In medical terminology under the traumatic shock defines the concept of a generalized response to a severe mechanical trauma , regardless of the cause of its origin, or the etiology of injury. Thus, causes of the occurrence of a shock state in the case of injuries are diverse .
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Traumatic shock: possible causes
Traumatic shock or painful shock , is consequence obtained fractures of the skull, thorax, pelvic bones or extremities, injuries of the abdominal cavity, which led to large blood loss and strongertheir pain. The occurrence of traumatic shock does not depend on the mechanism of injury and can be caused by:
- accidents in railway or road transport;
- violations of safety rules at work;
- natural or man-made disasters;
- falls from a height;
- with knife or gunshot wounds;
- thermal and chemical burns;
- frostbite.
Shock state of the body in case of trauma is one of the most dangerous conditions, requiring immediate emergency first aid measures according to the accepted standard of medical algorithm of actions in these situations.
Question : "Can I die from a painful traumatic shock?"
Answer : "Yes, perhaps, because not only the nerve fibers of the damaged organism continuously signal to the brain, painful impulses of pain, causing unbelievable suffering to the injured, but also the expiration of bloodfrom the body, and other pathological processes associated with the traumatic features inhibit the activity of the respiratory system, the heart and other. .. "
" And remember that there is such a thing as " post-traumatic shock ", which does not always have obvious signs, it is nevertheless also dangerous, it develops some time after getting injured."
Traumatic shock: classification - types of shock
Also widely used classification of traumatic shock according to Kulagin, according to which there are following its types:
- operating;
- turnstile;
- wounded. Occurs because of a mechanical trauma( depending on the injury site, divided into cerebral, pulmonary, visceral);
- hemorrhagic( develops with external and internal bleeding);
- is hemolytic;
- mixed.
Phases of traumatic shock: stages - erectile and torpid
Two phases( stages of traumatic shock) are distinguished, which are characterized by different signs:
Erectile ( excitation).The victim is in an alarming state at this stage, he can rush about, cry. Experiencing strong pain, the patient signals this in all ways: facial expressions, screaming, gestures. In this case, a person can be aggressive.
Torpid ( braking).The victim in this phase becomes depressed, apathetic, listless, drowsiness. Although the pain syndrome does not pass, he ceases to signal about it. The arterial pressure begins to decrease, the heart rate increases.
Degrees of traumatic shock: signs of shock state
Given the severity of the victim's condition, 4 degrees of traumatic shock are distinguished:
Mild degree: signs of
- can develop against a background of fractures( pelvic injuries);
- the patient is afraid, contact, but at the same time a little inhibited;
- the skin becomes white;
- reflexes are reduced;
- appears cold sticky sweat;
- the mind is clear;
- there is a tremor;
- pulse reaches 100 beats per minute;
- heart palpitations.
Moderate: symptoms of
- develop with multiple fractures of ribs, tubular long bones;
- patient hindered, sluggish;
- pupils dilated;
- pulse - 140 beats / min;
- marked cyanosis, pallor of the skin, adynamia.
Severe: manifestations of
- are formed when the skeleton is damaged and burns;
- consciousness saved;
- trembling of the limbs;
- cyanotic nose, lips, fingertips;
- skin is earthy-gray;
- the patient is deeply retarded;
- pulse is 160 beats per minute.
The fourth degree( terminal phase) of the
- is unconscious;
- blood pressure is below 50 mmHg.p.
- for the patient is characterized by cyanotic lips;
- gray skin;
- pulse barely perceptible;
- superficial rapid breathing( tachypnea);
- must provide first aid.
Traumatic shock: characteristic features of
Often the symptoms of pain can be determined visually. The victim's eyes become dim, sunken, the pupils widen. Pale skin, cyanotic mucous( nose, lips, fingertips) is noted.
The patient may moan, scream, complain of pain. The skin becomes cold and dry, the elasticity of the tissues decreases. The body temperature decreases, while the patient chills.
Other main symptoms of traumatic shock:
- severe pain;
- massive blood loss;
- mental stress;
- convulsions;
- appearance of spots on the face;
- tissue hypoxia;
- can rarely be an involuntary discharge of urine and feces.
Erectile shock phase
With a sudden single-stage excitation of the nervous system, triggered by trauma, there is an erectile phase of shock.
The victim is conscious at this stage, but at the same time underestimates the complexity of his situation. He is excited, can adequately answer questions, but the orientation in space and time is broken. The look is restless, eyes shine.
The duration of the erectile stage varies from 10 minutes to several hours.
The traumatic phase is characterized by the following symptoms:
- rapid breathing;
- pale skin;
- marked tachycardia;
- by a fine twitching of muscles;
- shortness of breath.
