Treatment of traumatic shock. Traumatic shock: causes, clinical picture, emergency care What is shock in trauma

Anyone can come face to face with such a phenomenon as traumatic shock, because the main mechanism of its occurrence, which comes from the name, is not uncommon in the modern world. So, traumatic shock is a kind of pathological condition, the cause of which can be injury and the accompanying blood loss, which poses a threat to human life.

The reasons that cause it may differ from each other, but the symptoms are traditionally unchanged and manifest themselves with the same signs.

In case of traumatic shock, the first thing to start with is to stop the bleeding, anesthetize the person and urgently try to get him to the hospital. This condition is treated by resuscitators, but in the absence of such a specialist, any doctor should provide assistance.

The prognosis for survival depends on the severity of the shock and the phase in which treatment is initiated, as well as the injury that led to it.

Traumatic shock, as the name suggests, is caused by trauma

The concept of injury can be different, for example, if a person twists his leg, this is also an injury, but for some reason it never leads to shock. The causes are only severe injuries accompanied by massive blood loss. Such damage may include:

traumatic brain injury;
severe injuries to the neck, chest, abdomen or limbs;
multiple fractures;
frostbite;
burns;
heavy gunshot wounds, especially tubular bones;
abdominal trauma with damage internal organs;
fracture of the pelvic bones;
surgical interventions, especially with inadequate anesthesia.

Development mechanism

At the first sign of traumatic shock, a person should be sent to the hospital

The cause of shock is not only rapid blood loss, but also traumatic injury, as a result of which vital functions are disrupted. important organs and systems. The body tries to transfer the remaining blood to vital organs, in particular the brain, and protect them from oxygen starvation, less important ones can endure. This is how shock develops, which is complemented by strong pain impulses. The brain, in turn, receiving a signal that there is little blood, gives a command to the adrenal glands and they begin intensive production of hormones such as adrenaline and norepinephrine. They cause blood vessels to constrict, causing blood to ultimately flow from the extremities to more important organs and systems.

But after some time, this compensatory mechanism also ceases to fulfill its main tasks. There is not enough oxygen, and as a response, the vessels located on the periphery expand, blood rushes into this channel. Peripheral vasculature then it stops responding to commands from the “center”.

There is an acute shortage of blood and due to this, interruptions in the normal functioning of the heart begin, blood circulation suffers and is disrupted to an even greater extent. Blood pressure drops sharply, along with kidney function, liver and intestinal function are impaired.

The vessels spasm, and the blood... defense mechanism increases its coagulability, as a result of which their blockage develops. DIC syndrome (disseminated intravascular coagulation syndrome) develops. With this complication, the blood clots slowly, and then cannot clot at all. If DIC syndrome develops, bleeding may reappear at the site of injury, as well as hemorrhages under the skin or organs. All of the above only leads to a worsening of the condition and causes death.

Degrees, types and phases of traumatic shock

There are several types of shock:

Primary or early occurs as a reaction to injury or immediately after it.
Secondary or late for its development requires a certain time, it takes from 4 to 24 hours after exposure to a traumatic factor. The result of its development is additional trauma, for example, hypothermia, transportation or rebleeding. The most common secondary shock is a reaction to surgery in the wounded.

There are also degrees of traumatic shock, and each will have its own characteristic manifestations:

At first, blood pressure does not go beyond the limits normal indicator, there is vasospasm, the heartbeat is accelerated (tachycardia).
The second degree is characterized by a fall blood pressure from 80 to 50 millimeters of mercury (mmHg).
The third degree gives more pronounced violations, blood pressure continues to drop, and kidney failure develops.
In the fourth stage there is agony, and then death.

Erectile, when the body tries to compensate for the damage.
Torpid, in which the body’s capabilities are completely depleted.

But modern classification has a slightly different meaning, and it includes stages:

Compensation when the body copes with the problem of shock on its own.
Subcompensation, the body itself is able to cope with the shock, but its strength is almost running out.
Decompensation, when the body is unable to fight for life on its own.

Symptoms

Immediately after receiving an injury, the person is agitated, restless, and emotionally unstable.

With traumatic shock, the manifestations depend on many factors, and shock itself is very easy to suspect; it is enough to know some diagnostic criteria.

During shock, you can observe the same symptoms as with massive blood loss, for example, rupture of internal organs.

