Traumatic shock signs and first aid. Traumatic shock: emergency care

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

traumatic shock(T79.4)

general information

Short description

traumatic shock- rapidly developing life threatening a condition that occurs as a result of exposure to the body of severe mechanical injury.

Traumatic shock is the first stage of a severe form of an acute period of traumatic disease with a peculiar neuro-reflex and vascular reaction of the body, leading to profound disorders of blood circulation, respiration, metabolism, and endocrine gland functions.

Triggers of traumatic shock are pain and excessive (afferent) impulses, acute massive blood loss, traumatization of vital organs, mental shock.

Purpose of the stage: restoration of the function of all vital systems and organs

Code (codes) according to ICD-10:

T79.4 Traumatic shock

Ruled out:

Shock (caused):

Obstetric (O75.1)

Anaphylactic

NOS (T78.2)

Due to:

Pathological reaction to food (T78.0)

Adequately prescribed and correctly administered drug (T88.6)

Serum reactions (T80.5)

Anesthesia (T88.2)

Electrical induced (T75.4)

Non-traumatic NKD (R57.-)

From being struck by lightning (T75.0)

Postoperative (T81.1)

Accompanying abortion, ectopic or molar pregnancy (O00-O07, O08.3)

T79.8 Other early complications of trauma

T79.9 Early complication injury, unspecified

Classification

In the course of traumatic shock:

1. Primary - develops at the time or immediately after the injury.

2. Secondary - develops delayed, often several hours after the injury.

Stages of traumatic shock:

1. Compensated - there are all signs of shock, with a sufficient level of blood pressure, the body is able to fight.

3. Refractory shock - all ongoing therapy is unsuccessful.

The severity of traumatic shock:

Shock 1 degree - GARDEN 100-90 mm Hg, pulse 90-100 in 1 minute, satisfactory filling.

Shock of the 2nd degree - GARDEN 90-70 mm Hg, pulse 110-130 per 1 minute, weak filling.

Shock 3rd degree - GARDEN 70-60 mm Hg, pulse 120-160 per 1 minute, very weak filling (filamentous).

Shock 4 degrees - blood pressure is not determined, the pulse is not determined.

Factors and risk groups

1. Rapid blood loss.

2. Overwork.

3. Cooling or overheating.

4. Fasting.

5. Repeated injuries (transportation).

6. Penetrating radiation and burns, that is, combined damage with mutual aggravation.

Diagnostics

Diagnostic criteria: the presence of mechanical injury, Clinical signs blood loss, decrease blood pressure, tachycardia.

Characteristic symptoms shock:

Cold, moist, pale cyanotic or marbled skin;

Sharply slowed blood flow of the nail bed;

Darkened consciousness;

dyspnea;

Oliguria;

Tachycardia;

Decrease in arterial and pulse pressure.

An objective clinical examination reveals

There are two phases in the development of traumatic shock.

erectile stage occurs immediately after the injury and is characterized by a pronounced psychomotor agitation of the patient against the background of centralization of blood circulation. The behavior of patients may be inadequate, they rush about, scream, make erratic movements, euphoric, disoriented, resist examination and assistance. Getting in touch with them is sometimes extremely difficult. Blood pressure may be normal or close to normal. There may be various respiratory disorders, the nature of which is determined by the type of injury. This phase is short-term and by the time assistance is provided, it may change into a torpid one or stop.

For torpid phase characterized by darkening of consciousness, stupor and the development of a coma as an extreme degree of cerebral hypoxia caused by disorders of the central circulation, a decrease in blood pressure, a soft, frequent pulse, pale skin. At this stage on prehospital stage the ambulance doctor should rely on the level of blood pressure and try to determine the amount of blood loss.

The determination of the volume of blood loss is based on the ratio of pulse rate to the level of systolic blood pressure (S/SBP).

With shock 1 tbsp (blood loss 15-25% of the BCC - 1-1.2 l) SI = 1 (100/100).