Torpid phase of shock
As the increase in circulatory failure increases, the torpid phase of shock develops.
The patient has a pronounced inhibition, while he has a pale appearance. The skin acquires a gray shade or a marble pattern, which indicates a stagnation in the vessels.
At this stage, the limbs become cold, and the respiration is shallow, rapid. There is a fear of death. Other symptoms of pain shock in the torpid phase:
- skin dryness;
- cyanosis;
- weak pulse;
- dilated pupils;
- intoxication;
- reduced body temperature.
Causes of traumatic shock
As we have already said, a traumatic condition occurs as a result of severe damage to the human body:
- extensive burns;
- gunshot wounds;
- craniocereberal trauma( falls from height, accidents);
- severe blood loss;
- surgical intervention.
- Other causes of traumatic shock:
- intoxication;
- overheating or subcooling;
- DIC-Syndrome;
- fasting;
- vasospasm;
- is an allergy to insect bites;
- overstrain.
First aid for traumatic shock: the algorithm of emergency treatment
As you understand, the algorithm of first aid in case of traumatic shock to the victim for a simple passer-by or for a person with a medical background and practical skills that have witnessed the accident will be different.
The task of passer-by : to help the victim, as far as possible, to provide a temporary stop of bleeding, minimize the aggravation of traumatic injuries, instruct someone, call for an emergency ambulance!
Remember! In no case can you independently fix damaged limbs, without the absolute need to move the wounded. Not having eliminated bleeding, it is impossible to impose the tire, to take from a wound injuring subjects as it can lead to a lethal outcome.
Tasks and actions of doctors !The brigade of doctors who arrived arrived immediately to provide medical assistance to the victim. If necessary, resuscitation( cardiac or respiratory), as well as compensation for blood loss with the use of salt and colloidal solutions. If required, additional anesthesia and antibacterial treatment of wounds are performed.
Then the victim is carefully transferred to a car and transported to a specialized medical facility. During the movement, the restoration of blood loss and resuscitation is continued.
In medicine, there is the concept of " golden hour ", during which it is necessary to provide assistance to the victim. Its timely provision is the guarantee of the preservation of human life. Therefore, before the brigade of ambulance doctors arrives, measures must be taken to eliminate the causes of traumatic shock.
Provision of pre-hospital care can save the life of a person injured. If a number of comprehensive measures are not taken in time, the victim may suffer death from a painful shock. Emergency care for trauma and traumatic shock involves the following algorithm of actions:
- Temporary stopping of bleeding with a tourniquet, a tight bandage and release from a traumatizing agent is a first aid, first aid for a painful shock.
- Rehabilitation therapy for airway patency( removal of foreign bodies).It is important to ensure free breathing. For this, the wounded person is laid on a flat surface in a comfortable position and free of airway from foreign bodies. If clothes short of breath, it should be unfastened. If there is no breathing, carry out artificial ventilation of the lungs.
- Anesthesia( Novalgin, Analgin, Ketorol).In fact, the most effective remedy against pain traumatic shock, to remove pain with the help of intravenous narcotic analgesics. But this will already be done by medical workers.
- For limb fractures, it is necessary to perform a primary immobilization( ensuring the immobility of injured limbs) with the help of improvised means. In the absence of such, hands are attached to the body, and the leg to the leg. Remember that is not recommended for when the vertebral column of a victim is broken.
- Overcooling warning. It is necessary to calm the traumatized and cover it with some kind of warm things to prevent hypothermia.
- Providing the victim with a plentiful drink( except for loss of consciousness and abdominal injuries).Perhaps, only in the absence of injuries of the abdominal cavity it is required to provide the victim with a copious drink( warm tea).
- Transportation to the nearest clinic.
Treatment of traumatic shock
For the treatment of traumatic shock in the hospital, there are 5 main directions:
- Therapy of non-hazardous lesions .The first life support measures are, as a rule, temporary( transport immobilization, harness and dressing), are carried out directly at the scene.
- Pulse interruption ( analgesic therapy ).Achieved with a combination of three methods: a local blockade;immobilization;use of neuroleptics and analgesics.
- Normalization of rheological properties of blood .Achieved by the introduction of crystalloid solutions.
- Correction of the metabolism of .Medical treatment begins with the elimination of respiratory acidosis and hypoxia by inhalation with oxygen. It is possible to make artificial ventilation of the lungs. In addition, intravenously with the help of an infusion pump, solutions of glucose with insulin, sodium bicarbonate, magnesium and calcium are injected.
- Shock Prevention .It presupposes nursing, appropriate treatment of respiratory acute deficiency( shock shock syndrome), changes in the myocardium and liver, renal acute deficiency( shock kidney syndrome).
