The manifestations of the torpid phase of shock are. Traumatic shock - causes and stages

- this is pathological condition that results from blood loss and pain syndrome injury and poses a serious threat to the life of the patient. Regardless of the cause of development, it always manifests itself with the same symptoms. Pathology is diagnosed based on clinical signs. An urgent stop of bleeding, anesthesia and immediate delivery of the patient to the hospital is necessary. Traumatic shock is treated under 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 the shock, as well as the severity of the trauma that caused it.

Traumatic shock - serious condition, which is the reaction of the body to an acute injury, accompanied by severe blood loss and intense pain. Usually develops immediately after injury and is direct reaction for damage, but under certain conditions (additional trauma) may occur after some time (4-36 hours). It is a condition that poses a threat to the life of the patient, and requires emergency treatment in the intensive care unit.

The reasons

Traumatic shock develops in all types of severe injuries, regardless of their cause, location and mechanism of damage. It can be caused by stab 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 large bones(especially multiple and accompanied by damage to the arteries) traumatic shock can cause extensive burns and frostbite, which are accompanied by a significant loss of plasma.

The development of traumatic shock is based on massive blood loss, severe pain syndrome, impaired function of vital important 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 respiratory function and oxygen supply to the body.

Pathogenesis

The trigger 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.), removing it from less important organs and tissues (muscles, skin, adipose tissue). The brain receives signals about the lack of blood and responds to them by stimulating the adrenal glands to release adrenaline and norepinephrine. These hormones act on peripheral vessels, causing them to constrict. As a result, the blood flows from the limbs and it becomes enough for the functioning of the vital organs.

After a while, the mechanism starts to fail. Due to the lack of oxygen, peripheral vessels dilate, so blood flows away from vital organs. At the same time, due to violations of tissue metabolism, the walls of peripheral vessels cease to respond to signals nervous system and the action of hormones, so there is no re-constriction of blood vessels, and the "periphery" turns into a blood depot. Due to insufficient blood volume, the work of the heart is disrupted, which further exacerbates circulatory disorders. Falling down arterial pressure. With a significant decrease in blood pressure, the normal functioning of the kidneys is disturbed, 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 tissues that have become dead without oxygen and a gross metabolic disorder.

Due to spasm and increased blood clotting, some of the small vessels are clogged with blood clots. This causes the development of DIC (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 of death.

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, air shock and tourniquet shock are distinguished. The classification of V.K. is widely used. Kulagin, according to which there are the following types traumatic shock:

• Wound traumatic shock (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 soft tissue compression.
• Operational traumatic shock.
• Hemorrhagic traumatic shock (developing with internal and external bleeding).
• Mixed traumatic shock.

Regardless of the causes of traumatic shock, it proceeds in two phases: erectile (the body tries to compensate for the disorders 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 (easy). The patient is pale, 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 about 140 beats / min.
• III (severe). Consciousness is preserved, the possibility of perception of the surrounding world is lost. The skin is earthy gray, the lips, nose and fingertips are cyanotic. Sticky sweat. The pulse is about 160 beats / min.
• IV (pre-agony and agony). Consciousness is absent, the pulse is not determined.

Symptoms of traumatic shock

In the erectile phase, the patient is agitated, complains of pain, and may scream or moan. He is anxious and scared. Often there is aggression, resistance to examination and treatment. The skin is pale, blood pressure is slightly elevated. There is tachycardia, tachypnea (increased breathing), trembling of the limbs or small twitching of individual muscles. The eyes are shining, the pupils are dilated, the look is restless. The skin is covered with cold clammy sweat. The pulse is rhythmic, body temperature is normal or slightly elevated. At this stage, the body still compensates for the violations that have arisen. Gross violations of activity internal organs absent, no DIC.

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 ceases or almost ceases to signal 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 on the peripheral arteries weakens, becomes thready, and then ceases to be determined.

The patient's eyes are dim, sunken, the pupils are dilated, the gaze is motionless, shadows under the eyes. There is a pronounced pallor of the skin, cyanosis of the mucous membranes, lips, nose and fingertips. The skin is dry and cold, tissue elasticity is reduced. Facial features are sharpened, nasolabial folds are smoothed out. The body temperature is normal or low (it is also possible to increase the temperature due to a wound infection). The patient is chilled even in a warm room. Often there are convulsions, involuntary excretion of feces and urine.

