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Shock


A sharp progressive violation of all vital functions of the body, developing as a result of an injury. It is based on 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 reasons, shock is distinguished: traumatic, operational, hemolytic (developing in connection with hemolysis during transfusion of incompatible blood). Psychic, anaphylactic, septic and other types are also distinguished.
According to clinical manifestations, it happens: mild, moderate and severe shock or 1 degree - with a systolic blood pressure of 90 mm RT. st .; II degree - with blood pressure of 90-70 mm RT. st .; IIl degrees - with blood pressure of 70-50 mm RT. Art. and IV degree - with blood pressure below 50 mm RT. Art.
According to the time of development, primary (early) shock, which develops at the time of injury or immediately after it, and secondary (late) shock, which usually occurs several hours after injury, are detected, when neuroreflex disorders are aggravated by intoxication, absorption of tissue breakdown products, additional trauma or amplification pain after the termination of anesthesia.
Previously, shock was subdivided into erectile and torpid, but now it is generally accepted 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 of a pronounced motor and mental arousal in the victim. This phase passes into the torpid phase, characterized by inhibition, 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, the differential diagnosis of shock with a serious condition caused by other causes is often difficult. Acute blood loss, severe, life-incompatible injuries, fat embolism, hypoxemia, intoxication occur with a clinical picture that resembles shock, but a thorough examination of the anamnesis and symptoms helps correct recognition.
Treatment:
The most successful complex pathogenetic shock therapy, begun in the early phases of its development. During treatment, the area of ​​injury, the transmission path of nerve impulses, the presence of certain factors aggravating the course of shock, and the resulting disturbances in the functions of the cardiovascular and respiratory systems, metabolism, etc. are taken into account. The main tasks are:
1. The cessation of the flow of nerve impulses from the periphery to the center, ie the flow of pain impulses from the area of ​​injury to the central nervous system.
2. Reducing the excitability of the central nervous system by creating absolute rest, the appointment of analgesic and sedative drugs, the fight against toxemia, hypoxemia, plasma and blood loss.
3. Elimination of the effects of shock, restoration of impaired functions, primarily hemodynamics.