulation, euphoric patient is not aware of the severity of their condition.Art.Art.Art.