The skin of a person with shock becomes pale, it may be moist, and cold to the touch. If a person can speak, then he will tell you that he is tormented by dry mouth and a feeling of thirst. Breathing becomes more frequent, weakness develops, against the background of which the pulse becomes just as frequent, and sometimes it can be very difficult to feel it. In the first stages of shock, a person is restless, later consciousness becomes confused or disappears altogether.

In the first stages of shock, a person with a broken leg or some other complex injury is eager to go somewhere, and may come to the hospital himself, despite the severity of the injury. This state may often be absent or last very little and pass into the inhibition phase.

The last stage of traumatic shock is characterized by a lack of consciousness

The erectile phase or compensation occurs immediately after injury. The person is excited, talks a lot, perhaps has a feeling of fear, often accompanied by anxiety. Consciousness does not go away, but spatial and temporal orientation are disturbed. The skin is pale, the heartbeat and breathing are rapid, the pressure does not go beyond normal limits or increases slightly. If the injury is severe, this phase may not appear at all and turn into torpid or subcompensation, decompensation.

It has been noted that the shorter the erectile or arousal phase, the more severe the traumatic shock.

During the torpid phase, subcompensation, decompensation, the person is lethargic and inhibited. All this is manifested due to oppressed activity nervous system, liver, kidneys, lungs and heart. During this phase there are 4 degrees of severity with their own characteristic clinical manifestations:

First or mild degree manifested by pale skin, but with clear consciousness, the person is slightly inhibited, reflexes are reduced, and there is shortness of breath. The pulse rate is up to 100 beats (the norm is 60 – 90 beats per minute);
The second degree or medium, in which the victim is lethargic and lethargic, the pulse is approximately 140 beats per minute;
The third degree is called severe, the person in it is in a state of consciousness, but the world and does not perceive stimuli in any way. The skin takes on an earthy gray tint, the tip of the nose is bluish, the fingers and lips are the same color, and the sweat is sticky. The pulse rate rises to 160 beats;
The fourth stage is called agony or preagony. There is no consciousness or reflexes. The pulse is threadlike, sometimes it simply disappears, breathing movements gradually fade away.

In the first minutes from the point of view clinical manifestations It is not always possible to assess a person’s condition correctly, especially immediately after an injury. The main thing is to take all anti-shock measures in a timely manner, then the chance of survival and normal recovery increases.

Degrees of traumatic shock:

Shock I degree (mild shock)

The patient is somewhat inhibited and sociable. Pain sensitivity is preserved, visible mucous membranes are pale or normal in color. Rapid breathing respiratory failure no (in the absence of vomiting and aspiration of vomit).

I degree of traumatic shock develops against the background of a closed hip fracture, combined fracture of the femur and tibia, mild pelvic fracture and other skeletal injuries.

Shock II degree (moderate)

Blood pressure 80-75 mm Hg. Art., pulse increases to 110-120 beats/min, pallor is expressed skin, cyanosis, adynamia, lethargy.

The second degree of traumatic shock develops with multiple fractures of long tubular bones, multiple fractures of the ribs, and severe fractures of the pelvic bones.

Shock III degree (severe shock)

Blood pressure 60 mm Hg. Art., but may be lower, the pulse increases to 130-140 beats/min. Heart sounds are very muffled. The patient is deeply inhibited. The skin is pale, with pronounced cyanosis and an earthy tint.

III degree of traumatic shock develops with multiple concomitant or combined injuries, damage to the skeleton, large muscle masses and internal organs of the chest, abdomen, skull, as well as burns.

Shock IV degree

With further deterioration of the patient's condition, terminal state requiring resuscitation measures. Consciousness fades, the skin is cyanotic, blood pressure is less than 60 mm Hg. Art., pulse 140-160 beats/min. The pulse can only be determined in large vessels.

Treatment of the wounded in a state of shock should be early, comprehensive and adequate. The last requirement presupposes compliance of therapeutic and diagnostic measures with the characteristics of injuries depending on their location, severity and nature, as well as compliance with the individual characteristics of the body’s general reaction to damage.

The main objectives of treatment include several groups of measures, determined by the need and urgency of their implementation at various stages of medical evacuation.

1. Interruption of pathological afferent impulses from lesions is the first group of anti-shock measures, which is aimed at elimination of pain syndrome and its immediate consequences.