With shock 2 tbsp (blood loss 25-45% of the BCC - 1.5-2 l) SI = 1.5 (120/80).

With shock 3 tbsp (blood loss of more than 50% of the BCC - more than 2.5 l) SI = 2 (140/70).

When assessing the volume of blood loss, one can proceed from the known data on the dependence of blood loss on the nature of the injury. So, with an ankle fracture in an adult, blood loss does not exceed 250 ml, with a shoulder fracture, blood loss ranges from 300 to 500 ml, lower legs - 300-350 ml, hips - 500-1000 ml, pelvis - 2500-3000 ml, with multiple fractures or combined trauma, blood loss can reach 3000-4000 ml.

Taking into account the possibilities of the prehospital stage, it is possible to compare various degrees shock and their clinical features.

Shock 1 degree(mild shock) is characterized by blood pressure of 90-100/60 mm Hg. and pulse 90-100 bpm. (SHI=1), which can be satisfactorily filled. Usually the victim is somewhat inhibited, but easily comes into contact, reacts to pain; skin and visible mucous membranes are often pale, but sometimes have a normal color. Respiration is rapid, but in the absence of concomitant vomiting and aspiration of vomit respiratory failure no. It occurs against the background of a closed fracture of the femur, a combined fracture of the femur and lower leg, a non-severe fracture of the pelvis with other similar skeletal injuries.

Shock grade 2(shock moderate) is accompanied by a decrease in blood pressure to 80-75 mm Hg, and the heart rate increases to 100-120 bpm. (SHI=1.5). Severe pallor of the skin, cyanosis, adynamia, lethargy are observed. Occurs with multiple fractures of the long tubular bones, multiple rib fractures, severe pelvic fractures, etc.

Shock grade 3(severe shock) is characterized by a decrease in blood pressure to 60 mm Hg. (but may be lower), the heart rate increases to 130-140 bpm. Heart sounds become very muffled. The patient is deeply inhibited, indifferent to the environment, the skin is pale, with pronounced cyanosis and an earthy tint. It develops with multiple combined or combined trauma, damage to the skeleton, large muscle masses and internal organs, chest, skulls and burns.

With further aggravation of the patient's condition, a terminal condition may develop - shock of the 4th degree.

List of main diagnostic measures:

1. Collection of complaints, anamnesis, general therapeutic.

2. Visual examination, general therapeutic.

3. Measurement of blood pressure in the peripheral arteries.

4. Study of the pulse.

5. Heart rate measurement.

6. Measurement of respiratory rate.

7. General therapeutic palpation.

8. General therapeutic percussion.

9. General therapeutic auscultation.

10. Registration, interpretation and description of the electrocardiogram.

11. Studies of the sensory and motor spheres in the pathology of the central nervous system.

List of additional diagnostic measures:

1. Pulse oximetry.

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Treatment

Medical care tactics

Traumatic shock treatment algorithm

General activities:

1. Assess the severity of the patient's condition (it is necessary to focus on the patient's complaints, the level of consciousness, the color and moisture of the skin, the nature of breathing and pulse, the level of blood pressure).

2. Provide measures to stop bleeding.

3. Interrupt shockogenic impulses (adequate anesthesia).

4. Normalization of BCC.

5. Correction of metabolic disorders.

6. In other cases:

Lay the patient with a raised foot end by 10-45%, Trendelenburg position;

Ensure the patency of the upper respiratory tract and access to oxygen (if necessary, mechanical ventilation).

Specific events:

1. Stopping external bleeding at the prehospital stage is carried out by temporary methods (tight tamponade, applying a pressure bandage, finger pressure directly in the wound or distal to it, applying a tourniquet, etc.).

Ongoing internal bleeding at the prehospital stage is almost impossible to stop, so the actions of the ambulance doctor should be aimed at the speedy, careful delivery of the patient to the hospital.

