Nervous shock symptoms. Shock: manifestations and symptoms, degrees and types, emergency care

Pain shock is manifested by a reaction to pain, which primarily affects the nervous, cardiovascular and respiratory systems.

It occurs gradually and has different stages.

If immediate action is not taken, this situation can result in a dangerous outcome, including death.

It is important to have time to provide first aid to the victim before the medical team arrives.

Pain shock is a rapidly developing and life threatening the body’s reaction to excessive pain, accompanied by severe disturbances in the functioning of all systems and organs.

Its main feature, besides acute pain, – pressure decrease.

Causes

The main cause of shock is blood flow injury caused by a painful stimulus, which can be:

• cold;
• burn;
• mechanical influences;
• electric shock;
• fractures;
• knife or bullet wounds;
• complications of diseases (food bolus stuck in the esophagus, uterine rupture, ectopic pregnancy, colic in the liver and kidneys, heart attack, perforated ulcer stomach, stroke).

Trauma disrupts the integrity of blood vessels and is accompanied by blood loss. As a result, the volume of circulating fluid decreases, organs are not fed with blood, lose the ability to perform functions and die.

To maintain vital blood supply at the proper level important organs(brain, heart, lungs, liver, kidneys) compensatory mechanisms come into play: blood leaves other organs (intestines, skin) and arrives at these. Those. distribution (centralization) of blood flow occurs.

But this is only enough for a while.

The next compensatory mechanism is tachycardia - an increase in the strength and frequency of heart contractions. This increases blood flow through the organs.

Since the body works for wear and tear, after a certain period of time the compensation mechanisms become pathological. The tone of the microcirculatory bed (capillaries, venules, arterioles) decreases, blood stagnates in the veins. This causes the body to experience another shock, because... the total area of ​​the venules is enormous and blood does not circulate through the organs. The brain receives a signal about repeated blood loss.

Second to lose muscle tone capillaries. Blood is deposited in them, causing blood clots and obstruction to occur there. The blood clotting process is disrupted because plasma flows out of it, and another portion enters the same place with a new flow shaped elements. Due to the fact that capillary tone is not restored, this phase of shock is irreversible and final, heart failure occurs.

Due to poor blood supply in other organs, their secondary failure appears.

The central nervous system cannot perform complex reflex acts; disturbances in its work progress as ischemia (death of tissue) of the brain develops.

The changes also affect respiratory system: hypoxia occurs, breathing quickens and becomes shallow or, conversely, hyperventilation occurs. This negatively affects the non-respiratory functions of the lungs: fighting toxins, purifying incoming air from impurities, shock absorption of the heart, vocal function, and blood deposition. Blood circulation in the alveoli suffers, which leads to edema.

Because kidneys are very sensitive to lack of oxygen, urine production decreases, then observed renal failure in acute form.

This is the mechanism of the stress reaction of the gradual involvement of all organs.

Damage spinal cord resulting injury leads to spinal shock. This condition is dangerous to life and health, so it is important to provide first aid correctly and on time. Follow the link for more details on treatment tactics.

Symptoms, signs and phases

The first phase of pain shock is excitation, the second is inhibition. Each of them has its own symptoms.

At the initial stage (erectile), the patient is excited, he experiences euphoria, increased heart rate, breathing movements, finger trembling, high pressure, the pupils dilate, he is not aware of his condition. A person can shout out sounds and make rough movements. The stage lasts up to 15 minutes.

The first phase of painful shock is replaced by torpid one. Its main symptom is a decrease in pressure, as well as:

• lethargy, apathy, lethargy, indifference to what is happening (although there may be excitement and anxiety);
• pale skin;
• undetectable, frequent, thread-like pulse;
• decreased body temperature;
• coldness of hands and feet;
• loss of sensation;
• shallow breathing;
• blue lips and nails;
• large drops of sweat;
• decreased muscle tone.

It is the second phase that manifests itself in acute heart failure and stress response in the form of failure of all other organ systems to such an extent that it is impossible to maintain vital functions.