Suppression of pain impulses is achieved:

Administration of narcotic and non-narcotic analgesics;

Performing regional anesthesia (novocaine, lidocaine blockades);

Immobilization of the damaged segment of the limb or spine;

Gentle transportation;

General anesthesia in naval medical units.

The use of various blockades, while eliminating pain, does not mask the picture of concomitant internal injuries. It should be borne in mind that against the background of circulatory disorders, absorption medicinal substances slows down sharply, so standard doses of local anesthetics must be reduced, otherwise, as shock emerges, their resorptive effect will fully manifest itself with a picture of secondary hemodynamic depression. For closed fractures of the limb bones, chest, pelvis, spine, a 1% solution of novocaine (30-40 ml) is injected directly into the site of injury. Deepening and lengthening the duration of the analgesic effect is achieved by adding 96 rectified alcohol (1:10).

For multiple rib fractures, novocaine (0.5% - 100 ml) is additionally injected into the muscles of the intercostal space, corresponding to the broken rib near the spine. For fractures of the pelvis, in particular the iliac bones, 200 ml of 0.25% novocaine is injected along the inner surface of the wing ilium into the retroperitoneal space from a point at the upper anterior spine (according to Shkolnikov-Selivanov), for fractures of the pubic and ischial bones - injection into the hematoma (1% solution).

For open fractures of long tubular bones, cross-sectional anesthesia is performed (injection of 0.5% novocaine from 3-4 points - 200 ml mixed with antibiotics). Above the damage, the muscles of the main groups are infiltrated layer by layer to the bone. The analgesic effect is enhanced by a simultaneous injection of novocaine (0.5% - 100 ml) into the area of the main nerves of the lower limb: femoral - above the Pupart ligament 1 cm outward from the femoralis; ischial (position on the side, on the stomach) - immediately under the femoral-gluteal fold in the middle of its length, its approximate depth is 5 cm. On the lower leg, 0.5% novocaine (20 ml) is injected in the upper third directly under the head of the fibulae to a depth of 7 cm ( peroneal nerve); for blockade of the tibial nerve - through a puncture of the interosseous membrane into the posterior muscular-fascial sheath.

Analgesics are used general action, sedatives, desensitizing, neuroplegic and other drugs. The quality of post-traumatic pain relief can be significantly improved through the use of seduxen (25 mg). Its combination with fortral (50 mg) is advisable. Dipidolor (15 mg) has an analgesic effect 2 times stronger than morphine and lacks such negative properties the latter, as the ability to cause nausea, vomiting, and respiratory depression.

Neuroleptanalgesia (NLA) involves the administration of 2 drugs: droperidol and fentanyl. The final result of these effects comes down to a pronounced suppression of pain and psycho-emotional lability. NLA allows for anesthesia in combination with muscle relaxants and low concentrations of N 2 O and other drugs (Viadril, hemithiamine, sodium hydroxybutyrate). Anesthesia is justified as a method general anesthesia to perform surgical interventions at the stages of qualified and specialized care.

2. The second group of anti-shock measures is aimed at stopping ongoing external or internal bleeding, replenishment of blood loss and restoration of blood volume with subsequent adjustment and normalization of hemodynamics.

Temporary stopping of external bleeding is carried out by applying a pressure bandage or clamp to a bleeding vessel in the wound, or by suturing the vessel through the skin also proximal to the site of its injury, by applying a tourniquet to a segment of the limb proximal to the site of bleeding and in close proximity to the wound. Ligation of the vessel or restoration of its integrity (suturing the site of injury) are methods for finally stopping external bleeding.

Hemothorax, hemopericardium and hemoperitoneum require measures aimed at eliminating the cause of internal bleeding and eliminating the consequences of the accumulation of blood spilled into the cavity. These will be, respectively: drainage of the pleural cavity according to Bulau, puncture of the pericardium according to Larrey, laparotomy.

Whole blood transfusion is the method of choice to eliminate the dangerous consequences of blood loss. However, the use of blood in early dates almost impossible. In this regard, at the first stage of medical care, immediate infusion of large volumes of plasma substitutes is necessary to eliminate dangerous degree hypovolemia.

If blood pressure is undetectable, it should be at least 250-500 ml per minute.

At the stage of qualified and specialized care, the best infusion agents for volume replacement are plasma and homologous preparations from its fractions (albumin, protein). Colloidal solutions such as dextrans (polyglucin, macrodex), gelatinol, and polyvinol have a pronounced substitution effect.

