Treatment of patients in the after-shocks period

Clinical experience suggests that to make a clear distinction between the shock and the after-shocks periods in practice very difficult. It is considered that the shock period ends stable normalization of blood circulation.
For patients who suffered a shock, characterized by extreme lability indicators of functions of different organs and systems, rather frequent changes relatively prosperous States life-threatening, the possibility of developing severe complications from respiratory, cardiovascular, gastrointestinal tract and urinary tract, etc., In the after-shocks period we often observe severe laryngitis, tracheitis, bronchitis, pneumonia, pulmonary edema. Some patients, especially those with severe concomitant injuries, have developed severe vascular collapse, and before that prolonged hypotension may entail and violations of the kidneys. In this period also possible complications of the gastrointestinal tract. Finally, very often, even in cases seemingly completely filled severe blood loss postgemorragical, and possibly toxic anaemia.
These observations suggest that intensive therapy should not continue only until the patient is in a state of shock, and during the acute period of the traumatic disease, i.e., up until the General condition of the patient will be continued satisfactory.
From this it follows that in the after-shocks period should carefully evaluate not only the General condition of the victim, but also actively (oseltamivir) to affect all the organs and systems of the body. This requirement is especially difficult because of the reaction of each individual patient in the after-shocks period is very individual, however, certain principles of prevention of possible complications and treatment of major syndromes of traumatic disease seems to be quite real.
Thus in the after-shocks of the period, as in the period of combat shock, should continue drip intravenous transfusion of krovezamenitel or blood and in combination with vitamins C, B1, B6 and PP, glucose and insulin. The tendency to bleeding or questionable hemostasis to this complex add menadione, fibrinogen, and so on, on the contrary, if the trend towards
thrombosis - fibrinolizin, anticoagulants, etc.
To neutralize circulating in the blood of histamines and similar substances, to strengthen the analgesic action of analgesics, for easy ganglion blockade efferent nerve pathways in the after-shocks of the period of the widely used solutions of pipolfen or Dimedrol. When kollaptoidnye reactions and unstable blood pressure to the above-mentioned tools add hydrocortisone (prednisolone).
The big place in the after-shocks period occupy pulmonary complications. Therefore, the care of respiratory ways should be given great importance. When laryngitis, tracheitis, bronchitis effective inhalations with pairs soda solutions, oils (eucalyptus, menthol and other) or volatile (fresh infusion of onions or garlic on water). When available tracheostomy these activities complement regular washing of the respiratory tract and systematic toilet area tracheostomy.
Warning pneumonia is due to the elevated position of the patient, breathing exercises, timely treatment of diseases of the upper respiratory tract, if possible, often turn in bed and good ventilation. When developed pneumonia these events are added to the active antibacterial therapy, cupping, mustard and other
Extremely dangerous pulmonary complication is pulmonary edema. In its initial stages in the lungs listening plenty wet scattered wheezing, and at the height of development - even at a distance hear the roaring wheezing.
In the first case, it is sometimes sufficient doing inhalation of oxygen, passed through alcohol, and injection cordiamine. In more severe cases, along with known therapeutic measures shown bloodletting and intravenous glucose with strophanthin. To resort to the bloodletting can, of course, only in cases where the injury was not accompanied by loss of blood. It should be remembered that the bloodletting effectively only when the blood is removed quickly and in sufficient quantities (within 200-400 ml). Slow bloodletting and in small amounts does not cause the necessary adjustment in blood circulation and is almost pointless.
Fighting complication from the gastrointestinal tract is held by perirenal procaine blockades, re anaesthetic plots pain pulsation, systematic evacuation of stomach and intestinal contents with a probe and enemas.
Constant study of acid-base balance and study in the dynamics of the content of non-protein nitrogen in the blood (residual nitrogen) allows to install developing kidney failure and to carry out measures on stimulation of activity of kidneys - intravenous mannitol solution, perirenal blockade, etc.,
Of particular importance in the after-shocks of the period given to alleviating pain, which often serves as the main cause of developing complications. The most accessible and appropriate pain relievers and activities in these conditions, we consider periodic inhalation mixture of nitrous oxide and oxygen (1 : 1), injections of morphine or of dipyrone in combination with Pipolphenum or Dimedrol, intramuscular injection of 10% solution amidopirina, local anesthesia by infiltration of tissues or blocking nerve trunks.
We consider erroneous position, when in the after-shocks period, preference is given unconditionally parenteral nutrition of patients. Only if there is direct contraindications for food intake you can use this backup route of administration of nutrients. In the preparation of the diet should remember that the function of internal organs in the after-shocks period not restored immediately, so food must be light, digestible, high-calorie and varied.
Thus, the after-shocks period requires that each medical worker not less voltage effort than the period of struggle with shock and conduct intensive care. And, as in shock period, therapeutic and prophylactic measures should not be held in a standardized manner. Such patients require long-careful surveillance, because at any moment they
may be changes and disruption of one or another system that will require extra make significant adjustments to treatment.