Shock: description of the phenomenon. Shock conditions of various origins Causes shock

shock states- acute severe pathological processes, the cause of which can be trauma, infection, poisoning. They are designed to support life, but if rescue is not started in time, they can cause irreversible, lethal damage.

general description

The most famous doctor - N. Burdenko - described shock, not as a stage of dying, but as a struggle of an organism striving to survive. Indeed, in this state, the metabolism slows down, brain activity decreases, arterial pressure, temperature. All forces are directed to maintaining the vital activity of the most important organs: the brain, liver, lungs.

However, unfortunately, human body not adapted for a long stay in a state of shock. The redistribution of blood flow and the resulting lack of nutrition and respiration of peripheral tissues inevitably cause cell death.

The task of a person who finds himself next to a patient who develops shock is call an ambulance immediately . The sooner resuscitation begins, the more chances the patient has to survive and restore health.

Causes of shocks

Doctors distinguish the following types of shock conditions:

• Hypovolemic shock - with a sharp loss of a large volume of fluid;
• Traumatic - in case of injury, burns, electric shock, and so on;
• Painful endogenous - with acute pain associated with pathologies internal organs(nephrogenic, cardiogenic, and so on);
• Infectious-toxic - with acute poisoning substances released by microorganisms;
• Anaphylactic - when substances that cause an acute and powerful allergic reaction enter the body;
• Post-transfusion - after an injection.

It is easy to see that in each case, the shock may have several causes. For example, with an extensive burn, both acute loss of fluid and unbearable pain are observed, and intoxication develops.

It is more important for us to know how the state of shock develops, what are its external signs- symptoms.

Stages of shock

Excitation stage

This period usually goes unnoticed. It is characterized by an increase in the patient's activity, increased breathing, and an accelerated heartbeat. In this state, the patient can make some efforts to save his life. But the duration of this stage is short.

Deceleration stage

It is this state that becomes noticeable to others. The mechanisms of its development are as follows:

The activity of various parts of the brain is inhibited. The victim becomes lethargic, sleepy, loses consciousness.

The circulating blood is redistributed - its main volume flows to the internal organs. At the same time, the heartbeat increases, but the strength of myocardial contractions decreases. The blood vessels constrict to maintain normal pressure. But such a state is replaced by an overstrain of the vascular wall - at some point, the vessels relax, and the pressure drops critically. In parallel, the human blood thickens (DIC). At a later stage, the reverse state may occur - critical inhibition of coagulation. The skin of a person becomes pale, marble, the limbs become cold, the lips turn blue. Breathing shallow, weak. Rapid but weak pulse. Convulsions are possible.

terminal stage

Stopping normal metabolic processes leads to tissue damage and dysfunction of internal organs. The more systems damaged, the less hope for saving lives and restoring health.

hypovolemic shock

Associated with sudden loss of body fluids. In this regard, the volume of circulating blood decreases, the water-salt (electrolyte) balance is disturbed. It can occur not only with bleeding (trauma, internal bleeding), but also with severe vomiting, profuse diarrhea, excessive sweating, overheating.

Hypovolemia - the most common state of shock in children of the first years of life (especially infants). Often, parents do not realize that a few episodes of vomiting or diarrhea, even when in a hot and stuffy room, the baby can lose a significant amount of fluid. And this state can lead to shock and the most tragic consequences.

You need to understand that when vomiting, loose stool, increased sweating removes important trace elements from the body: potassium, sodium, calcium. And this affects all systems - the tone of the muscles (including those that ensure the functioning of internal organs) and the transmission of nerve impulses are disturbed.

The rate of fluid loss plays an important role in the development of shock. In infants, even a single dose (about 200 ml) can cause severe hypovolemia.

Symptoms of hypovolemia are: pallor and cyanosis of the integument, dryness of the mucous membranes (tongue, like a brush), cold hands and feet, superficial breathing and palpitations, low blood pressure, apathy, lethargy, lack of reactions, convulsions.

Parents should always monitor the drinking regimen of the child. Especially during periods of illness, in hot weather. If the baby has diarrhea or vomiting, you should immediately consult a doctor. It's best to call an ambulance. The fastest and most complete lost fluid is restored with intravenous administration.

burn shock

Has its own characteristics. The initial stage of excitation lasts noticeably longer. At the same time, blood pressure remains normal or even elevated. This is due to a significant concentration of adrenaline, which is released into the blood during stress and due to severe pain.