The volume of administered colloidal substitutes should be strictly limited (1-1.5 l). After transfusion colloidal solutions if necessary, proceed to crystalloid infusion. Among the latter, a multicomponent saline solution is preferred, especially with the addition of sodium lactate. For blood loss of 1-1.5 liters, only a colloid substitute is used; for blood loss of 1.5-3 liters, the ratio of colloid and crystalloid solutions is 1:1; if blood loss exceeds 3 liters, one volume of colloidal plasma substitute should be administered for 2 volumes of blood; later they switch to the administration of crystalloid solutions.

Among the pharmacological agents for hypotension, pressor amines are used: norepinephrine (1:1000, 1-2 ml per 500 ml of 5% glucose), mesaton (1% - 1.0), ephedrine (5% - 1-2 ml). The introduction of corticosteroids is effective: prednisolone (36 mg/kg), dexamethasone (6 mg/kg).

3. The third group of measures is aimed at combating respiratory failure. When severe respiratory disorders and especially signs of asphyxia occur, these measures become a priority. Emergency restoration and constant maintenance of airway patency is a decisive measure, not only eliminating the immediate threat of death, but also being the main means of preventing secondary pulmonary complications. Release from stagnant secretions at the stage of extended resuscitation is facilitated by inhalation of O2 with hot vapors of substances that dilute mucus and sputum. Respiratory analeptics include cititone or lobeline (1:1000, 1-2 ml intravenously), which are effective only when breathing is maintained. If spontaneous breathing after intubation is not restored for a long time (more than 72 hours), intubation should be replaced with tracheostomy. Tracheostomy is also performed for injuries to the jaws, face, neck, larynx, trachea, and injuries to the cervical spine.

This group of measures also includes: elimination of open pneumothorax, drainage of tension pneumothorax and hemothorax, restoration of the bone frame of the chest in case of multiple rib fractures, oxygen inhalation and transfer to mechanical ventilation.

Oxygen therapy is carried out subject to patency respiratory tract and sufficient depth of spontaneous breathing and during mechanical ventilation.

In case of respiratory failure due to pulmonary contusion, the following is required: reduction of intravenous infusion therapy up to 2-2.5 l with switching the required additional volume to intra-aortic administration; carrying out long-term multi-level analgesia through retropleural blockade (administration of 15 ml of 1% lidocaine solution every 4 hours through a catheter), intramuscular administration of droperidol 3 times a day and intravenous administration of fentanyl 4-6 times a day, 0.1 mg; use of rheologically active drugs in hemodilution mode (0.4 l of rheopolyglucin), disaggregants (trental), direct anticoagulants (heparin up to 20,000 units per day), aminophylline (10.0 ml of 2.4% solution up to 3 times a day), saluretics (Lasix up to 100 mg per day), as well as glucocorticoids (prednisolone 10 mg/kg body weight).

4. The fourth group includes measures to restoration of metabolism and functions of the endocrine glands. To combat acidosis, which especially often occurs when soft tissue is crushed, a solution of sodium bicarbonate (3-5% - 100-200 ml) and special buffer solutions are injected intravenously.

Hormonal drugs that can be used are: norepinephrine, ACTH, hydrocortisone. With a decrease in diuresis, which develops with prolonged hypotension or as a result of intoxication from crushed tissues, osmodiuretics (mannitol, urogliuk, lasix) may be recommended.

In the event of the development of multiple organ failure, intensive care measures take on a syndromic character.

The most important component of the treatment of shock is the implementation of emergency and urgent surgical interventions aimed, as noted above, at stopping ongoing bleeding, eliminating asphyxia, damage to the heart and other vital organs, as well as the hollow organs of the abdomen. In this case, intensive therapy measures are carried out as preoperative preparation. It is necessary to operate under complete anesthesia with simultaneous blood transfusion and elimination of hypoxia.

Traumatic shock is a type of hypovolemic shock that develops as a result of rapid loss of blood/lymph. The condition is aggravated by severe pain, which always accompanies injuries, and neuropsychic shock. If competent assistance is not immediately organized, a person can die in a matter of minutes.