2. Pain relief:

1st option - intravenous administration 0.5 ml of a 0.1% solution of atropine, 2 ml of a 1% solution of diphenhydramine (diphenhydramine), 2 ml of a 0.5% solution of diazepam (Relanium, Seduxen), then slowly 0.8-1 ml of a 5% solution of ketamine (calypsol) .

In severe traumatic brain injury - do not administer ketamine!

2nd option - intravenous administration of 0.5 ml of a 0.1% solution of atropine, 2-3 ml of a 0.5% solution of diazepam (Relanium, Seduxen) and 2 ml of a 0.005% solution of fentanyl.

In case of shock accompanied by ARF, intravenously inject sodium hydroxybutyrate 80-100 mg / kg in combination with 2 ml of a 0.005% fentanyl solution or 1 ml of a 5% ketamine solution in 10-20 ml of an isotonic solution of 0.9% sodium chloride or 5% glucose.

3. Transport immobilization.

4. Replenishment of blood loss.
With an undetectable level of blood pressure, the infusion rate should be 250-500 ml per minute. A 6% solution of polyglucin is administered intravenously. If possible, preference is given to 10% or 6% solutions of hydroxyethyl starch (stabizol, refortan, HAES-steril). At the same time, no more than 1 liter of such solutions can be poured. Signs of the adequacy of infusion therapy is that after 5-7 minutes the first signs of detectability of blood pressure appear, which in the next 15 minutes rise to a critical level (SBP 90 mm Hg).

In mild to moderate shock, preference is given to crystalloid solutions, the volume of which should be higher than the volume of blood lost, as they quickly leave the vascular bed. Enter 0.9% sodium chloride solution, 5% glucose solution, polyionic solutions - disol, trisol, acesol.

10. * Oxygen

List of additional medicines:

2. *Sodium bicarbonate 4% 200.0 ml, vial.

3. *Dopamine 200 mg per 400 ml

4. * Pentastarch (refortan) 500 ml, fl.

5. * Pentastarch (stabilizol) 500 ml, fl.

* - drugs included in the list of essential (vital) medicines.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
   1. 1. Clinical guidelines based on evidence-based medicine: Per. from English. / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. 2nd ed., rev. - M.: GEOTAR-MED, 2002. - 1248 p.: ill. 2. A guide for emergency physicians / Ed. V.A. Mikhailovich, A.G. Miroshnichenko - 3rd edition, revised and supplemented - St. Petersburg: BINOM. Knowledge Laboratory, 2005.-704p. 3. Tactics of management and emergency medical care in emergency conditions. A guide for doctors./ A.L. Vertkin - Astana, 2004.-392p. 4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and protocols for diagnosis and treatment, taking into account modern requirements. Guidelines. Almaty, 2006, 44 p. 5. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On Approval of the List of Essential (Essential) Medicines”. 6. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 “On amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854 “On approval of the Instructions for the formation of the List of essential (vital) medicines”.

Information

Head of the Department of Emergency and Urgent Care, Internal Medicine No. 2 of the Kazakh National medical university them. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University. S.D. Asfendiyarova: Candidate of Medical Sciences, Associate Professor Vodnev V.P.; Candidate of Medical Sciences, Associate Professor Dyusembaev B.K.; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; Candidate of Medical Sciences, Associate Professor Bedelbayeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute for the Improvement of Doctors - Ph.D., Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for the Improvement of Doctors: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.

Attached files

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A significant type of injury, such as wounds, severe burns, concussion, and others, is often accompanied by such a serious condition of the body as traumatic shock, in which first aid is as effective as it is quickly provided. In itself, this complication occurs in combination with a sharp weakening in the veins, capillaries and arteries of the blood flow. This, in turn, leads to severe blood loss and severe pain.

