The discussion about the definition of traumatic shock and its place in the pathogenesis of traumatic disease

Despite the long history of the doctrine of traumatic shock, the question of its definition is still debated. In the literature, as shown I. K. Ahunbaeva and G. L. Frenkel (1960, 1967), published many different definitions. Has not led to a consensus numerous discussions at various formulas of recent years. In particular, for many years does not stop the debate about whether traumatic shock "process" (item pathophysiologists) or a "state" (item clinicians). In our opinion, this discussion is not so much can serve as an occasion for reflection, how much is surprising, as it is obvious that in terms of cause-effect relationships in nature, including, in biology and medicine, pathophysiological understanding of the process, acting causal quality, cannot be opposed clinical notion of "state", in all cases, which is the external manifestation occur in the body processes. Therefore, if you build a bridge between the pathophysiology and clinic, you completely abandon disputes and, focusing on the obvious fact full of the relationship between physiological and pathological processes in the body, and their external clinical manifestations, to recognize these phenomena are interrelated, although learn representatives of different medical specialties.
As regards the definition of traumatic shock, it would be ideal if it reflected the nature and severity of anatomical damage, the degree of jizneopisanii General condition of the victims, the representative and the power phase of pathogenesis, it triggers and the degree of involvement of various organs, systems, processes, etc., However, it is clear that any wording may be found to be optimal only in cases of extreme concreteness, not excluding the essence of the phenomenon. In this connection it is interesting to consider the most popular definition of traumatic shock, many of which can be considered a classic (table. 1, 2).

In these definitions, the concept of "traumatic shock" is considered as the alarm signal, without any clinical and pathogenetic of detail.
Without criticism and detailed discussion the above-cited definition, we consider it necessary to note that in the determination of any pathological conditions, including traumatic shock, should be based on a proper understanding of its essence. This General truth we have to remember because in many practical guidelines and monographic literature traumatic shock is treated in isolation from the traumatic disease in General, essentially as an independent nosological unit. Not always taken into account and its etiology.
                 
Our long experience in the field of trauma resuscitation convinces us that this kind of position is incorrect in its essence, because they unintentionally weaken attention and reduce the alertness of the doctor, and thus can lead to large losses in time when helping with injuries and as a result to serious and sometimes irreparable consequences. In this connection there is a need to more clearly define the place of traumatic shock in a pathogenetic chain of traumatic disease and on the basis of this attempt to its definition as a typical pathological condition.
Getting to the decision of this question, we first tried to define the concept of "trauma" and "trauma disease." The injury is damage to the body caused by the action, usually sudden, traumatic factor traumatic illness is common suffering of the body caused by trauma.
Using these definitions, we had the opportunity schematically represent the dynamics of occurrence and development of traumatic disease and place of its pathogenesis and symptoms of traumatic shock (scheme 2).

Scheme 2. Clinical pattern of occurrence and development of traumatic disease

Thus, as it follows from the diagram 2, the definition of traumatic shock can be the following: traumatic shock - variant of development of traumatic disease, clinically characterized by life-threatening disturbances of the function of organs.
Speaking about the traumatic shock, as the variant of development of traumatic disease, in any case you should not consider it inevitable appearance of shock is possible only in certain situations under the joint influence of external and internal conditions.