When tissue is damaged high temperature a large amount of potassium enters the blood, which negatively affects nerve conduction and heart rate, the condition of the kidneys.

Through the burned integument, a person loses a critical volume of plasma - the blood thickens sharply, blood clots appear that can block the flow of blood to vital organs.

When it comes to children in the first three years of life, any burn is a reason for urgent medical attention. In case of electrical injury, patients of any age are hospitalized.

Percentages are used to estimate the area of ​​the burn - 1% is equal to the area of ​​\u200b\u200bthe palm of the victim. If 3% or more of the body is burned, in order to avoid serious consequences, you should seek medical help.

Cardiogenic shock

Associated with acute heart failure. The reasons for this condition may be different:

• myocardial infarction,
• congenital heart disease,
• trauma and so on.

At the beginning, the patient experiences a lack of air - he begins to cough, tries to take a sitting position (the most comfortable for forced breathing). The skin is covered with cold sweat, the hands and feet become cold. Possible heart pain.

As cardiogenic shock develops, breathing becomes even more difficult (pulmonary edema begins) - it becomes bubbling. Mucus appears. Sharply increasing edema is possible.

Anaphylactic shock

Another common type of shock. Is an immediate allergic reaction that occurs upon contact (often during or immediately after injection) with active substances - drugs, household chemicals, food, and so on; or when bitten by an insect (more often, bees, wasps, hornets).

A huge amount of compounds that cause an inflammatory reaction are released into the blood. including histamine. Because of this, there is a sharp relaxation vascular walls- the volume of the bloodstream critically increases, despite the fact that the volume of blood does not change. The pressure drops.

An outside observer may notice the appearance of a rash (urticaria), difficulty breathing (due to swelling of the airways). Pulse - rapid, weak. Arterial pressure is sharply reduced.

The victim needs immediate resuscitation.

Infectious-toxic shock

It develops in acute poisoning of the body with toxins secreted by microorganisms, and the decay products of the microorganisms themselves. It is especially important for parents of young children to be aware of this condition. After all, in babies, such a shock can also occur when (dangerous toxins are released, diphtheria bacillus and other bacteria).

Children's body is not balanced in comparison with adults. Poisoning quickly leads to disorders of the autonomic vascular system(reflex), cardiovascular activity. It is important to understand that tissues deprived of sufficient nutrition produce their own toxins. These compounds increase poisoning.

Symptoms may vary. In general, it corresponds to other shock states. It is important that parents are aware of the possibility of such a condition and correctly assess increased arousal or lethargy, pallor, cyanosis, marbling of the skin, chills, muscle twitching or convulsions, tachycardia.

What to do with any shock?

In all the above descriptions, the most frequent species shocks, we mentioned the main thing to do: ensure the provision of full medical care.

Nothing to look forward to: call an ambulance immediately or take the victim to the hospital yourself (if it's faster!). When self-transporting, choose a hospital where there is an intensive care unit.

It's okay if you confuse shock with a less dangerous condition. If you simply observe the patient, try to help him on your own, it is possible that irreversible damage and death will occur.

Story

The state of shock was first described by Hippocrates. The term "shock" was first used in Mr. Le Dran. At the end of the 19th century, possible mechanisms for the development of the pathogenesis of shock began to be proposed, among them the following concepts became the most popular:

• paralysis of the nerves innervating the vessels;
• depletion of the vasomotor center;
• neurokinetic disorders;
• dysfunction of the endocrine glands;
• a decrease in the volume of circulating blood (BCC);
• capillary stasis with impaired vascular permeability.

The pathogenesis of shock

From a modern point of view, shock develops in accordance with G. Selye's theory of stress. According to this theory, excessive exposure to the body causes specific and non-specific reactions in it. The first depend on the nature of the impact on the body. The second - only on the strength of the impact. Nonspecific reactions under the influence of a superstrong stimulus are called the general adaptation syndrome. The general adaptation syndrome always proceeds in the same way, in three stages:

1. stage compensated (reversible)
2. decompensated stage (partially reversible, characterized by a general decrease in the body's resistance and even death of the body)
3. terminal stage (irreversible, when no therapeutic effects can prevent death)

Thus, shock, according to Selye, is a manifestation non-specific reaction body to overexposure.

hypovolemic shock

This type of shock occurs as a result of a rapid decrease in circulating blood volume, which leads to a drop in the filling pressure of the circulatory system and a decrease in venous return of blood to the heart. As a result, a violation of the blood supply to organs and tissues and their ischemia develops.