Traumatic shock: main phases and symptoms

In traumatic shock, its two main phases become relevant. Thus, the first phase is defined as the erectile phase; it occurs at the moment a person receives an injury with a simultaneous sharp excitation noted in the nervous system. The second phase is defined as the torpid phase, and is accompanied by inhibition caused by a general depression in the activity of the nervous system, including the activity of the kidneys, liver, lungs and heart. The second phase is characterized by the division into the following degrees:

• I degree of shock (mild). Paleness of the victim, clarity of consciousness is noted, slight lethargy, shortness of breath and decreased reflexes are possible. The increase in heart rate reaches about 100 beats / min.
• II degree of shock (moderate severity). There is marked lethargy and lethargy of the victim, while the pulse is about 140 beats / min.
• III degree of shock (severe). The victim remains with preserved consciousness, but at the same time he loses the ability to perceive the world around him. The color of the skin is earthy gray, in addition, the presence of sticky sweat, cyanosis of the fingertips, nose and lips is noted. The increase in heart rate is about 160 beats / min.
• IV degree of shock (state of preagony or agony). The victim is unconscious, it is not possible to determine the pulse.

Traumatic shock: first aid

• First of all, traumatic shock involves, as the main measure of first aid, the elimination of the causes that provoked it. Accordingly, first aid should be focused on relieving pain or reducing it, stopping the bleeding that has occurred and taking those measures that will ensure improvement. respiratory functions and functions characteristic of cardiac activity.
• To reduce the pain of the injured limb or the victim himself, a position is provided that will create optimal conditions for its reduction. You should also give the victim painkillers. In extreme cases, in the absence of the latter, you can give a small amount of vodka or alcohol.
• Without stopping the bleeding, the fight against the state of shock will be ineffective, for this reason, this factor of influence is eliminated as soon as possible. In particular, traumatic shock and first aid in stopping bleeding involves the application of a pressure bandage or tourniquet, etc.
• The next step is to ensure the transportation of the victim to the hospital. It is better if an ambulance is used for this, under the conditions of which the possibility of providing appropriate measures is determined. In any case, the victim during transportation is provided with maximum peace.

It is important to realize that the prevention of traumatic shock is easier than the consequences of its treatment. Be that as it may, first aid for traumatic shock involves compliance with the following five principles: pain reduction, provision of fluid for oral administration, warming, peace and quiet, and careful transportation (only to a medical facility).

Actions that should be excluded in traumatic shock

• The victim must not be left alone.
• It is impossible to transfer the victim without urgent need. If this is still a necessary measure, then you need to act very carefully - this will eliminate additional injury and deterioration of the general condition.
• In no case should you try to set yourself or straighten the damaged limb - as a result, an increase in traumatic shock may be provoked as a result of increased bleeding and pain.
• It is also impossible to apply a splint without first stopping the bleeding, because as a result of this it may intensify, which, accordingly, will aggravate state of shock or even lead to death.

The state of traumatic shock is a dangerous manifestation of a complication after any type of injury.

First aid for traumatic injuries should be provided immediately, as this condition causes irreversible consequences in the body and often leads to the death of the victim.

With traumatic shock, urgent hospitalization is needed, since medical intervention is necessary to stop it.

Even with minor injuries, this condition is recorded in 3% of the victims. If the injuries are extensive and accompanied by severe external or internal bleeding, open or closed fractures, the rates reach 15%. At the same time, the percentage of death in traumatic shock is very high, reaching more than half of all recorded cases.

Causes and mechanisms of development

At the present stage, doctors associate the development of traumatic shock with two factors: extensive blood loss and severe pain.

At the same time, it is blood loss that primarily contributes to the development of this condition, since the theory of “painful” shock cannot explain why the disease does not occur, for example, in parturient women. Therefore, the hypothesis of hypovolemia is taken as the basis for the occurrence of the disease.

According to this theory, the state of traumatic shock is caused by extensive loss of blood and plasma due to such injuries:

• Severe bruises, accompanied by internal hemorrhages;
• fractures;
• Ruptures of internal organs;

After stopping the bleeding, it is important to ensure the weakening of the pain syndrome. To do this, use any available.

Note!

If the victim is fainting, do not put an anesthetic in his mouth!