The diagnosis of shock is made if there is acute disorder blood circulation, life-threatening. It is the renewal normal movement blood is the goal that needs to be achieved when removing a person from this state.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

Hypovolemic shock is a condition caused by very rapid loss of blood or lymph. In the case of traumatic shock, the cause of blood loss is severe injuries that damage blood vessels, bones, and soft tissues.

The body does not have time to compensate for the lost volume of fluid, and the functions of vital organs are disrupted. And with very large volumes of blood loss, no compensatory mechanisms are simply capable of restoring normal blood supply to the vessels.

If the losses are within 10% (this is approximately 400-500 ml of blood), a shock state does not develop.

The body is able to cope with this itself by temporarily “diluting” the blood (hemodilution) and releasing young forms of red blood cells into the blood.

If the bleeding is severe, shock occurs.

The classification based on the volume of blood lost is as follows:

15-25% (approximately 700-1300 ml) – first degree shock (compensated and reversible).
25-45% (1300-1800 ml) – second degree (decompensated and reversible).
More than 50% (2000-2500) - third degree (decompensated and irreversible).

These grades are considered stages if bleeding continues and symptoms worsen.

At the first stage the body is able to cope with the consequences of the injury, it is usually conscious, behaves adequately, the heart, against the background of decreased blood pressure and moderate tachycardia, works without interruption.

At the second stage the pressure drops more, as a result of poor blood supply, the work of the heart is disrupted, and the speed of blood flow drops. Confusion develops, severe shortness of breath, and the skin turns blue.

The third stage is called irreversible, since complications develop that cannot be cured by any means. existing methods. Characterized by loss of consciousness low temperature body, blood pressure below 60 mm Hg. Art., thready pulse.

Causes of shock development

Traumatic shock, as the name implies, is caused by injuries. Bleeding is not necessarily open; sometimes it develops inside the body, without damaging the skin.

Main reasons:

Open fractures with damage to large vessels;
Traumatic brain injuries;
Gunshot wounds;
Numerous combined injuries (for example, during an accident);
Closed (bruises) and open injuries abdomen and chest with injuries to internal organs.

With such injuries, the volume of blood in the vessels very quickly decreases. Tissue hypoxia develops - they lack oxygen and nutrients. Due to impaired blood flow, metabolic products accumulate in the tissues, and intoxication increases. This triggers a chain of compensatory reactions that help cope with the condition if the injury is not too severe and help is provided on time. In other cases, the body’s attempts to compensate for blood loss lead to failure of the functioning of internal organs.

Mechanism of development and symptoms

Clinically, the state of shock develops through two phases:

Erectile (excitement phase);
Torpid (braking phase).

In the first phase of traumatic shock, clinical signs are determined by severe pain, causing an outburst huge amount catecholamines (adrenaline, norepinephrine, cortisol, etc.) from the adrenal glands into the blood. This leads to increased agitation, panic, and sometimes aggressiveness. The victim often does not realize the severity of his condition, rushes to go, refuses help, etc.

If the injury is severe or the victim’s body is weakened, its compensatory capabilities are small, the erectile stage can last only a few seconds or minutes. In some cases, when consciousness immediately switches off from pain shock, it is completely absent.

Symptoms in the erectile phase:

Restlessness, tossing;
Pale and cold skin;
Cold sweat;
Small muscle twitching, tremors;
Dilated pupils, sparkle in the eyes;
Increased heart rate and breathing;
Blood pressure is normal or even elevated.

Then comes the second - torpid phase. The body tries to compensate for blood/lymph loss by centralizing blood circulation (blood flows from the periphery, heading to vital internal organs).

Symptoms in the torpid phase:

Decreased blood pressure;
Drowsiness, apathy, slow reaction, prostration;
Reduced pain sensitivity;
Intense thirst, dry lips;
Chills, feeling cold;
Sunken, dull eyes, sharpened facial features;
Pale, bluish, dry skin;
Lack of urine or highly concentrated urine due to dehydration.

A child’s blood volume is less than that of an adult, and sensitivity to hypoxia is higher, so the development state of shock observed with smaller volumes of loss.

Children are characterized by a long course of the second stage, which complicates the assessment of the severity of the condition. The transition to the third stage is sudden and unexpected.

Help with shock

First aid consists of immediately calling a medical team if the described symptoms develop, even if the victim refuses. If this is not possible, you need to arrange for the person to be transported to the nearest hospital. The “golden hour” rule applies here - if during this time you do not have time to provide qualified assistance, the prognosis worsens sharply.