In this phase, the following degrees of shock are distinguished:

• I degree– disturbances in the movement of blood through the vessels are not pronounced, blood pressure and pulse are normal.
• II degree - pressure during contraction of the heart muscle decreases to 90-100 mm Hg. Art., there is lethargy, rapid pulse, the skin becomes white, the peripheral veins collapse.
• III degree - the patient’s condition is serious, blood pressure drops to 60-80 mm Hg, pulse is weak, 120 beats per minute, skin is pale, freezing sweat appears.
• IV degree - the victim’s condition is regarded as very serious, his thoughts are confused, he loses consciousness, his skin and nails turn blue, and a marbled (spotted) pattern appears. Blood pressure – 60 mm Hg. Art., pulse - 140-160 beats per minute, it can only be felt on large vessels.

It is most convenient to calculate blood loss using the value of “upper” blood pressure.

Table. Dependence of blood loss on systolic pressure

If you have low blood pressure or a traumatic brain injury, you should not use analgesics!

First aid for painful shock

First, the patient must be warmed up using heating pads, blankets, warm clothes, and then given hot tea. In case of painful shock, the victim is prohibited from giving anything to drink. If there is vomiting or abdominal wounds, drinking liquids is prohibited!

A cold object, such as ice, is applied to the injury site. It is not permissible to remove foreign objects from the patient’s body before the doctors arrive!

If the painful shock is caused by an injury, it is necessary to stop the bleeding by applying tourniquets, bandages, clamps, tampons, and pressure cotton-gauze bandages.

In case of blood loss, the damaged vessel is clamped with a tourniquet; in case of wounds, fractures and damage to the integrity of soft tissues, a splint is applied. It should extend beyond the joints above and below the damaged area of ​​the bone, and a spacer should be placed between it and the body.

The patient can be transported only after the symptoms of shock have resolved.

Corvalol, Valocordin and Analgin will help relieve an attack of pain at home.

Treatment

Each stage has its own therapeutic measures, but there are general rules for treating shock.

• Help should be provided as early as possible (the shock lasts about a day).
• Therapy is long-term, complex and depends on the cause and severity of the condition.

Medical measures include:

• bringing the volume of circulating fluid to the desired level (replenishment of blood loss through intravenous infusion of solutions);
• normalization of the internal environment of the body;
• pain relief with painkillers;
• elimination of respiratory problems;
• preventive and rehabilitation measures.

In case of shock of I-II degree, plasma or 400-800 ml of Polyglucin is injected intravenously to block pain. This is important when moving the patient over a long distance and preventing shock from worsening.

While the patient is moving, the medications are stopped.

In case of shock of II-III degree, after the administration of Polyglyukin, 500 ml of saline or 5% glucose solution is transfused, later Polyglyukin is again prescribed with the addition of 60-120 ml of Prednisolone or 125-250 ml of adrenal hormones.

In severe cases, infusions are made into both veins.

In addition to injections, local anesthesia with a 0.25-0.5% Novocaine solution is performed at the fracture site.

If the internal organs are not affected, the victim is given 1-2 ml of 2% Promedol, 1-2 ml of 2% Omnopon or 1-2 ml of 1% morphine for pain relief, and also injected with Tramadol, Ketanov or a mixture of Analgin and Diphenhydramine in a ratio of 2 :1.

During shock of the III-IV degree, anesthesia is performed only after the appointment of Polyglucin or Reopoliglucin, analogues of adrenal hormones are administered: 90-180 ml of Prednisolone, 6-8 ml of Dexamethasone, 250 ml of hydrocortisone.

The patient is prescribed medications that increase blood pressure.

It is impossible to achieve a rapid increase in blood pressure. Introduce protein substances that increase arterial pressure(mesaton, dopamine, norepinephrine), strictly prohibited!

For any type of shock, inhalation of oxygen is indicated.

