Trauma can lead to many consequences: from less severe (concussion, bruises, superficial cuts) to more serious (deep injuries with trauma to the parenchymal organs, intracranial hemorrhage, massive internal or external bleeding). However, the most dangerous complication of an injury is a traumatic shock. Therefore, it is important to know the main symptoms, classification, diagnosis, treatment, and, of course, the pathogenesis of traumatic shock.
Pathogenesis: what is it?
At its core, pathogenesis is a step-by-step description of the development of a certain pathology from the first processes that became the starting key for the development of a particular disease, to the outcome of the disease and its consequences. Knowing the pathogenesis of any pathology will help to understand why it manifests itself precisely with these symptoms, why these diagnostic methods are used and why a certain treatment is prescribed.
Thus, even a brief pathogenesis of traumatic shock is the key to understanding it, and therefore to timely diagnosis and treatment.
What is shock?
Each of us periodically uses the phrase "I'm in shock." But shock is not just a state of surprise, it is a serious pathological syndrome that can lead to irreversible consequences.
Therefore, before proceeding directly to the etiology and pathogenesis of traumatic shock, it is necessary to understand what does the concept of "shock" mean?
Shock is an acute urgent (emergency) condition of the body, which is characterized by a progressive circulatory disorder. This subsequently leads to a decrease in the amount of oxygen in the blood (hypoxemia) and a decrease in the supply of oxygen to the tissues (hypoxia). As a result, metabolic acidosis develops (blood becomes more acidic), which leads to even greater circulatory disorders. That is, a so-called vicious circle is formed.
Causes of Traumatic Shock
The starting link for the development of the pathogenesis of traumatic shock is trauma, as a rule, of a severe degree. Most often, the following types of injuries lead to this pathological process:
- fractures of the lower extremities and pelvic bones;
- gunshot wounds;
- injuries to internal organs;
- damage to large vessels with heavy blood loss;
- surgery with significant loss of blood.
Pathogenesis: compensation phase
As noted above, with the development of this type of shock, the trigger is injury. Injury accompanied by severe pain or heavy blood loss causes stress reserves to activate. The main such reserves are two body systems:
- sympatho-adrenal;
- renin-angiotensin-aldosterone.
The sympatho-adrenal system causes the endocrine glands (mainly the adrenal glands) to release specific stress hormones into the blood: adrenaline, norepinephrine, corticosteroids. These biologically active substances directly affect the vascular wall, causing spasm and narrowing of peripheral vessels. They are located in the skin, muscles, kidneys, liver, lungs, etc. In addition, this system helps to accelerate the heartbeat for more active circulation of blood through the vessels.
When blood loss is high, blood supply to all internal organs, including the kidneys, deteriorates. It is then, in conditions of renal ischemia, that the renin-angiotensin-aldosterone system is activated, which also provokes vascular spasm. This is achieved both by the direct activity of angiotensin and by the activation of aldosterone with it, which also has a vasoconstrictor effect.
Generalized narrowing of the peripheral vessels leads to a disorder of microcirculation, that is, blood circulation of the internal organs. However, our body is not stupid. Narrowing the vessels on the periphery, it increases the blood supply to the most important organs of the person: the heart, brain and adrenal glands. The phenomenon of "centralization of blood circulation" occurs.
Pathogenesis: decompensation phase
What we have? Significantly reduced blood supply to peripheral organs and moderate delivery of blood to vital organs. If this occurs over time, a prolonged microcirculation disorder leads to hypoxia. And oxygen is necessary for a sufficient amount of ATP energy. If oxygen is not enough, energy is catastrophically low, and lactic acid, lactate, is synthesized instead. This substance is very dangerous, its accumulation makes the blood more acidic, metabolic acidosis occurs.
In addition, the exhaustion of the heart muscle, which was previously activated by the sympathoadrenal system, contributes to circulatory disorders. However, subsequently, the heart simply "gets tired" of the increased load and the heart rate decreases.
Acidosis leads to an even greater circulatory disorder and closes the same "vicious circle".
Pathogenesis: a brief outline
Briefly, the pathogenesis of traumatic shock can be described step by step as follows:
- Injury.
- Blood loss / pain.
- A decrease in the amount of circulating blood.
- Activation of compensatory mechanisms (sympathoadrenal and renin-angiotensin systems).
- Disruption of compensation.
- Reduced cardiac output.
- Lowering blood pressure.
- Disturbance of peripheral circulation.
- Blood clotting disorder.
Shock phases
In the pathogenesis of traumatic shock, phases and severity are of great importance. Indeed, the patient’s prognosis for survival directly depends on them. The further the shock went in its development and the harder it is, the less likely the victim will recover.