Symptoms of intoxication are revealed. The patient suffers from thirst, the tongue is lined, the 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 heavy drinking. Urine dark, concentrated, anuria possible in severe shock ( complete absence urine).

Diagnostics

Traumatic shock is diagnosed when the corresponding symptoms are identified, the presence of a fresh injury or other possible cause occurrence of this pathology. To assess the condition of the victim, periodic measurements of the pulse and blood pressure are performed, prescribe laboratory research. Scroll diagnostic procedures determined by the pathological condition that caused the development of traumatic shock.

Everyone can meet face to face with such a phenomenon as traumatic shock, because the main mechanism of its appearance, which comes from the name, is not uncommon in the modern world. So, traumatic shock is a kind of pathological condition, which can be caused by trauma 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 manifested by the same signs.

At 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. Resuscitators are involved in the treatment of such a condition, 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 in what phase of care is started, as well as the trauma that led to it.

The cause of traumatic shock, as the name implies, is trauma.

The concept of injury can be different, so 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 can be:

• traumatic brain injury;
• severe injuries to the neck, chest, abdomen or limbs;
• multiple fractures;
• frostbite;
• burns;
• severe gunshot wounds, especially tubular bones;
• abdominal trauma with damage to 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 the work of vital organs and systems is disrupted. The body tries to transfer the remaining blood to the vital organs, in particular the brain, and protect them from oxygen starvation, less important can and suffer. 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 to intensively produce hormones such as adrenaline and norepinephrine. They cause the vessels to narrow, the blood eventually flows from the limbs to more important organs and systems.

But after a while, this compensatory mechanism ceases to fulfill its main tasks. There is not enough oxygen, and as a response, the vessels located on the periphery expand, the blood rushes into this channel. peripheral vasculature after that it stops responding to commands from the "center".

There is an acute shortage of blood and due to this, interruptions in blood flow begin. normal operation heart, blood circulation suffers and is disturbed to an even greater extent. Blood pressure drops sharply, along with the work of the kidneys, the function of the liver and intestines is disturbed.

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

Degrees, types and phases of traumatic shock

There are several types of shock:

1. Primary or early occurs as a reaction to injury or immediately after it.
2. 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 re-bleeding. The most common secondary shock, as a reaction to surgery in the wounded.

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

1. At first, blood pressure does not go beyond normal, there is a vasospasm, the heartbeat is accelerated (tachycardia).
2. The second degree is characterized by a drop in blood pressure from 80 to 50 millimeters of mercury (mm Hg).
3. The third degree gives more pronounced violations, blood pressure still falls, kidney failure develops.
4. In the fourth stage, there is agony, and then death.

• Erectile, when the body tries to compensate for damage.
• Torpid, with it 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.
• 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 itself.

Symptoms

Immediately after injury, a person is agitated, restless, emotionally unstable

In traumatic shock, the manifestations depend on many factors, and it is not difficult to suspect the shock itself, it is enough to know some diagnostic criteria.

During shock, the same symptoms can be observed 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 that he is tormented by dry mouth, a feeling of thirst. Breathing becomes more frequent, weakness develops, against which the pulse becomes just as frequent, and it is sometimes very difficult to feel it. In the first stages of shock, a person is restless, later the consciousness becomes confused or disappears altogether.

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

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, maybe a feeling of fear, often accompanied by anxiety. Consciousness does not go away, but the spatial and temporal orientation are violated. The skin is pale, the heartbeat and breathing are quickened, the pressure does not go beyond the normal range or slightly increases. If the injury is severe, this phase may not manifest itself at all and turn into torpid or subcompensation, decompensation.

One of the deadly dangerous states of the human body requiring immediate action is a traumatic shock. Consider what traumatic shock is and what emergency care should be provided for this condition.

Definition and causes of traumatic shock

Traumatic shock is a syndrome that is a severe pathological condition that threatens life. It occurs as a result of severe trauma. various parts body and organs:

• pelvic fractures;
• traumatic brain injury;
• severe gunshot wounds;
• extensive;
• damage to internal organs due to abdominal trauma;
• severe blood loss;
• surgical interventions, etc.