Even after some time after the state of shock, due to impaired blood supply, pathology is possible internal organs. This is expressed in poor coordination of movements, inflammation peripheral nerves. Without taking anti-shock measures, death occurs from painful shock, so it is important to be able to provide first aid.

Video on the topic

Shock – pathological change functions life systems organism, in which there is a violation of breathing and blood circulation. This condition was first described by Hippocrates, but the medical term appeared only in the mid-18th century. Since various diseases can lead to the development of shock, for a long time scientists have proposed a large number of theories of its origin. However, none of them explained all the mechanisms. It has now been established that the basis of shock is arterial hypotension, which occurs when the volume of circulating blood decreases, cardiac output and general peripheral vascular resistance decrease, or when fluid is redistributed in the body.

Manifestations of shock

The symptoms of shock are largely determined by the cause that led to its appearance, but there are also common features of this pathological condition:

• impaired consciousness, which can manifest itself as agitation or depression;
• decrease in blood pressure from minor to critical;
• an increase in heart rate, which is a manifestation of a compensatory reaction;
• centralization of blood circulation, in which spasm of peripheral vessels occurs, with the exception of the renal, cerebral and coronary;
• pallor, marbling and cyanosis of the skin;
• rapid shallow breathing that occurs with increasing metabolic acidosis;
• change in body temperature, usually it is low, but when infectious process increased;
• the pupils are usually dilated, the reaction to light is slow;
• in particularly severe situations, generalized convulsions, involuntary urination and defecation develop.

There are also specific manifestations of shock. For example, when exposed to an allergen, bronchospasm develops and the patient begins to choke; with blood loss, a person experiences a pronounced feeling of thirst, and with myocardial infarction, chest pain.

Degrees of shock

Depending on the severity of shock, there are four degrees of its manifestations:

1. Compensated. At the same time, the patient’s condition is relatively satisfactory, the function of the systems is preserved. He is conscious, systolic blood pressure is reduced, but exceeds 90 mm Hg, pulse is about 100 per minute.
2. Subcompensated. Violation is noted. The patient's reactions are inhibited and he is lethargic. Skin covering pale, damp. The heart rate reaches 140-150 per minute, breathing is shallow. The condition requires prompt medical intervention.
3. Decompensated. The level of consciousness is reduced, the patient is very inhibited and reacts poorly to external stimuli, does not answer questions or answers in one word. In addition to pallor, there is marbling of the skin due to impaired microcirculation, as well as cyanosis of the fingertips and lips. The pulse can only be determined in the central vessels (carotid, femoral artery); it exceeds 150 per minute. Systolic blood pressure is often below 60 mmHg. There is a disruption in the functioning of internal organs (kidneys, intestines).
4. Terminal (irreversible). The patient is usually unconscious, breathing is shallow, and the pulse is not palpable. By the usual method, using a tonometer, pressure is often not determined, and heart sounds are muffled. But the skin appears blue spots in places of congestion venous blood, similar to corpses. Reflexes, including pain, are absent, the eyes are motionless, the pupil is dilated. The prognosis is extremely unfavorable.

To determine the severity of the condition, you can use the Algover shock index, which is obtained by dividing the heart rate by the systolic blood pressure. Normally it is 0.5, with the 1st degree -1, with the second -1.5.

Types of shock

Depending on the immediate cause, there are several types of shock:

1. Traumatic shock resulting from external influence. In this case, the integrity of some tissues is violated and pain occurs.
2. Hypovolemic (hemorrhagic) shock develops when the volume of circulating blood decreases due to bleeding.
3. Cardiogenic shock is a complication various diseases heart (, tamponade, rupture of aneurysm), in which the ejection fraction of the left ventricle sharply decreases, as a result of which arterial hypotension develops.
4. Infectious-toxic (septic) shock is characterized by a pronounced decrease in peripheral vascular resistance and an increase in the permeability of their walls. As a result, a redistribution of the liquid part of the blood occurs, which accumulates in the interstitial space.
5. develops as allergic reaction in response to intravenous exposure to a substance (injection, insect bite). In this case, histamine is released into the blood and blood vessels dilate, which is accompanied by a decrease in pressure.