The reasons

The volume of circulating blood can quickly decrease due to the following reasons:

• blood loss;
• plasma loss (for example, with a burn, peritonitis);
• loss of fluid (for example, with diarrhea, vomiting, profuse sweating, diabetes and diabetes insipidus).

stages

Depending on the severity of hypovolemic shock, three stages are distinguished in its course, which successively replace each other. it

• The first stage is non-progressive (compensated). There are no vicious circles at this stage.
• The second stage is progressive.
• The third stage is the stage of irreversible changes. At this stage, no modern anti-shock agents can bring the patient out of this state. At this stage, medical intervention can restore blood pressure for a short period of time and minute volume heart to normal, but this does not stop the destructive processes in the body. Among the reasons for the irreversibility of shock at this stage, a violation of homeostasis is noted, which is accompanied by severe damage to all organs, damage to the heart is of particular importance.

vicious circles

In hypovolemic shock, many vicious circles form. Among them highest value has a vicious circle that contributes to myocardial damage and a vicious circle that contributes to insufficiency of the vasomotor center.

A vicious cycle that promotes myocardial damage

A decrease in the volume of circulating blood leads to a decrease in the minute volume of the heart and a drop in blood pressure. A drop in blood pressure leads to a decrease in blood circulation in coronary arteries heart, which leads to a decrease in myocardial contractility. A decrease in myocardial contractility leads to an even greater decrease in cardiac output, as well as to a further drop in blood pressure. The vicious circle closes.

A vicious circle that contributes to the insufficiency of the vasomotor center

Hypovolemia is caused by a decrease in cardiac output (that is, a decrease in the volume of blood expelled from the heart in one minute) and a decrease in blood pressure. This leads to a decrease in blood flow in the brain, as well as to a disruption in the activity of the vasomotor (vasomotor) center. The latter is in medulla oblongata. One of the consequences of a violation in the vasomotor center is a drop in the tone of the sympathetic nervous system. As a result, the mechanisms of centralization of blood circulation are disrupted, blood pressure drops, and this, in turn, triggers a violation of cerebral circulation, which is accompanied by even greater inhibition of the vasomotor center.

shock organs

Recently, the term "shock organ" ("shock lung" and "shock kidney") has often been used. This means that the impact of a shock stimulus disrupts the function of these organs, and further violations of the state of the patient's body are closely related to changes in the "shock organs".

"Shock Lung"

Story

This term was first introduced into practice by Ashbaugh (year) when describing the syndrome of progressive acute respiratory failure. However, even in the year Burford and Burbank described a similar clinico-anatomical syndrome, calling it "wet (wet) light". After some time, it was found that the picture of the “shock lung” occurs not only in shocks, but also in craniocerebral, thoracic, abdominal injuries, with blood loss, prolonged hypotension, aspiration of acidic gastric contents, massive transfusion therapy, increasing decompensation of the heart, thromboembolism of the pulmonary artery. Currently, no relationship has been found between the duration of shock and the severity of pulmonary pathology.

Etiology and pathogenesis

The most common cause of the development of "shock lung" is hypovolemic shock. Ischemia of many tissues, as well as a massive release of catecholamines, lead to the entry of collagen, fat and other substances into the blood, which cause massive thrombosis. Because of this, microcirculation is disturbed. A large number of blood clots settle on the surface of the vessels of the lungs, which is associated with the peculiarities of the structure of the latter (long convoluted capillaries, double blood supply, shunting). Under the action of inflammatory mediators (vasoactive peptides, serotonin, histamine, kinins, prostaglandins), vascular permeability in the lungs increases, bronchospasm develops, the release of mediators leads to vasoconstriction and damage.

Clinical picture

The “shock lung” syndrome develops gradually, reaching its apogee usually after 24-48 hours, the outcome is often a massive (often bilateral) damage to the lung tissue. The process is clinically divided into three stages.