Factors predisposing to the development of traumatic shock and aggravating its course are:

• hypothermia or overheating;
• intoxication;
• overwork;
• starvation.

The mechanism of development of traumatic shock

The main factors in the development of traumatic shock are:

• massive blood loss;
• severe pain syndrome;
• violation of the activity of vital organs;
• mental stress caused by trauma.

Rapid and massive blood loss, as well as plasma loss, lead to a sharp reduction in the volume of circulating blood. As a result, blood pressure decreases, the process of oxygen delivery is disrupted and nutrients tissue, tissue hypoxia develops.

As a result, the accumulation of toxic substances in the tissues occurs, develops metabolic acidosis. Lack of glucose and other nutrients leads to increased breakdown of fats and protein catabolism.

The brain, receiving signals about a lack of blood, stimulates the synthesis of hormones that cause peripheral vessels to narrow. As a result, the blood flows from the limbs, and it becomes enough for the vital organs. But soon this compensatory mechanism begins to falter.

Degrees (phases) of traumatic shock

There are two phases of traumatic shock, characterized by different symptoms.

erectile phase

At this stage, the victim is in an agitated and anxiety, experiencing strong pain and signal them all accessible ways: shouting, facial expressions, gestures, etc. At the same time, he can be aggressive, resist attempts to provide assistance, examination.

There is blanching of the skin, increased blood pressure, tachycardia, increased respiration, trembling of the limbs. At this stage, the body is still able to compensate for violations.

Torpid phase

In this phase, the victim becomes lethargic, lethargic, depressed, and experiences drowsiness. Pain does not subside, but he ceases to signal them. Blood pressure begins to decrease, and the heart rate increases. The pulse gradually weakens, and then ceases to be determined.

There is marked pallor and dryness of the skin, cyanosis, become apparent (thirst, nausea, etc.). The amount of urine decreases even with heavy drinking.

Emergency care for traumatic shock

The main stages of first aid for traumatic shock are as follows:

In medicine, a number of pathologies are distinguished that develop very quickly, sometimes instantly, threaten the life of the victim and require emergency assistance in the first minutes, because delay can lead to irreversible consequences. Traumatic (painful) shock is one of these conditions, from the name it is obvious that its development is preceded by a mechanical injury, and the injury is very severe or extensive.

Causes of traumatic shock

This life-threatening condition can be caused by various injuries: fracture of the pelvic bones, damage to other large bones and blood vessels, severe gunshot and stab wounds, trauma to the head, abdomen with damage to internal organs, extensive burns, crush injuries, polytrauma in an accident, a fall from a height, etc. People most often receive such severe injuries in some extreme situations.

Development mechanism

The mechanism of development of this pathology is quite complex, it can be compared with chain reaction, where the previous process starts and aggravates the next one. In the development of traumatic shock leading role two factors play - this is a rapid loss of blood (if any) and a pronounced pain syndrome. And sometimes it's hard to tell which one is leading.

When you receive a severe injury, accompanied by severe pain, a signal is sent to the brain, which is a superstrong stimulus for it. In response to this signal, there is a powerful release of the stress hormone - adrenaline. This leads first to a spasm of small vessels, and then their atony develops. As a result, a very large volume of blood is turned off from the circulation, which is “stuck” in small capillaries. The total volume of blood flow falls, the heart, brain, lungs, liver and other organs experience circulatory deficiency.

Subsequent brain signals, "requiring" an additional release of hormones that constrict blood vessels in order to raise blood pressure, lead to the depletion of the body's compensatory capabilities. Tissues in conditions of hypoxia (lack of oxygen due to impaired blood supply) accumulate various substances leading to intoxication of the body.

If there is damage to blood vessels in the mechanism of injury, especially large ones, then this makes the situation doubly worse, since blood flow disturbance will develop much faster. The faster the blood loss occurs, the more severe the person's condition and the less chance of a favorable outcome, since in such extreme conditions the body will not have time to adapt and turn on compensatory mechanisms.