There are other types of shock which include various signs. For example, burn shock develops as a result of injury and hypovolemia due to large losses of fluid through the wound surface.

Help with shock

Every person should be able to provide first aid for shock, since in most situations minutes count:

1. The most important thing to do is to try to eliminate the cause that caused the pathological condition. For example, if there is bleeding, you need to clamp the arteries above the injury site. And when an insect bites you, try to prevent the poison from spreading.
2. In all cases, with the exception of cardiogenic shock, it is advisable to elevate the victim's legs above his head. This will help improve blood flow to the brain.
3. In cases of extensive injuries and suspected spinal injuries, it is not recommended to move the patient until the ambulance arrives.
4. To replenish fluid loss, you can give the patient a drink, preferably warm, water, as it will be absorbed faster in the stomach.
5. If a person has severe pain, he can take an analgesic, but it is not advisable to use sedatives, since this will change the clinical picture of the disease.

Emergency doctors in cases of shock use either intravenous solutions or vasoconstrictors(dopamine, adrenaline). The choice depends on the specific situation and is determined by a combination of various factors. Medication and surgery shock directly depends on its type. Thus, in case of hemorrhagic shock, it is urgent to replenish the volume of circulating blood, and in case of anaphylactic shock, antihistamines and vasoconstrictors must be administered. The victim must be urgently transported to specialized hospital, where treatment will be carried out under the monitoring of vital signs.

The prognosis for shock depends on its type and degree, as well as the timeliness of assistance. For mild symptoms and adequate therapy recovery almost always occurs, whereas with decompensated shock there is a high probability fatal outcome, despite the efforts of doctors.

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Shock represents pathological process, which occurs as a response human body to exposure to extreme stimuli. In this case, shock is accompanied by disturbances in blood circulation, metabolism, breathing, and functions. nervous system.

The state of shock was first described by Hippocrates. The term "shock" was coined by Le Dran in 1737.

Shock classification

There are several classifications of the state of shock.

According to the type of circulatory disorders, they distinguish the following types shock:

• cardiogenic shock, which occurs due to circulatory disorders. In the case of cardiogenic shock due to lack of blood flow (impaired cardiac activity, dilation of blood vessels that cannot hold blood), the brain experiences a lack of oxygen. In this regard, in a state of cardiogenic shock, a person loses consciousness and, as a rule, dies;
• hypovolemic shock is a condition caused by a secondary decrease in cardiac output, acute deficiency of circulating blood, and a decrease in venous return to the heart. Hypovolemic shock occurs with loss of plasma (anhydremic shock), dehydration, loss of blood (hemorrhagic shock). Hemorrhagic shock can occur when a large vessel is damaged. As a result, blood pressure quickly drops to almost zero. Hemorrhagic shock occurs when the pulmonary trunk, inferior or superior veins, or aorta rupture;
• redistributive - it occurs due to a decrease in peripheral vascular resistance with increased or normal cardiac output. It can be caused by sepsis, drug overdose, anaphylaxis.

According to severity, shock is divided into:

• shock of the first degree or compensated - the person’s consciousness is clear, he is communicative, but a little inhibited. Systolic pressure is more than 90 mm Hg, pulse is 90-100 beats per minute;
• shock of the second degree or subcompensated - the person is inhibited, the heart sounds are muffled, the skin is pale, the pulse is up to 140 beats per minute, the pressure is reduced to 90-80 mm Hg. Art. Breathing is rapid, shallow, consciousness remains. The victim answers correctly, but speaks quietly and slowly. Antishock therapy is required;
• shock of the third degree or decompensated - the patient is inhibited, adynamic, does not respond to pain, answers questions in monosyllables and slowly or does not answer, speaks in a whisper. Consciousness may be confused or absent. The skin is covered with cold sweat, pale, and acrocyanosis is pronounced. The pulse is threadlike. Heart sounds are muffled. Breathing is frequent and shallow. Systolic blood pressure less than 70 mm Hg. Art. Anuria is present;
• fourth degree shock or irreversible – terminal state. The person is unconscious, heart sounds cannot be heard, skin gray with marble pattern and stagnant spots, lips are bluish, pressure is less than 50 mm Hg. Art., anuria, pulse is barely noticeable, breathing is rare, there are no reflexes or reactions to pain, the pupils are dilated.

