Shock is a state of dangerous and profound depression of the vital functions of the human body, including its consciousness, in response to the impact of the strongest environmental irritants or disruption of internal biochemical, psychoemotional processes. There are a lot of types of shock, basically they are classified by the nature of damaging factors. Most often practicing physicians have to meet in the fight with cardiogenic and traumatic shock.
Today, the subject of our consideration will be the first emergency aid for cardiogenic and traumatic shock.
CONTENTS
Shock: cardiogenic and traumatic, causes, symptoms
Shock state develops when exposed to extreme pain stimuli:
- traumatic external injuries: stroke, fracture, dislocation, burn, prolonged compression of tissues;
- after blood transfusion with incompatible group,
- serum administration, medications for intolerance,
- large blood loss,
- myocardial infarction - cardiogenic shock,
- other causes.
A shock is a heavier condition than collapse.
When the patient is sick:
- languid,
- is apathetic,
- is indifferent to the environment,
- almost does not complain of pain.
Other symptoms:
- skin patches of the patient are pale,
- face is covered with cold sweat,
- is noted rare, shallow breathing,
- small frequent pulse,
- low blood pressure.
In the initial stages of shock, consciousness is preserved.
These symptoms can be expressed in varying degrees depending on the stage of shock.
Cardiogenic shock: first emergency
I quote the sequence of therapeutic measures for cardiogenic shock:
- Pain relief of the .Since the intense pain syndrome that occurs with myocardial infarction is one of the reasons for lowering blood pressure, you need to take all measures to quickly and completely stop it.
- Heart rate normalization .Stabilization of hemodynamics is impossible without eliminating cardiac rhythm disturbances, since an acute onset of tachycardia or bradycardia in conditions of myocardial ischemia leads to a sharp decrease in impact and minute ejection. The most effective and safe way to stop tachycardia at low arterial pressure is electropulse therapy. If the situation allows for drug treatment, the choice of an antiarrhythmic drug depends on the type of arrhythmia. With bradycardia, which, as a rule, is caused by an acute atrioventricular blockade, the only effective remedy is endocardial pacemaking. Injections of atropine sulfate most often do not give a significant and lasting effect.
- If, after eliminating the pain syndrome and normalizing the frequency of ventricular contraction, the arterial pressure does not stabilize, this indicates the development of true cardiogenic shock .In this situation, it is necessary to increase the contractile activity of the left ventricle, stimulating the remaining viable myocardium. For this, sympathomimetic amines are used: Dopamine ( Dopamine ) and Dobutamine ( Dobetrex ), selectively acting on beta-1-adrenergic receptors of the heart.
Dopamine is administered intravenously by drip. For this, 200 mg( 1 ampoule) of the drug is diluted in 250-500 ml of 5% glucose solution. The dose in each specific case is selected experimentally, depending on the dynamics of blood pressure. Usually start with 2-5 μg / kg per 1 minute( 5-10 drops per 1 minute), gradually increasing the rate of administration until stabilization of systolic blood pressure at a level of 100-110 mm Hg. Art.
Dobutrex is available in 25 ml vials containing 250 mg of dobutamine hydrochloride in lyophilized form. Before use, the dry substance in the vial is dissolved by adding 10 ml of the solvent, and then diluted in 250-500 ml of 5% glucose solution. Intravenous infusion begins with a dose of 5 μg / kg per 1 minute, increasing it until the appearance of a clinical effect. The optimal speed of administration is selected individually. It rarely exceeds 40 mcg / kg per 1 min, the effect of the drug begins 1-2 minutes after administration and very quickly stops after its termination due to a short( 2 min) half-life.
Nonspecific anti-shock measures
Simultaneously with the introduction of sympathomimetic amines for the purpose of influencing various parts of the pathogenesis of shock, the following drugs are used:
- glucocorticoids: Prednisolone - 100-120 mg intravenously;
- Heparin - 10,000 units of intravenous injection;
- Sodium bicarbonate - 100-120 ml of 7.5% solution;
- Reopoliglyukin - 200-400 ml, if the administration of large amounts of fluid is not contraindicated( for example, when a shock is combined with pulmonary edema);
- in addition, oxygen inhalation is performed.
Despite the development of new approaches to the therapy of cardiogenic shock, mortality in this complication of myocardial infarction ranges from 85 to 100%.
Therefore, the best "treatment" of shock is its prevention, which consists in rapid and complete relief of pain syndrome, heart rhythm disturbances and limitation of the heart attack zone.
Traumatic shock: first emergency care
In case of traumatic shock, as with any other types of shock, first aid is to eliminate the cause of shock .
The patient is given a sniff of ammonia, warmers, give tea, coffee, alcohol, vodka, Analgin, Amidopyrin( if necessary, Promedol or Morphine) and always call an ambulance.
If fractures, if immobilization was not performed before, do it.
With anaphylactic shock , it is necessary to stop the administration of the allergenic substance, apply a tourniquet to the limb( if we inject the drug into the hand), inject epinephrine( 0.5 ml), or inject 1 ml of dexamethasone intramuscularly.
When bleeds , a pressure bandage is applied from the superficial vessels, with a bleeding from deeper vessels - a tourniquet( center of the lesion over the clothing).If the tourniquet was applied earlier, but the bleeding continues, you must apply another tourniquet slightly higher than the first, and then remove the first tourniquet.
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Source: YNGorgov. Official and traditional medicine. The most detailed encyclopedia.- Moscow: Izd-vo Eksmo, 2012.