Sometimes with mild or medium degree severity of shock, its development can stop spontaneously. This means that the body was still able to compensate for the above-described pathological processes. However, such a victim still requires serious emergency medical care.

Symptoms of traumatic shock

During this pathology, two stages are distinguished: erectile and torpid.

1. The erectile stage in many victims lasts a few minutes, and sometimes less. Intense pain and fear lead them to strong arousal, the person may scream, moan, cry, may become aggressive and resist help. The victims have an unnatural pallor of the skin, cold sticky sweat, rapid breathing and palpitations. The more active and inappropriate behavior a person during the erectile stage of traumatic shock, the more difficult the torpid one will proceed.
2. The torpid stage usually comes on very quickly. Patients stop screaming, move actively, lethargy or loss of consciousness occurs. This does not mean that they stop feeling pain, just that the body no longer has the strength to signal it. That is why even if the patient is unconscious, all manipulations must be performed very carefully.

Chills may appear in patients, the skin becomes even more pale, cyanosis (cyanosis) of the lips and mucous membranes is observed. The blood pressure of the victim decreases, the pulse is weak, sometimes barely palpable, and at the same time it is quickened. In the future, disturbances in the functioning of internal organs develop: (reduction in urine output or its absence), pulmonary, hepatic, etc.

The severity of pain shock

Depending on the severity of the symptoms, 4 degrees of severity of the torpid stage of shock are distinguished. The classification is based on the state of the patient's hemodynamics and is necessary to determine treatment tactics and prognosis.

I degree of shock (mild)

The patient's condition is satisfactory, consciousness is clear, not inhibited, he clearly understands the speech addressed to him and adequately answers questions. Hemodynamic parameters are stable: blood pressure does not fall below 100 mm Hg. Art., the pulse is well palpable, rhythmic, the frequency does not exceed 100 beats per minute. Breathing is even, slightly rapid, up to 22 times per minute. Mild traumatic shock often accompanies fractures of large bones without damage to large blood vessels. The prognosis in such cases is usually favorable, the victim needs immobilization of the injured limb, anesthesia (often with the use of narcotic analgesics) and infusion therapy, selected by the doctor.

II degree of shock (medium)

The patient has depression of consciousness, he can be inhibited, he does not immediately understand the speech addressed to him. In order to get an answer, you need to ask the same question several times. There is pallor of the skin and acrocyanosis (cyanosis of the extremities). Hemodynamics is seriously impaired, blood pressure does not rise above 80-90 mm Hg. Art., the pulse is weak, its frequency exceeds 110-120 beats. per minute. Breathing is rapid, shallow. The prognosis for the victim is very serious, in the absence necessary assistance the next stage of shock may develop.

III degree of shock (severe)

The victim is in a stupor or unconscious, practically does not react to irritants, the skin is pale, cold. Blood pressure falls below 75 mm Hg. Art., the pulse is difficult to determine only on large arteries, the frequency of strokes is more than 130 beats per minute. The prognosis in this situation is unfavorable, especially when, against the background of ongoing therapy and in the absence of bleeding, it is not possible to raise blood pressure.

IV degree of shock (terminal)

The patient is unconscious, the pressure is below 50 mm Hg. Art. or not determined at all, the pulse is not felt. Victims diagnosed with this stage of traumatic shock rarely survive.

First aid for traumatic shock

Traumatic shock is a condition requiring urgent medical care provided with special equipment and a wide range drugs. But the first aid provided on the spot by a person who happened to be nearby is extremely important and can save the life of the victim. There are many cases when people who received non-fatal injuries died precisely from shock.

• If an injured person is found, an ambulance should be called immediately.
• It is impossible to remove splinters, a knife or other objects from the wound, sometimes they “block” the vessels and their removal can lead to increased bleeding and additional trauma to the victim.
• Also, you should not try to remove the remnants of clothing from a person who has received a burn.

Stop bleeding

The first thing to do in such a situation is, if any. This can be done with a tourniquet, pressure bandage, tamponade open wound, a belt, scarf, rope, etc. are suitable as improvised means.