According to the pathogenetic mechanism, the following types of shock are distinguished:

• hypovolemic shock;
• neurogenic shock is a condition that develops due to damage to the spinal cord. The main signs are bradycardia and arterial hypotension;
• traumatic shock is a pathological condition that threatens human life. Traumatic shock occurs with fractures of the pelvic bones, traumatic brain injuries, severe gunshot wounds, abdominal injuries, large blood loss, and operations. The main factors determining the development of traumatic shock include: loss large quantity blood, severe pain irritation;
• infectious-toxic shock - a condition caused by exotoxins of viruses and bacteria;
• septic shock– a complication of severe infections, which is characterized by a decrease in tissue perfusion, which leads to impaired delivery of oxygen and other substances. Most often develops in children, the elderly and patients with immunodeficiency;
• cardiogenic shock;
• anaphylactic shock is an immediate allergic reaction, which is a state of high sensitivity of the body that occurs upon repeated exposure to an allergen. The rate of development of anaphylactic shock ranges from a few seconds to five hours from the moment of contact with the allergen. At the same time, in the development of anaphylactic shock, neither the method of contact with the allergen nor the time matter;
• combined.

Help with shock

When providing first aid for shock before the ambulance arrives, it must be borne in mind that improper transportation and first aid can cause a delayed state of shock.

Before the ambulance arrives, you must:

• if possible, try to eliminate the cause of shock, for example, free trapped limbs, stop bleeding, extinguish clothes that are burning on a person;
• check the victim’s nose and mouth for the presence of foreign objects and remove them;
• check the victim’s pulse and breathing; if such a need arises, perform artificial respiration and cardiac massage;
• turn the victim's head to the side so that he cannot choke on vomit and suffocate;
• find out whether the victim is conscious and give him an analgesic. Having ruled out an abdominal injury, you can give the victim hot tea;
• loosen the victim’s clothing around the neck, chest, and waist;
• warm or cool the victim depending on the season.

When providing first aid for shock, you need to know that you should not leave the victim alone, let him smoke, or apply a heating pad to the injury sites so as not to cause blood flow from vital organs.

Prehospital ambulance for shock includes:

• stopping bleeding;
• ensuring adequate lung ventilation and patency respiratory tract;
• anesthesia;
• transfusion replacement therapy;
• in case of fractures - immobilization;
• gentle transportation of the patient.

As a rule, severe traumatic shock is accompanied by improper ventilation of the lungs. An airway or Z-shaped tube may be inserted into the victim.

External bleeding must be stopped by applying a tight bandage, tourniquet, clamp to the bleeding vessel, or clamping the damaged vessel. If there are signs of internal bleeding, the patient needs to be taken to the hospital as quickly as possible for emergency surgery.

Medical care for shock must meet the requirements of emergency treatment. This means that those agents that produce an effect immediately after their administration to the patient should be immediately used.

If you do not provide assistance to such a patient in time, this can lead to severe disturbances in microcirculation, irreversible changes in tissues and cause the death of a person.

Since the mechanism of shock development is associated with a decrease in vascular tone and a decrease in blood flow to the heart, therapeutic measures, first of all, should be aimed at increasing arterial and venous tone, as well as increasing the volume of fluid in the bloodstream.

Since shock can be caused different reasons, then measures must be taken to eliminate the causes of this condition and against the development of pathogenetic mechanisms of collapse.