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Shock


A sharp progressive violation of all the vital functions of the body, developing as a result of injury. At the core - severe changes in the functions of the central nervous system.
Shock is noted in 5-10% of patients with serious injuries and often complicates the course of heavy operations.
Depending on the causes, shock is distinguished: traumatic, operative, hemolytic (developing due to hemolysis during the incompatible blood transfusion). There are also mental, anaphylactic, septic and other types.
According to clinical manifestations, it can be: mild, moderate and severe shock or 1 degree - with a systolic blood pressure of 90 mm Hg. v .; II degree - with an arterial pressure of 90-70 mm Hg. v .; IIl degree - with blood pressure 70-50 mm Hg. Art. and IV degree - with blood pressure below 50 mm Hg. Art.
By the time of development, primary (early) shock develops at the time of injury or immediately after it, and secondary (late) shock, which usually occurs several hours after the injury, when nerve reflex disorders are aggravated by intoxication, absorption of tissue breakdown products, additional trauma or gain pain after cessation of anesthesia.
Previously, shock was divided into erectile and torpid, but at present it is considered that these are not its separate types, but successively developing phases of a single pathological process. The erectile phase of shock develops at the time of injury and is short-lived. It is characterized by the presence in the victim of a pronounced motor and mental arousal. This phase enters a torpid phase, characterized by depression, inhibition of the nervous system and a sharp decrease in all vital functions of the body.
Recognition:
Diagnosing shock is easy. But with multiple injuries, differential diagnosis of shock with a serious condition caused by other causes is often difficult. Acute blood loss, severe injuries that are incompatible with life, fat embolism, hypoxemia, and intoxication proceed with a clinical picture resembling shock, but a thorough examination of the anamnesis and symptomatology help correct recognition.
Treatment:
The most successful complex, pathogenetic therapy of shock, started in the early phases of its development. The treatment takes into account the area of ​​injury, the pathways of transmission of nerve impulses, the presence of certain factors that aggravate the course of shock, and the disturbed functions of the cardiovascular and respiratory systems, metabolism, etc. caused by it. The main tasks are:
1. Termination of the flow of nerve impulses from the periphery to the center, i.e. the flow of pain impulses from the area of ​​injury to the central nervous system.
2. Reducing the excitability of the central nervous system through the creation of absolute rest, the appointment of analgesic and sedative drugs, the fight against toxemia, hypoxemia, plasma blood loss.
3. The elimination of the effects of shock, the restoration of impaired functions, primarily hemodynamics.