1. The first stage (initial). Arterial hypoxemia (lack of oxygen in the blood) dominates, the x-ray picture of the lung is usually not changed (with rare exceptions, when an x-ray examination shows an increase in the pulmonary pattern). Cyanosis (bluish skin tone) is absent. The partial pressure of oxygen is sharply reduced. Auscultation reveals scattered dry rales.
2. Second stage. In the second stage, tachycardia increases, that is, the frequency increases heart rate, tachypnea (respiratory rate) occurs, the partial pressure of oxygen decreases even more, mental disorders intensify, the partial pressure of carbon dioxide rises slightly. Auscultation reveals dry, and sometimes small bubbling rales. Cyanosis is not expressed. Radiologically, a decrease in the transparency of the lung tissue is determined, bilateral infiltrates appear, unclear shadows.
3. Third stage. In the third stage, without special support, the body is not viable. cyanosis develops. X-ray reveals an increase in the number and size of focal shadows with their transition to confluent formations and total darkening of the lungs. The partial pressure of oxygen is reduced to critical figures.

"Shock Kidney"

Pathological anatomical preparation of the kidney of a patient who died from acute kidney failure.

The term "shock kidney" reflects acute disorder kidney function. In pathogenesis, the leading role is played by the fact that during shock, compensatory shunting of arterial blood flow into the direct veins of the pyramids occurs with a sharp decrease in hemodynamic volume in the region of the cortical layer of the kidneys. This is confirmed by the results of modern pathophysiological studies.

pathological anatomy

The kidneys are somewhat enlarged, swollen, their cortical layer is anemic, pale gray in color, the pericerebral zone and pyramids, on the contrary, are dark red. Microscopically, in the first hours, anemia of the vessels of the cortical layer and a sharp hyperemia of the pericerebral zone and direct veins of the pyramids are determined. Microthromboses of capillaries of glomeruli and adductor capillaries are rare.

In the future, increasing dystrophic changes in the nephrothelium are observed, covering first the proximal and then the distal parts of the nephron.

Clinical picture

The picture of the "shock" kidney is characterized by a clinic of progressive acute renal failure. In its development, acute renal failure in shock goes through four stages:

The first stage occurs while the cause that caused acute renal failure is in effect. Clinically, there is a decrease in diuresis.

The second stage (oligoanuric). To the most important clinical signs oligoanuric stage of acute renal failure include:

• oligoanuria (with the development of edema);
• azotemia (smell of ammonia from the mouth, itching);
• kidney enlargement, back pain, positive symptom Pasternatsky (the appearance of red blood cells in the urine after tapping in the projection area of ​​the kidneys);
• weakness, headache, muscle twitching;
• tachycardia, expansion of the boundaries of the heart, pericarditis;
• dyspnea, congestive rales in the lungs up to interstitial pulmonary edema;
• dry mouth, anorexia, nausea, vomiting, diarrhea, cracks in the mucous membrane of the mouth and tongue, abdominal pain, intestinal paresis;

The third stage (restoration of diuresis). Diuresis can be normalized gradually or rapidly. Clinical picture This stage is associated with emerging dehydration and dyselectrolytemia. The following signs develop:

• weight loss, asthenia, lethargy, lethargy, possible infection;
• normalization of nitrogen-excretory function.

Fourth stage (recovery). Homeostasis indicators, as well as kidney function, return to normal.

Literature

• Ado A.D. Pathological physiology. - M., "Triada-X", 2000. S. 54-60
• Klimiashvili A. D. Chadaev A. P. Bleeding. Blood transfusion. Blood substitutes. Shock and resuscitation. - M., "Russian State medical University", 2006. S. 38-60
• Meyerson F. Z., Pshennikova M. G. Adaptation to stressful situations and physical activity. - M., "Triada-X", 2000. S. 54-60
• Poryadin GV Stress and pathology. - M., "Miniprint", 2002. S. 3-22
• Pods V. I. General surgery. - M., "Medicine", 1978. S. 144-157
• Sergeev ST. Surgery of shock processes. - M., "Triada-X", 2001. S. 234-338

Notes

a symptom complex of violations of the vital functions of the body, arising as a result of a discrepancy between tissue blood flow and the metabolic need of tissues.

