Shock

Shock syndrome severe disorders of blood circulation, of respiration, metabolism and endocrine glands caused by the disorder of neurohumoral regulation of vital processes in life threatening conditions.
Stimuli that causes shock, can be exogenous (pain with mechanical, thermal injury, the action of toxins and other) and endogenous (pain in myocardial infarction, perforated ulcer, when education in the body of toxic products etc).

Classification

(Aetiological basis)
I. Pain shock: 1) exogenous pain shock (trauma):
a) in case of mechanical damages;
b) with thermal and chemical burns; C) if frostbite; d) when electric shock; 2) endogenous pain shock: a) cardiogenic; b) nephrogenic; C) in acute intestinal obstruction; d) when the rupture of a hollow organ abdominal cavity.
II. Humoral shock: 1) anaphylactic; 2) hemolytic; 3) the adrenaline; 4) bacterial; 5) toxic.
III. Psychogenic shock resulting from severe psychological shocks (horror, anger, despair, fear and others).
Proposed other classifications, but they have not received General recognition.
The most commonly in clinical practice occurs pain shock caused by mechanical injury (actually traumatic shock), thermal damage (burns shock) and myocardial infarction (cardiogenic shock). When humoral shocked role of the damaging factor belongs appearing in the blood of toxic products of endogenous origin (the calling anaphylactic, hemolytic shock, and so on) and exogenous (causing traumatic toxicosis, bacterial shock). Humoral shock is less common than painful, but runs always extremely difficult, with high fatality.
Expressed shock psychogenic origin is very rare, but depressed mental state (mountain fright), nervous exhaustion contribute to the development and heavier over the shock of another origin. Over the shock exacerbate blood loss, starvation, intoxication, and also features of somatic state of the body (chronic diseases of cardiovascular system, respiratory system, liver, kidneys and so on).
Pathophysiological changes in shock determine the peculiarities of the development of the clinical picture and for shock and depend on the type of shock. However, the severity of the General condition of the victim is the secondary changes associated with disorders of blood circulation.
  • Traumatic shock
  • Burn cardiogenic septic toxic cold hemolytic citrate shock
  • The clinical picture of shock
  • Diagnosis of shock and forecast
  • Treatment of shock
  • Preventive measures should be designed to eliminate all factors that can cause shock. Therefore, all the above methods of treatment of shock, has started on time and correctly applied, are both preventive: analgesia, replenish blood loss, preventing dehydration and cooling, mental and physical fatigue, etc.
    Toxic shock - see Traumatic toxicosis.
    Crucial in the treatment of the victim in a state of shock, has continuity in therapeutic activities between specialized team, assisting at the scene, and a hospital, the host of the patient.

    Shock (eng. shock) - terrible symptom complex resulting from a kind of body reaction to the impact of extreme stressors caused by a sharp disturbance of the nervous regulation of vital processes and expressed severe hemodynamic disorders, respiration and metabolism.
    Stimuli that serve the cause of the shock can come from the external environment or to be endogenous in origin. Perceived stressors can by exteroceptive, interpretacii or through the second signal system. Often the role of the shock factor play a pain that occur in severe mechanical, thermal and chemical impacts on the organs and tissues of the victim.
    Classification of shock is based on etiological factor.
    I. Pain shock. A. Exogenous, or traumatic, W.: 1) W. in case of mechanical damages; 2) burn W.; 3) W. if frostbite; 4) electric shock; 5) operational W. B. Endogenous pain shock: 1) cardiogenic; 2) nephrogenic; 3) W. when biliary colic; 4) W. when ileus; 5) W. when perforation of a hollow organ abdominal cavity.
    II. Humoral shock: 1) W. with the introduction of incompatible or foreign proteins; 2) hemolytic W.; 3) anaphylactic W.; 4) insulin W.; 5) the adrenaline W.; 6) histamine W.; 7) toxic W. (traumatic toxicosis).
    III. Psychogenic shock.


    Pathological anatomy. Morphological changes in shock have little characteristic and associated mostly with secondary disorders of blood circulation and anoxic changes of fabrics, accompanying this reaction. So differential postmortem diagnosis of shock with other pathological processes, accompanied expressed by anoxia, is not so much based on positive as negative data, allowing to exclude all other causes of death (for example, blood loss, embolism, etc). It is necessary to distinguish the changes inherent in any form of shock from the changes that are unique to the particular its variants (for example, trauma, blood transfusion, anaphylactic shock and other).
    When any form of shock there are disorders of blood circulation, dystrophic changes and disorders of blood condition. Disorders of blood circulation expressed redistribution and the depositing of blood in the internal organs - liver, portal system, in the lungs. This is accompanied by edema of the relevant authorities, especially the brain. Sometimes there is limbs deep veins thrombosis, acute pulmonary emphysema, bleeding in the mouth and serous membranes, swelling of the gallbladder bed. Microscopically, you can catch the signs of high permeability of the walls of the arterioles and capillaries, swelling and dystrophic changes in tissue. Increased permeability of the vascular membrane is revealed in the form of plasturgie in the walls of blood vessels, leading sometimes to fibrinoidnogo necrosis them, combined with the edema of surrounding tissues.
    Degenerative and necrobiotic changes are more pronounced only in the brain, the heart, the liver. In the brain, they are manifested in the form of chromatolysis, karyolysis in nerve cells and glia, the collapse of synaptic structures; in parenchymatous organs - protein, fatty degeneration and necrobiosis parenchymal cells.
    All morphological changes in shock advance at a lengthening of the period that elapsed from the start of the shock to death. They can vary dramatically due to massive blood transfusions, artificial respiration, because this changes krovenapolnenia and increased swelling.
    Different types of shock have some specific features. So, in anaphylactic shock the most dramatic changes occur in the brain in the form of severe disorders of blood circulation and necrobiosis nerve cells. Very early on has a severe emphysema and swelling.
    With traumatic shock, especially in combination with blood, the electoral Deposit of the blood does not occur and all organs look pale, which is due to the paralysis of the mechanisms regulating vascular tone and creates different levels of the blood supply to organs.
    The most distinct morphological changes observed in many species transfusion shock. So, through transfusions of blood incompatible prevail phenomenon of intravascular hemolysis with renal impairment on the type of "Blackwater nephrosis". When using bacterial contaminated blood marked heavy necrobiotic changes in the internal organs. When pouring hot blood - common thrombosis. If poured RH-incompatible blood picture shock morphologically is erased and at the forefront are the phenomena of intravascular hemolysis with renal impairment.

    Endogenous shock. The source of the potent sensitizer there may be pain arising of pathological processes occurring in the internal organs,the so - called cardiogenic shock, resulting spasm or acute obliteration of coronary vessels for angina or myocardial infarction, nephrogenic shock of renal colic caused by the acute obstruction of the ureters, shock when biliary colic, acute intestinal obstruction or other disasters in the abdominal cavity.

    Humoral shock can develop as a result of introduction incompatible proteins (anaphylactic shock; transfusion shock - see Transfusion), with an overdose of insulin, adrenaline. In these cases, introduced from the outside of the substance or play a role shock factors or form them in the body (hemolytic shock when administered intravenously distilled water). Endogenous toxic shock may occur and the result of education humoral agents shock action in the body, such as the prolonged compression syndrome, with traumatic toxicosis.

    Psychogenic shock may occur as a result of emergency irritations that come through the second signal system (sudden heavy experience, mental shock - horror, anger, despair, fear, grief).
    Treatment of endogenous and humoral shock is reduced to holding of the General protivosokovh activities with a simultaneous impact on the focus of pathological activity.