A conscious person needs to ensure a free flow of air: remove or loosen the pressing elements of clothing.

If the patient is unconscious, he is gently turned on his side and his tongue is fixed to prevent choking with vomit.

If the victim does not show signs of life, he needs to be given first aid: artificial respiration and heart massage.

Regardless of the season, after injury, the patient feels a feverish chill. Therefore, it is important to warm it by covering it with any warm clothes.

6999 0

This acutely developing and life-threatening condition, which occurs as a result of a severe injury, is characterized by a critical decrease in blood flow in the tissues (hypoperfusion) and is accompanied by clinically pronounced disturbances in the activity of all organs and systems.

Leading in the pathogenesis of traumatic shock is pain (powerful pain impulses coming from the site of injury to the central nervous system). A complex of neuroendocrine changes in traumatic shock leads to the launch of all subsequent body responses.

Redistribution of blood. At the same time, the blood supply to the vessels of the skin, subcutaneous fat, and muscles increases with the formation of stasis areas in them and the accumulation of red blood cells. In connection with the movement of large volumes of blood to the periphery, relative hypovolemia is formed.

Relative hypovolemia leads to a decrease in venous return of blood to the right side of the heart, a decrease in cardiac output, and a decrease in blood pressure. A decrease in blood pressure leads to a compensatory increase in total peripheral resistance, impaired microcirculation. Violation of microcirculation, its progression is accompanied by hypoxia of organs and tissues, the development of acidosis.

Traumatic shock is often combined with internal or external bleeding. Which, of course, leads to an absolute decrease in the volume of circulating blood. Despite the exceptional importance of blood loss in the pathogenesis of traumatic shock, traumatic and hemorrhagic shocks should not be equated. In case of severe mechanical damage, the pathological effect of blood loss is inevitably accompanied by the negative influence of nerve-pain impulses, endotoxicosis and other factors, which makes the state of traumatic shock always more severe compared to "pure" blood loss in an equivalent volume.

One of the main pathogenetic factors that form traumatic shock is toxemia. Its influence begins already at 15-20 minutes from the moment of injury. The endothelium and, first of all, the kidney are exposed to toxic effects. In this connection, multiple organ failure is formed quite quickly.

Diagnosis of traumatic shock occurs on the basis of clinical data: systolic and diastolic blood pressure, pulse, color and moisture of the skin, diuresis. In the absence of arrhythmia, the degree and severity of hemodynamic disturbances can be assessed using the shock index (Algover).

With closed fractures, blood loss is:
. ankles - 300 ml;
. shoulder and lower leg - up to 500 ml;
. thighs - up to 2 l;
. pelvic bones - up to 3 liters.

Depending on the magnitude of systolic blood pressure, 4 degrees of severity of traumatic shock are distinguished:
1. I degree - systolic pressure drops to 90 mm Hg. Art.;
2. II degree of severity - up to 70 mm Hg. Art.;
3. III degree of severity - up to 50 mm Hg;
4. IV degree of severity - less than 50 mm Hg. Art.

Clinic

At the III degree of traumatic shock, the condition of the patients is severe, consciousness is preserved, lethargy is noted. The skin is pale, with an earthy tint (appears when pallor is combined with hypoxia), cold, often covered with cold, clammy sweat. BP was consistently reduced to 70 mm Hg. Art. and less, the pulse is accelerated to 100-120 in 1 min, weak filling. Shortness of breath is noted, thirst is disturbing. Diuresis is sharply reduced (oliguria). IV degree of traumatic shock is characterized by an extremely serious condition of patients: severe adynamia, indifference, skin and mucous membranes are cold, pale gray, with an earthy tint and a marble pattern. Pointed facial features. BP is lowered to 50 mm Hg. Art. and less. CVP close to zero or negative. The pulse is threadlike, more than 120 beats per minute. Anuria or oliguria are noted. At the same time, the state of microcirculation is characterized by paresis of peripheral vessels, as well as DIC. Clinically, this is manifested by an increase in tissue bleeding.