Two phases are distinguished during a traumatic shock:
- Erectile - the patient is inadequate, may not even be aware of his condition, he may scream, resist resistance. The skin turns pale, severe sweating is observed, the heart rate and respiration increase. The duration of the phase is from one to several minutes.
- Torpid - consciousness sharply weakens, up to a coma, the skin turns pale even stronger, the heartbeat slows down sharply, the pulse is very weak, threadlike.
Severity
There is also a classification of the pathogenesis of traumatic shock depending on the severity of clinical symptoms and pathological processes in the body. There are four degrees of shock severity:
- The patient is stable, conscious, adequately responding to what is happening, blood pressure and heart rate within normal limits. The forecast is favorable.
- Mild impairment of consciousness, the patient answers questions, but only after a certain time and in monosyllables, the skin turns pale, blood pressure is slightly reduced, the pulse is quickened, weakened. This stage requires urgent assistance, as it is prone to progression and the transition to the next.
- Consciousness is significantly reduced, it may be absent, the skin is pale, the pressure is sharply reduced, the pulse is weak, but palpable. The prognosis is unfavorable, often goes to the next stage, even with medical assistance.
- Unconscious patient, very low pressure or none at all, pulse is not palpable. Extremely unfavorable prognosis, high probability of death.
Symptoms
Since the main pathogenesis of traumatic shock is a violation of blood circulation in the internal organs, there are symptoms of pathology in the work of all organs and systems of the body.
First of all, the brain suffers because it is the organ that is most sensitive to insufficient oxygen supply. If his work is disturbed, such signs of traumatic shock as changes in consciousness appear. In the erectile phase, this is manifested by excitation of the nervous system, in the torpid phase, its oppression occurs on the contrary, and the person loses consciousness.
Another important sign is a violation of the heart and blood vessels. Due to a drop in cardiac output, that is, a decrease in the ability of the heart to pump blood, a drop in blood pressure, a decrease in heart rate and heart rate. And due to a spasm of the peripheral vessels, the pale skin of the patient is visually observed.
All these signs will help determine the presence of traumatic shock in a patient for timely assistance.
First aid
The pathogenesis of traumatic shock and treatment are inextricably linked. Anyone can become his witness on the street, just following their business. And the ambulance may take a considerable time. Therefore. how to conduct first emergency medical care for traumatic shock, everyone should know. We bring to your attention the main stages of first aid for traumatic shock:
- It is necessary to call an ambulance.
- If you observe a wound with a bullet or fragments in it, in no case remove them, as this can lead to increased bleeding.
- Try to ensure that the victim has access to air: unfasten the buttons on the shirt, remove the neck-pulling jewelry, open the windows, etc.
- Stop the bleeding. If arterial bleeding (there is an outflow of a pulsating bright red stream), it is necessary to apply a tourniquet above the site of the outflow of blood. A tourniquet can serve as a shirt, T-shirt, towel, and more. To make sure that the tourniquet is applied correctly, you need to check the pulse on the arteries distal to the site of bleeding. There is no pulse - the tourniquet is superimposed correctly. If the bleeding is venous (dark blood flows without pulsation), a pressure dressing should be applied to the wound.
- If the patient is pale, and the limbs are cold to the touch, it is worth warming him, covering him with a blanket or things.
- Since trauma is often accompanied by severe pain, painkillers should be given to the victim. An intramuscular injection of analgin or, with very severe pain, morphine will be ideal. However, in extreme situations this is most often not the case. Then you can put a tablet of analgin under the tongue.
- Transportation. In extreme situations, when the location of the victim in a certain place is dangerous or waiting for an ambulance can take a long time, it may be necessary to transport the patient. But it is worth remembering that the transportation pose is very specific depending on the damage. Therefore, it is worth changing the patient’s placement only in extreme cases!
Forbidden
When providing medical care for traumatic shock, you need to know exactly what actions are not recommended or even completely prohibited:
- make the patient move;
- transport the victim with bone fractures;
- leave the victim alone;
- try to correct a dislocation or fracture on your own;
- twist the patient’s head, as you always need to be afraid of a fracture of the cervical spine;
- if there are special or homemade tires for immobilizing a broken limb, and you know the rules for applying them, it is forbidden to do this without first stopping the bleeding.
Traumatic shock - the most difficult condition of the body, bearing a direct threat to human life. Therefore, it is so important to know the main phases, severity, symptoms and pathogenesis of traumatic shock. All this knowledge will help to recognize him in time and provide qualified first aid.