Principles of treatment of traumatic shock in a hospital - resuscitation department
The next stage of rendering assistance to a seriously injured person is started in the emergency room after receiving the patient.
First: Assessing the severity of the condition of the victim
It is important to objectively assess the patient's condition in order to really imagine its severity and prognosis. Now the points are quite common. To determine the degree of oppression of consciousness, which is an important prognostic criterion, use the Glasgow scale. Prognosis: 8 points or more - good chances for improvement, 5-8 points - life threatening situation, 3-5 points - potentially fatal outcome, especially when detecting fixed pupils.
The second: Algorithm of rendering assistance to the victim with a traumatic shock
In case of traumatic shock, the speed of performing medical measures is very important. Therefore, it is advisable to adhere to a general algorithm for rendering assistance to the victim with severe trauma.
Initial inspection of
In the initial examination, in addition to assessing the severity of the patient's condition, determine the nature of the injury and the need for immediate assistance. Experienced specialist conducts an examination within 1-2 minutes. At the same time, he must, first of all, answer two questions: is ventilation adequate? What is the state of hemodynamics?
Provide adequate ventilation
Initially, the diagnosis of the degree of violation of the function of breathing.
Lack of breathing is an indication for urgent resuscitation.
When breathing is preserved, the mouth is examined and simultaneously released from the mucus, foreign bodies, vomit. Determine the frequency and depth of breathing on the excursion of the chest, it is possible to use the "thread" and "mirror" method. The thorax is palpated to reveal fractures of the ribs, crepitus, asymmetry.
At auscultation determine the symmetry of respiratory noise. Pay attention to the rhythm of breathing and its frequency.
Note the color of the skin( the presence or absence of cyanosis).
After the examination, the question of the need for intubation of the trachea should be solved. Indication for it can be: a violation of consciousness, low blood pressure, extensive head injuries, face, neck, chest injury, respiratory failure.
After resolving the issue of the intubation of the trachea, optimal ventilation should be ensured. This can be achieved using an Ambu-type bag or mechanical fans of various designs.
Ensuring adequate blood circulation
First of all, you should immediately diagnose: determine the presence of heartbeats. And in their absence, proceed to cardiac recovery - an indirect massage of the heart.
With the preservation of cardiac activity, you need to assess the state of the circulation. For this, it is necessary to pay attention to the characteristics of the pulse, the amount of blood pressure, the color and temperature of the skin.
The next step in the care should be the implementation of venous access. At extremely low arterial pressure, infusion occurs in 3-4 veins simultaneously. At a catheterization it is not necessary to forget about necessity of a fence of 10-15 ml of a blood for definition of group of a blood and reaction to compatibility. After an emergency catheterization, it is advisable to change the catheters after 48 hours because of the danger of septic complications.
After venous access, saline and colloidal solutions are started to maintain BCC.Of the latter, the drugs of choice are polyglucin, reopolyglucin, gelatin. Immediately after determining the blood group, blood transfusion is indicated, and after determining compatibility, blood transfusion or erythrocyte mass.
Evaluation of neurological damage
The severity of neurological damage is assessed by the general diagnostic principles of the diagnosis after relative stabilization of the condition.
Diagnosis and treatment of other serious injuries
Diagnosis of the nature of injuries of the musculoskeletal system and internal organs is important for the further treatment of the injured and should be made as quickly as possible after the patient leaves the critical condition, and sometimes in parallel with the first urgent measures.
It should be noted that the nature of the damage, primarily the internal organs, affects the order of actions. So, when a spleen ruptures with intra-abdominal hemorrhage, immediately after a minimal stabilization the patient is taken to the operating room, and the anti-shock therapy is performed on the operating table during the operation.
Third: Features of treatment of traumatic shock
After carrying out the above urgent measures, further traumatic shock therapy is carried out. In this case, you should pay attention to a number of specific traumatic shock moments.
Important in the treatment of traumatic shock is antibacterial therapy. Its meaning is preventive.
Traumatic shock causes severe immunosuppression, therefore the presence of massive damage zones is a predisposing factor for the development of suppuration and traumatic sepsis, which significantly worsens the prognosis.
Recently, with the first signs of septic complications, immunomodulating agents are successfully used, in particular Roncoleukin .
Adequate surgical tactics and full replacement of blood and plasma loss play an important role in the prevention of infectious complications. After removing the patient from shock, they begin to fully diagnose and correct all the lesions detected.
Prevention of traumatic shock
Prevention of post-traumatic shock is also important! And this - the timely detection of signs of traumatic shock and timely preventive measures can prevent its transition to a more severe stage even in the pre-medical period of rendering assistance to the victim.
That is, the prevention of the development of a more severe condition in this case can be called the very first aid, rendered quickly and correctly.
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