The clinical picture of traumatic shock reflects the specific features of certain types of injuries. So, with severe wounds and injuries of the chest, psychomotor agitation, fear of death, hypertonicity of skeletal muscles are observed; a short-term rise in blood pressure is replaced by a rapid fall. In traumatic brain injury, there is a pronounced tendency to arterial hypertension, masking clinical picture hypocirculation and traumatic shock. With intra-abdominal injuries, the symptoms of a developing

Urgent care

Ensure patency of the upper respiratory tract using the Safar triple maneuver, assisted ventilation.
. Inhalation with 100% oxygen for 15-20 minutes, followed by a decrease in the oxygen concentration in the inhaled mixture to 50-60%.
. In the presence of tension pneumothorax - drainage of the pleural cavity.
. Stop bleeding by finger pressure, tight bandage, tourniquet, etc.
. Transport immobilization (should be done as early and as reliably as possible).
. Pain relief through the use of all types of local and conduction anesthesia. Used for fractures of large bones local anesthetics in the form of blockades directly to the fracture zone, nerve trunks, osteofascial cases.
. The following analgesic cocktails are administered parenterally (intravenously): atropine sulfate 0.1% solution 0.5 ml, sibazon 0.5% solution 1-2 ml, tramadol 5% solution 1-2 ml (but not more than 5 ml) or promedol 2 % solution 1 ml.
. Or atropine sulfate 0.1% solution 0.5 ml, sibazon 0.5% solution 1 ml, ketamine 1-2 ml (or at a dose of 0.5-1 mg / kg of body weight), tramadol 5% solution 1-2 ml (but not more than 5 ml) or promedol 2% solution 1 ml.

It is possible to use other analgesics in equivalent doses.

The most important task in the treatment of traumatic shock is the most rapid restoration of blood supply to tissues. With an undetectable level of blood pressure, jet transfusions into two veins (under pressure) are necessary in order to achieve a rise in systolic pressure to a level of at least 70 mm Hg in 10-15 minutes. Art. The infusion rate should be 200500 ml per 1 minute. Due to the significant expansion of the vascular space, it is necessary to introduce large volumes of fluid, sometimes 3-4 times the expected blood loss. The rate of infusion is determined by the dynamics of blood pressure. Jet infusion should be carried out until the blood pressure rises steadily to 100 mm Hg. Art.

Table 8.5. The program of infusion therapy during the transportation of the victim

The sequence of measures may vary depending on the prevalence of certain violations. The victim is transported to the hospital while intensive care is ongoing.

Sakrut V.N., Kazakov V.N.

traumatic shock- a serious condition that threatens a person's life, arising as a reaction to an acute injury, which is accompanied by large blood loss and intense pain. Shock occurs at the time of receiving a traumatic effect in case of pelvic fractures, gunshot, craniocerebral injuries, severe injuries of internal organs, in all cases associated with a large loss of blood.

Traumatic shock is considered a companion of all severe injuries, regardless of their causes. Sometimes it can occur after some time when receiving additional injury. In any case, traumatic shock is a very dangerous phenomenon, posing a threat to human life, requiring immediate recovery in intensive care.

Classification

Depending on the cause of the injury, types of traumatic shock are classified as:

• Surgical;
• Endotoxin;
• Shock resulting from a burn;
• The shock resulting from the fragmentation;
• Shock from exposure to a shock wave;
• Shock resulting from the application of a tourniquet.

According to the classification of V.K. Kulagina there are such types of traumatic shock: Operational; Wound (appears as a result of mechanical impact, it can be visceral, cerebral, pulmonary, occurs with multiple injuries, sharp compression of soft tissues); Mixed traumatic; Hemorrhagic (develops due to bleeding of any nature).

Phases

Regardless of the causes of shock, it goes through two phases - erictile (excitation) and torpid (inhibition).