Temporarily stop the bleeding. If there is bleeding from a limb, lift it. Apply a pressure bandage, a tourniquet (if the blood flows like a fountain), and press the vessel with your fingers. The tourniquet is applied for no more than 40 minutes, then it must be loosened for 15 minutes.
Immobilize the injured limb with a splint. Bend your arm at the elbow and secure it in this position. Straighten your leg at the hip and knee.
Unfasten tight clothing;
Turn the victim's head to the side if he is unconscious to prevent asphyxia and aspiration of vomit;
If there is a suspicion of spinal injuries or fractures, do not change the position of the victim’s body in space. If there are no visible injuries, set the position on your back with your legs elevated 15-30° (Trendelenburg).
Cover the victim with something warm to prevent hypothermia.
If there is no suspicion of intestinal damage or internal bleeding, give me something to drink.

After this, emergency assistance should be provided by qualified specialists.

They assess the situation and either carry out on-site measures that will bring the victim out of severe shock so that he can be transported, or go straight to the hospital.

How not to harm the victim

Some actions can only make the situation worse. If there is a person nearby in a state of shock, the main thing is not to panic and not to take the wrong actions out of despair.

What not to do:

Change the position of the body in space if there is a suspicion of fractures or spinal injuries.
Trying to straighten dislocations, remove debris and splinters from the wounds, and tear off the remains of clothing from a burned person.
Give the victim alcohol and energy drinks.
Trying to give medicine or drink to an unconscious person.
Apply a tourniquet to bare limb or keep it for more than 40 minutes.
Move the victim without prior immobilization, try to sit him down or raise him to his feet.

Treatment methods

On site and during transport, doctors do the following:

Pain relief with opium alkaloids (morphine hydrochloride) and opioid analgesics (fentanyl, tramadol), novocaine blockades;
Restoring air access through the respiratory tract by eliminating aspiration syndrome, tracheal intubation, applying a laryngeal mask, connecting a ventilator, etc.;
Stopping bleeding using temporary methods;
Transfusion of plasma-substituting, glucose-saline solutions in order to maintain systolic pressure not lower than 75 mm Hg. Art.;
The use of drugs that stimulate cardiovascular activity;
Preventing fat embolism with certain medications.

After admission to the hospital, treatment methods are selected based on the pathogenesis of the injury (fracture, head injury, crushing of soft tissues, ruptures of internal organs, burns, etc.).

Possible complications

A serious consequence of traumatic shock is failure of internal organs. Sometimes it does not occur immediately, but several hours/days after the patient has recovered from an acute shock state. That is, it develops post-traumatic syndrome. The following complications are identified:

Shock lung. Due to blood loss, blood flow in the smallest vessels is reduced. They are shrinking sharply. The permeability of the capillary walls increases, which leads to plasma leakage into the lung tissue. Swelling develops. Due to hypoxia, the alveoli of the lungs are damaged and collapse, they stop filling with air - atelectasis occurs. Subsequently, pneumonia and necrosis of some tissues develop.
Shock bud. Due to hypoxia, structural disorders develop in this organ. The glomeruli lose their ability to filter blood, and urine formation is impaired (anuria). As a result of acute renal failure intoxication increases.
Shock gut. Due to a lack of nutrition and oxygen, the mucous membrane dies and peels off. Tissue permeability increases, intestinal barrier function decreases, and intestinal toxins enter the bloodstream.
Shock liver. Hepatocytes, sensitive to lack of oxygen, partially die. The detoxification and prothrombin-forming functions are impaired. Bilirubinemia develops.
Shock heart. The release of catecholamines into the blood leads to a sharp narrowing of blood vessels. Myocardial nutrition is disrupted and foci of necrosis form. Due to an increase in the concentration of potassium in the blood (a consequence of renal failure), heartbeat. As a result, cardiac output decreases and blood pressure drops.
DIC syndrome. As a result of spasm, a decrease in blood flow speed and an increase in blood clotting in response to trauma, blood begins to clot in the capillaries. The blood supply to tissues deteriorates even more.
Fat embolism. Blockage of blood vessels small particles lipids. It develops at lightning speed, acutely (2-3 hours) or subacutely (12-72 hours after injury). The vessels of the lungs, brain, kidneys and other organs become clogged, which leads to their acute failure. The exact reasons are unclear. Some associate embolism with injuries large bones or an increase in pressure inside them, which leads to the entry of particles bone marrow into the blood. Others believe the cause is changes in the biochemical composition of the blood.