During the development of shock, the main task of the body is to maintain adequate blood flow in the vital organs (heart and brain). Therefore, initially there is a narrowing of blood vessels in other organs and tissues, thus achieving centralization of blood circulation. Such prolonged vasoconstriction over time leads to the development of ischemia - a decrease in the blood supply to an organ or tissue, resulting from a weakening or cessation of inflow arterial blood. This leads to the development of biological active substances, contributing to an increase in vascular permeability, which ultimately leads to vasodilation. As a result, the protective adaptive mechanism of the body is disrupted - the centralization of blood circulation, which entails serious consequences.

According to the pathogenesis, the following types of shock are distinguished:

• hypovolemic;
• traumatic;
• cardiogenic;
• infectious-toxic;
• anaphylactic;
• septic;
• neurogenic;
• combined (contains all pathogenetic elements of various shocks).

The consequences of shock depend on the cause that served to develop such a condition. For example, shock can lead to complications such as failure of a number of internal organs, pulmonary and cerebral edema. Such formidable consequences can lead to death, so the shock requires increased attention.

Symptoms

When shocked, attention may be appearance patient. Such a person has pale and cold skin to the touch. The exceptions are septic and anaphylactic shocks, in which the skin is warm at the beginning of development, but then it does not differ in any way from the characteristics in other types of shock. General weakness, dizziness, nausea are pronounced. Perhaps the development of excitation, followed by lethargy or coma. Blood pressure is significantly reduced, which carries a certain danger. As a result, the stroke volume of blood is reduced, which is necessary to satisfy organs and tissues in oxygen. Therefore, tachycardia occurs - an increase in the number of heart contractions. In addition, there is the appearance of oligoanuria, which means a sharp decrease in the amount of urine excreted.

At traumatic shock Patients complain of severe pain caused by trauma. Anaphylactic shock is accompanied by shortness of breath, which occurs due to bronchospasm. Significant blood loss can also lead to the development of shock, in which case attention is drawn to internal or external bleeding. In septic shock, there is fever body, which is difficult to stop by taking antipyretics.

Diagnostics

For some time, the state of shock may go unnoticed, since there is no specific symptom indicating exclusively the development of shock. Therefore, it is important to evaluate all the symptoms that the patient has and to analyze the situation individually in each case. To make a diagnosis of shock, it is necessary to identify signs of insufficient blood circulation in tissues, as well as to detect the inclusion of compensatory mechanisms of the body.

First of all, attention is paid to the appearance of the patient. The skin is often cold to the touch and looks pale. May show cyanosis (bluish discoloration skin and/or visible mucous membranes). Blood pressure is measured to confirm hypotension. Patients complain of general weakness, dizziness, nausea, palpitations, and the amount of urine excreted sharply decreases.

It is important to compare all the symptoms as quickly as possible, make the correct diagnosis and begin appropriate treatment.

Treatment

Shock is an emergency condition that can lead to irreversible consequences. Therefore, it is extremely important to provide medical assistance in a timely manner. Prior to the arrival of specialists, nearby people should take first aid measures. First, you need to give the person a horizontal position with a raised foot end. Such actions contribute to an increase in venous return to the heart, which leads to an increase in the stroke volume of the heart. During shock, the heart can no longer cope with the stroke volume necessary to deliver the right amount of oxygen to the tissues. Although the horizontal position with raised legs does not fully compensate for the insufficiency of the stroke volume of the heart, it helps to improve this condition.

Medical care consists of infusion therapy and the introduction of drugs whose action is aimed at vasoconstriction. Infusion therapy is based on the introduction into the bloodstream of various solutions of a certain volume and concentration to fill the vascular bed.

Usage medicines, constricting blood vessels, is necessary to maintain blood pressure.

If breathing is disturbed, oxygen therapy or mechanical ventilation is used.

These general measures are aimed at combating the pathogenesis of shock, and there is also a symptomatic treatment that is different for each type of shock. So, for example, in case of traumatic shock, it is necessary to administer painkillers, immobilize fractures, or apply sterile dressing to the wound. Cardiogenic shock requires treatment of the underlying cause of the shock. Hypovolemic shock is often associated with blood loss, so it is important to understand that without eliminating the cause, that is, stopping the bleeding (application of a tourniquet, pressure bandage, clamping the vessel in the wound, etc.), general measures will not have the desired effect. Septic shock is accompanied by fever, so antipyretics are used as a symptomatic treatment, and to eliminate the cause itself, antibacterial drugs. In the treatment of anaphylactic shock, it is important to prevent delayed systemic manifestations; for this purpose, glucocorticosteroids and antihistamines. It is also necessary to stop the phenomenon of bronchospasm.