Erictile

This phase occurs at the time of a traumatic impact on a person with a simultaneous sharp excitation of the nervous system, manifested in excitement, anxiety, fear. The victim remains conscious, but underestimates the complexity of his situation. He can adequately answer questions, but has a disturbed orientation in space and time.

The phase is characterized by a pale cover of human skin, rapid breathing, severe tachycardia. Mobilization stress in this phase has a different duration, the shock can last from several minutes to hours. And with a severe injury, it sometimes does not manifest itself in any way. And a too short erictile phase often precedes a more severe course of shock in the future.

Torpidnaya

It is accompanied by a certain inhibition due to the inhibition of the activity of the main organs ( nervous system, heart, kidneys, lungs, liver). Increasing circulatory failure. The victim becomes pale. His skin has a gray tint, sometimes a marble pattern, indicating poor blood supply, congestion in the vessels, he is covered with cold sweat. The extremities in the torpid phase become cold, and breathing is rapid, superficial.

The torpid phase is characterized by 4 degrees, which indicate the severity of the condition.

• First degree.

Considered easy. In this condition, the victim has a clear consciousness, pale skin, shortness of breath, slight lethargy, the pulse beats up to 100 beats per minute, the pressure in the arteries is 90-100 mm Hg. Art.

• Second degree.

This is moderate shock. It is characterized by a decrease in pressure up to 80 mm Hg. Art., the pulse reaches 140 beats / min. A person has a pronounced lethargy, lethargy, shallow breathing.

• Third degree.

An extremely serious condition of a person in shock, who is in a confused mind or has completely lost it. The skin becomes earthy gray, and the tips of the fingers, nose and lips become cyanotic. The pulse becomes thready and quickens to 160 bpm. The person is covered in sticky sweat.

• Fourth degree.

The victim is in agony. This shock is characterized total absence pulse and consciousness. The pulse is barely palpable or completely imperceptible. Skin have a gray color, and the lips become bluish, does not respond to pain. The prognosis is most often unfavorable. The pressure becomes less than 50 mm Hg. Art.

First aid

Assistance activities:

• Immediately stop bleeding with a tourniquet, bandage, or tamponade of the wound. The main event in traumatic shock is considered to stop bleeding, as well as the elimination of the causes that provoked the state of shock.
• Provide enhanced access of air to the lungs of the victim, for which release him from tight clothing, lay him in such a way as to prevent ingress foreign bodies and liquids in Airways. If there are injuries on the body of the injured person that can complicate the course of shock, then measures should be taken to close the wounds with a bandage or use the means of transport immobilization for fractures.
• Wrap the victim in warm clothes to avoid hypothermia, which increases the state of shock. This is especially true for children and the cold season. The patient can be given a little vodka or cognac, drink plenty of water with salt dissolved in it and baking soda. Even if one does not feel severe pain, and this happens with shock, painkillers should be used, for example, analgin, maxigan, baralgin.
• call urgently ambulance or to deliver the patient to the nearest medical institution, it is better if it is a multidisciplinary hospital with an intensive care unit.
• Transport on a stretcher in maximum comfort. With continued loss of blood, lay the person with raised legs and lowered end of the stretcher in the head area.
• If the victim is unconscious or vomits, then lay him on his side. In overcoming a state of shock, it is important not to leave the victim unattended, to inspire him with confidence in a positive outcome.

It is important to observe 5 basic rules when providing emergency care:

• decline pain;
• The presence of plentiful drink for the victim;
• Warming up the patient
• Providing the victim with peace and quiet;
• Urgent delivery to a medical institution.

When traumatic shock is prohibited:

• Leave the victim unattended;
• Carry an injured person unnecessarily. If transfer cannot be avoided, then this must be done carefully to avoid causing additional injuries;
• In case of damage to the limbs, they cannot be adjusted by themselves, otherwise you can provoke an increase in pain and the degree of traumatic shock;
• Do not apply splints to injured limbs without achieving a reduction in blood loss. This can deepen the patient's state of shock and even cause his death.