Conclusion

Identification and relief of traumatic shock in early stage allows you to avoid severe complications, which improves the prognosis of recovery even with significant injuries. The main thing is to provide the victim with qualified medical care as quickly as possible.

How to help a victim before the ambulance arrives if he has traumatic shock

is a pathological condition that occurs as a result of blood loss and pain due to injury and poses a serious threat to the patient’s life. Regardless of the cause of development, it always manifests itself with the same symptoms. Pathology is diagnosed based on clinical signs. Urgent stoppage of bleeding, anesthesia and immediate delivery of the patient to the hospital are necessary. Treatment of traumatic shock is carried out in conditions intensive care unit and includes a set of measures to compensate for violations that have occurred. The prognosis depends on the severity and phase of shock, as well as the severity of the injury that caused it.

ICD-10

T79.4

General information

Traumatic shock - serious condition, which is the body’s response to acute injury, accompanied by severe blood loss and intense pain. Usually develops immediately after injury and is immediate reaction to damage, but under certain conditions (additional trauma) can occur after some time (4-36 hours). Is a condition that poses a threat to the patient’s life and requires urgent treatment in the intensive care unit.

Causes

Traumatic shock develops with all types of severe injuries, regardless of their cause, location and mechanism of injury. Its cause can be knife and gunshot wounds, falls from a height, car accidents, man-made and natural disasters, industrial accidents, etc. In addition to extensive wounds with damage to soft tissues and blood vessels, as well as open and closed fractures of large bones (especially multiple and accompanied by damage to the arteries), traumatic shock can cause extensive burns and frostbite, which are accompanied by significant loss of plasma.

The development of traumatic shock is based on massive blood loss, pronounced pain syndrome, dysfunction of vital organs and mental stress, conditioned acute injury. In this case, blood loss plays a leading role, and the influence of other factors can vary significantly. Yes, if damaged sensitive areas(perineum and neck), the influence of the pain factor increases, and with a chest injury, the patient’s condition is aggravated by impaired breathing function and supply of oxygen to the body.

Pathogenesis

The triggering mechanism of traumatic shock is largely associated with the centralization of blood circulation - a state when the body directs blood to vital organs (lungs, heart, liver, brain, etc.), diverting it from less important organs and tissues (muscles, skin, fatty tissue). The brain receives signals about a lack of blood and reacts to them by stimulating the adrenal glands to release adrenaline and norepinephrine. These hormones act on peripheral blood vessels, causing them to constrict. As a result, blood flows away from the extremities and there is enough of it for the functioning of vital organs.

After some time, the mechanism begins to malfunction. Due to the lack of oxygen, peripheral vessels dilate, causing blood to flow away from vital organs. At the same time, due to disturbances in tissue metabolism, the walls of peripheral vessels stop responding to signals from the nervous system and the action of hormones, so re-narrowing of blood vessels does not occur, and the “periphery” turns into a blood depot. Due to insufficient blood volume, the heart's function is impaired, which further aggravates circulatory problems. Blood pressure drops. With a significant decrease in blood pressure, normal operation kidneys, and a little later - the liver and intestinal wall. Toxins are released from the intestinal wall into the blood. The situation is aggravated due to the occurrence of numerous foci of dead tissue without oxygen and severe metabolic disorders.

Due to spasm and increased blood clotting, some small vessels become clogged with blood clots. This causes the development of DIC syndrome (disseminated intravascular coagulation syndrome), in which blood clotting first slows down and then practically disappears. With DIC, bleeding may resume at the site of injury, pathological bleeding occurs, and multiple small hemorrhages appear in the skin and internal organs. All of the above leads to a progressive deterioration of the patient’s condition and becomes the cause fatal outcome.

Classification

There are several classifications of traumatic shock depending on the causes of its development. Thus, in many Russian manuals on traumatology and orthopedics, surgical shock, endotoxin shock, shock due to crushing, burns, the action of a shock air wave and the application of a tourniquet are distinguished. The classification of V.K. is widely used. Kulagin, according to which there are the following types traumatic shock:

Wound traumatic shock (arising due to mechanical injury). Depending on the location of the damage, it is divided into visceral, pulmonary, cerebral, with limb injury, with multiple trauma, with compression of soft tissues.
Operational traumatic shock.
Hemorrhagic traumatic shock (developing with internal and external bleeding).
Mixed traumatic shock.