Medications

With the development of shock, it is important to provide access to the vein as quickly as possible, preferably not to one, but to several at once. This is necessary to start infusion therapy, as well as the introduction of drugs directly into the bloodstream. Infusion therapy has an impact on the main links of pathogenesis. It is able to maintain an optimal level of BCC (volume of circulating blood), which leads to stabilization of hemodynamics, improves microcirculation, thereby increasing oxygen delivery to tissues, and improves metabolism in cells.

Infusion solutions used for shock include:

• crystalloids (isotonic NaCl solution, Ringer's solution, glucose solutions, mannitol, sorbitol);
• colloids (hemodez, polydez, polyoxidin, polyglucin, reopoliglyukin).

Usually a combination of crystalloid and colloidal solutions is used. This tactic allows you to replenish the volume of circulating blood, and also regulates the balance of intracellular and interstitial fluids. The choice of volume and ratio of crystalloid and colloid solutions depends on each clinical case, which has its own characteristics.

Of the drugs that cause narrowing of the lumen of blood vessels, the main one is adrenaline. Intravenous administration contributes to the accumulation of the required concentration of the drug directly in the blood, which leads to the most rapid manifestation of the effect than with other methods of administration. Dobutamine and dopamine also have this effect. Their action occurs approximately 5 minutes after intravenous administration and lasts about 10 minutes.

Folk remedies

Shock of various etiologies requires exclusively medical attention, no prescriptions folk remedies unable to improve the patient's condition. Therefore, it is important not to waste precious time, but to immediately call specialists who will provide needed help and save from possible irreversible consequences. While waiting for the arrival of the ambulance, the first aid measures that were described earlier should be performed (put the person in a horizontal position with the foot end raised, warm the body). Not only the effectiveness of treatment, but also the life of a person depends on the right actions!

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

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General information

It's a difficult situation when the cardiovascular system cannot cope with the blood supply of the body, this is usually due to low blood pressure and damage to cells or tissues.

Causes of shock

Shock can be caused by a state of the body when blood circulation is dangerously reduced, for example, with cardiovascular diseases (heart attack or heart failure), with a large loss of blood (severe bleeding), with dehydration, with severe allergic reactions or blood poisoning (sepsis).

Shock classification includes:

• cardiogenic shock (associated with cardiovascular problems),
• hypovolemic shock (caused by low blood volume),
• anaphylactic shock (caused by allergic reactions),
• septic shock (caused by infections)
• neurogenic shock (disorders of the nervous system).

Shock is a life-threatening condition and requires immediate medical treatment, it is possible and urgent care. The patient's condition in shock can deteriorate rapidly, be prepared for primary resuscitation.

Shock Symptoms

Symptoms of shock may include fear or arousal, blue lips and nails, chest pain, confusion, cold, wet skin, reduced or stopped urination, dizziness, fainting, low blood pressure, paleness, excessive sweating, rapid pulse, shallow breathing, unconsciousness , weakness.

First aid for shock

Check Airways victim, artificial respiration should be performed if necessary.

If the patient is conscious and has no injuries to the head, limbs, back, lay him on his back, while the legs should be raised by 30 cm; keep your head down. If the patient has received an injury in which the raised legs cause a feeling of pain, then do not raise them. If the patient has received a severe injury to the spine, leave him in the position in which he was found, without turning over, and provide first aid by treating wounds and cuts (if any).

The person should remain warm, loosen tight clothing, do not give the patient any food or drink. If the patient is vomiting or drooling, turn his head to the side to ensure the outflow of vomit (only if there is no suspicion of a spinal cord injury). If, nevertheless, there is a suspicion of damage to the spine and the patient is vomiting, it is necessary to turn it over, fixing the neck and back.

call ambulance and continue to monitor vital signs (temperature, pulse, respiratory rate, blood pressure) until help arrives.

Preventive measures

Shock is easier to prevent than to treat. fast and timely treatment underlying causes will reduce the risk of severe shock. First aid will help control the state of shock.