The tourniquet is applied only when arterial bleeding when the blood "spouts" or flows in a pulsating stream from the wound. It is necessary to apply it above the wound, placing a towel, bandage, clothes under it (you cannot apply tourniquets directly on the skin). The time of application of the tourniquet must be recorded, this is very important for those who will provide further assistance to the victim. The fact that the tourniquet is applied correctly is evidenced by the stoppage of bleeding and the disappearance of the pulsation of the vessels below the site of application.

The time of continuous presence of the tourniquet on the limb should not exceed 40 minutes, after this time it must be loosened for 15 minutes, then tightened again.

Venous or massive capillary bleeding is stopped with a pressure bandage or tamponade of the wound, the injured limb must be elevated. In contrast to arterial venous bleeding blood of a very dark color follows from the damaged vessel slowly.

Making breathing possible

Unbutton or remove clothing that may be constricting chest and neck, remove from oral cavity foreign objects. If the victim is in unconscious you need to turn your head to the side and fix the tongue to exclude the possibility of vomit entering the respiratory tract and retraction of the tongue.

If there is no breathing or pulse, start artificial respiration and indirect massage hearts.

Warming the victim

Even in warm weather, with traumatic shock, a person may begin to feel chills, so it is necessary to warm him with a blanket, clothes, or any other available means. This is especially true in the cold season, since hypothermia aggravates the condition of the victim.

Anesthesia

It is unlikely that many of us will find in the bag an ampoule of analgin or other anesthetic and a syringe in order to inject the drug at least intramuscularly. In case of traumatic shock, if the victim is conscious, he can be given an analgin tablet, and it should not be swallowed, but put under the tongue until completely absorbed. This is possible only if the person is conscious.

One of the most dangerous conditions requiring urgent action is traumatic or painful shock. This process occurs as a response to various injuries (fracture, injury, damage to the skull). It is often accompanied by intense pain and large blood loss.

What is traumatic shock

Many people are interested in the question: what is pain shock and is it possible to die from it? According to pathogenesis, it represents the highest shock, syndrome or pathological condition that threatens human life. It can cause severe injury. The condition is often accompanied heavy bleeding. Often, the consequences of injuries can occur after some time - then they say that post-traumatic shock has come. In any case, this phenomenon poses a threat to human life and requires immediate remedial measures.

Traumatic shock - classification

Depending on the causes of the development of a traumatic condition, there are its different classifications. As a rule, pain syndrome can occur as a result of:

• tourniquet;
• surgical intervention;
• burns;
• endotoxin aggression;
• crushing of bones;
• impact of an air shock wave.

The classification of traumatic shock according to Kulagin is also widely used, according to which there are the following types:

• operating;
• turnstile;
• wound. Occurs due to mechanical injury (depending on the location of the injury, it is divided into cerebral, pulmonary, visceral);
• hemorrhagic (develops with external and internal bleeding);
• hemolytic;
• mixed.

Phases of traumatic shock

There are two phases (stages of traumatic shock), which are characterized by various signs:

1. Erectile (excitation). The victim at this stage is in an anxious state, he can rush about, cry. Experiencing strong pain, the patient signals this in all ways: facial expressions, screams, gestures. In this case, a person can be aggressive.
2. Torpid (braking). The victim in this phase becomes depressive, lethargic, lethargic, experiences drowsiness. Although the pain syndrome does not go away, it already ceases to signal it. Blood pressure begins to decrease, heart rate increases.

Degrees of traumatic shock

Taking into account the severity of the condition of the victim, 4 degrees of traumatic shock are distinguished:

• Light.
  1. can develop against the background of fractures (pelvic injuries);
  2. the patient is frightened, sociable, but at the same time a little inhibited;
  3. the skin becomes white;
  4. reflexes are reduced;
  5. cold sticky sweat appears;
  6. clear consciousness;
  7. tremor occurs;
  8. pulse reaches 100 beats per minute;
  9. cardiopalmus.
• Medium severity.
  • develops with multiple fractures of the ribs, tubular long bones;
  • the patient is lethargic, lethargic;
  • pupils are dilated;
  • pulse - 140 beats / min;
  • cyanosis, pallor of integuments, an adynamia is noted.
• Severe degree.
  • is formed when the skeleton is damaged and burns;
  • consciousness is preserved;
  • trembling of the limbs is noted;
  • bluish nose, lips, fingertips;
  • earthy gray skin;
  • the patient is deeply inhibited;
  • the pulse is 160 beats / min.
• Fourth degree (may be called terminal).
  • the victim is unconscious;
  • blood pressure below 50 mm Hg. Art.;
  • the patient is characterized by bluish lips;
  • skin covering gray color;
  • the pulse is barely perceptible;
  • superficial rapid breathing (tachypnea);
  • need to provide first aid.