Regardless of the causes of occurrence, traumatic shock occurs in two phases: erectile (the body tries to compensate for the violations that have arisen) and torpid (compensatory capabilities are depleted). Taking into account the severity of the patient’s condition in the torpid phase, 4 degrees of shock are distinguished:

I (light). The patient is pale and sometimes a little lethargic. Consciousness is clear. Reflexes are reduced. Shortness of breath, pulse up to 100 beats/min.
II (moderate). The patient is lethargic and lethargic. Pulse is about 140 beats/min.
III (severe). Consciousness is preserved, the ability to perceive the surrounding world is lost. The skin is earthy gray, the lips, nose and fingertips are bluish. Sticky sweat. Pulse is about 160 beats/min.
IV (preagonia and agony). There is no consciousness, the pulse is not detected.

Symptoms of traumatic shock

During the erectile phase, the patient is excited, complains of pain, and may scream or moan. He is anxious and scared. Aggression and resistance to examination and treatment are often observed. The skin is pale, blood pressure is slightly elevated. Tachycardia, tachypnea (increased breathing), trembling of the limbs or small twitching of individual muscles are noted. The eyes shine, the pupils are dilated, the look is restless. The skin is covered with cold, sticky sweat. The pulse is rhythmic, body temperature is normal or slightly elevated. At this stage, the body is still compensating for the disturbances that have arisen. There are no gross disturbances in the functioning of internal organs, no disseminated intravascular coagulation syndrome.

With the onset of the torpid phase of traumatic shock, the patient becomes apathetic, lethargic, drowsy and depressed. Despite the fact that the pain does not decrease during this period, the patient stops or almost stops signaling about it. He no longer screams or complains; he can lie silently, moaning quietly, or even lose consciousness. There is no reaction even with manipulations in the area of damage. Blood pressure gradually decreases and heart rate increases. The pulse in the peripheral arteries weakens, becomes thread-like, and then becomes undetectable.

The patient's eyes are dull, sunken, the pupils are dilated, the gaze is motionless, there are shadows under the eyes. There is marked pallor of the skin, cyanotic mucous membranes, lips, nose and fingertips. The skin is dry and cold, tissue elasticity is reduced. Facial features are sharpened, nasolabial folds are smoothed. Body temperature is normal or low (temperature may also increase due to wound infection). The patient gets chills even in a warm room. Convulsions and involuntary release of feces and urine are often observed.

Symptoms of intoxication are revealed. The patient suffers from thirst, his tongue is coated, his lips are parched and dry. Nausea and, in severe cases, even vomiting may occur. Due to progressive impairment of kidney function, the amount of urine decreases even with drinking plenty of fluids. Urine is dark, concentrated, with severe shock anuria is possible ( complete absence urine).

Diagnostics

Traumatic shock is diagnosed when appropriate symptoms are identified, a fresh injury or other possible reason the occurrence of this pathology. To assess the condition of the victim, periodic measurements of pulse and blood pressure are carried out, and laboratory research. Scroll diagnostic procedures determined pathological condition which caused the development of traumatic shock.

Treatment of traumatic shock

At the first aid stage, it is necessary to temporarily stop bleeding (tourniquet, tight bandage), restore airway patency, perform anesthesia and immobilization, and also prevent hypothermia. The patient should be moved very carefully to prevent re-traumatization.

In hospital at initial stage Resuscitation anesthesiologists perform transfusions of saline (lactasol, Ringer's solution) and colloid (reopolyglucin, polyglucin, gelatinol, etc.) solutions. After determining the rhesus and blood group, the transfusion of these solutions in combination with blood and plasma is continued. Provide adequate breathing using airways, oxygen therapy, tracheal intubation, or mechanical ventilation. Pain relief is continued. Perform bladder catheterization to precise definition amount of urine.

Surgical interventions are carried out according to vital indications in the amount necessary to preserve vital functions and prevent further aggravation of shock. They stop bleeding and treat wounds, block and immobilize fractures, eliminate pneumothorax, etc. Prescribe hormone therapy and dehydration, use drugs to combat cerebral hypoxia, and correct metabolic disorders.