Signs of traumatic shock

Often the symptoms of pain syndrome can be determined visually. The victim's eyes become dull, sunken, the pupils dilate. Pallor of the skin, cyanotic mucous membranes (nose, lips, fingertips) are noted. The patient may moan, scream, complain of pain. The skin becomes cold and dry, tissue elasticity decreases. The body temperature drops, while the patient is chilled. Other main symptoms of traumatic shock:

• strong pain;
• massive blood loss;
• mental stress;
• convulsions;
• the appearance of spots on the face;
• tissue hypoxia;
• rarely there may be involuntary excretion of urine and feces.

Erectile phase of shock

With a sharp simultaneous excitation of the nervous system, provoked by trauma, an erectile phase of shock occurs. The victim at this stage retains consciousness, but at the same time underestimates the complexity of his situation. He is agitated, can adequately answer questions, but orientation in space and time is disturbed. The look is restless, the eyes shine. The duration of the erectile stage ranges from 10 minutes to several hours. The trauma phase is characterized the following signs:

• rapid breathing;
• pale skin;
• severe tachycardia;
• small muscle twitching;
• shortness of breath.

Torpid shock phase

As circulatory failure increases, the torpid phase of shock develops. The victim has a pronounced lethargy, while he has pale appearance. The skin acquires a gray tint or marble pattern, which indicates stagnation in the vessels. At this stage, the extremities become cold, and breathing is superficial, rapid. There is a fear of death. Other symptoms of pain shock in the torpid phase:

• dry skin;
• cyanosis;
• weak pulse;
• dilated pupils;
• intoxication;
• low temperature body.

Causes of traumatic shock

A traumatic condition results from severe damage human body:

• extensive burns;
• gunshot wounds;
• craniocerebral injuries (falls from a height, accidents);
• severe blood loss;
• surgical intervention.

Other causes of traumatic shock:

• intoxication;
• overheating or hypothermia;
• DIC;
• starvation;
• vasospasm;
• allergy to insect bites;
• overwork.

Treatment of traumatic shock

• Therapy for non-hazardous injuries. The first life-supporting measures are, as a rule, temporary (transport immobilization, applying a tourniquet and bandage), are carried out directly at the scene.
• Interruption of impulses (pain therapy). Achieved by a combination of three methods:
  • local blockade;
  • immobilization;
  • use of neuroleptics and analgesics.
• Normalization rheological properties blood. Achieved through the introduction of crystalloid solutions.
• Metabolism correction. medical treatment begins with the elimination of respiratory acidosis and hypoxia with the help of oxygen inhalation. Can do artificial ventilation lungs. In addition, solutions of glucose with insulin, sodium bicarbonate, magnesium and calcium are administered intravenously using an infusion pump.
• Shock prevention. Assumes nursing care, appropriate treatment of respiratory acute insufficiency(shock lung syndrome), changes in the myocardium and liver, acute renal failure (shock kidney syndrome).

First aid for traumatic shock

Rendering first aid can save the life of an injured person. If a series of comprehensive measures are not carried out in time, then the victim may die from pain shock. Emergency care for injuries and traumatic shock involves the following algorithm of actions:

1. A temporary stop of bleeding with a tourniquet, a tight bandage and release from a traumatic agent is first aid, first aid for pain shock.
2. Rehabilitation therapy for patency respiratory tract(removal foreign bodies).
3. Anesthesia (Novalgin, Analgin), in case of fractures - immobilization.
4. Hypothermia warning.
5. Providing for the victim plentiful drink(with the exception of loss of consciousness and injuries abdominal cavity).
6. Transportation to the nearest clinic.

Video: traumatic shock and emergency anti-shock measures