With significant injuries - multiple fractures, extensive burns, concussions, wounds - such a serious condition of the body as traumatic shock often develops, first aid for which will be as effective as quickly as it is provided.
Due to relatively large blood loss, decreased tone of the vascular walls and severe pain, traumatic shock is accompanied by a sharp weakening of blood flow in the veins, arteries and capillaries. Besides severe disorders hemodynamics, this condition is expressed by serious respiratory and metabolic disorders.
Main phases and symptoms of traumatic shock
There are two phases of traumatic shock.
1. The erectile phase occurs at the time of injury and is accompanied by a sharp arousal noted in the nervous system. The victim feels severe pain and signals it by screaming or moaning.
2. The torpid phase is accompanied by inhibition resulting from inhibition of activity nervous system, including the liver, kidneys, lungs and heart. The patient does not complain of pain, which misleads the rescuers; this reaction is caused by a state of shock, and not by a weakening of pain. The second phase is divided into 4 more degrees:
· I degree of shock (mild): there is clarity of consciousness with slight retardation, decreased reflexes, shortness of breath, pale skin, increased heart rate up to 100 beats per minute.
· II degree (moderate): severe lethargy and lethargy, pulse up to 140.
· III degree (severe): while conscious, the victim loses perception of the surrounding world, the skin color becomes earthy-gray, the lips, nose, and fingers are blue, sticky sweat is possible, the pulse reaches 160 beats per minute.
· IV degree (preagonia or agony): there is no consciousness, the pulse is not detected.
First aid for traumatic shock
As a basic first aid measure, traumatic shock involves the maximum possible quick fix the reasons that provoked it, and the implementation of measures that will ensure improvement respiratory function and cardiac activity, stop bleeding and reduce pain.
· It is necessary to clear the upper respiratory tract of contaminants (for example, vomit) using a handkerchief or other clean cloth, eliminate tongue retraction and ensure patency respiratory tract. To do this, it is necessary to lay the victim on a flat, hard surface and immobilize him as much as possible. Please note that if you suspect a spinal fracture in cervical spine Any action to move a patient involves a huge risk to life.
· Determine the presence of a pulse (in the main arteries of the arm, neck, temple) and spontaneous breathing. If they are absent, proceed immediately artificial respiration in combination with indirect massage hearts. The ratio of breathing to chest pressure is 2:30, i.e. for 2 breaths 30 presses. Carry out until cardiac activity and respiratory function are restored; before the ambulance arrives or at least 30 minutes.
· Stop bleeding. You can use a makeshift tourniquet (such as a belt) or apply finger clamping of the artery to the vein.
· Cover open wounds with a sterile bandage. Give a pain reliever.
· If help does not arrive soon, immobilize broken limbs using available means (sticks, boards, umbrellas).
· It is necessary to ensure that the victim is transported to a hospital, preferably in an ambulance.
What should not be done in case of traumatic shock?
· Do not leave the victim alone.
· Do not move or carry it unless necessary. This can seriously worsen the condition. Therefore, all actions must be extremely careful.
· Do not stretch injured limbs or try to straighten them yourself.
Remember that traumatic shock poses a serious threat to human life. Under these conditions there should be no room for panic, fear or confusion; act intelligently, as quickly and efficiently as possible.
Polina Lipnitskaya
Traumatic shock is a serious condition that threatens the life of the victim and is accompanied by significant bleeding, as well as severe acute pain.
This is the shock of pain and blood loss from injury. The body cannot cope and dies not from injury, but from its own reaction to pain and blood loss (pain is the main thing).
Traumatic shock develops as a response human body for serious injuries. It can develop either immediately after injury or after a certain period of time (from 4 hours to 1.5 days).
The victim, who is in a state of severe traumatic shock, requires emergency hospitalization. Even with minor injuries, this condition is observed in 3% of victims, and if the situation is aggravated by multiple injuries internal organs, soft tissue or bones, then this figure increases to 15%. Unfortunately, the mortality rate from this type of shock is quite high and ranges from 25 to 85%.
Traumatic shock is a consequence of skull fractures, chest, pelvic bones or limbs. And also as a result of damage abdominal cavity, which led to large blood losses and severe pain. The appearance of traumatic shock does not depend on the mechanism of injury and can be caused by:
Who is at risk?
Most often, those who work in hazardous industries, have problems with the cardiovascular and nervous systems, as well as children and the elderly can suffer traumatic shock.
Traumatic shock is characterized by 2 stages:
In a person who has low level adaptation of the body to tissue damage, the first stage may be absent, especially with severe injuries.
Each stage has its own symptoms.
Symptoms of the first stage
The first stage, which occurs immediately after injury, is characterized by severe pain, accompanied by screams and moans of the victim, increased excitability, loss of temporal and spatial perception.
Observed
Pulse rate and blood pressure do not exceed normal. This condition can last several minutes or hours. The longer this stage, the easier the subsequent torpid stage passes.
Symptoms of the second stage
The stage of inhibition during traumatic shock develops against the background of increasing blood loss, leading to deterioration of blood circulation.
The victim becomes
In medicine, there is a concept of the “golden hour”, during which it is necessary to provide assistance to the victim. Its timely provision is the key to preserving human life. Therefore, before the ambulance team arrives, it is necessary to take measures to eliminate the causes of traumatic shock.
Algorithm of actions
1. Elimination of blood loss is the first step in providing assistance. Depending on the complexity of the case and the type of bleeding, tamponing, application pressure bandage or tourniquet.
2. After this, the victim must be helped to get rid of pain by using any painkillers from the analgesic group
3. Ensuring free breathing. To do this, the wounded person is laid on a flat surface in a comfortable position and the airways are cleared of foreign bodies. If clothing restricts breathing, it should be unbuttoned. If there is no breathing, artificial ventilation is performed.
4. In case of fractures of the limbs, it is necessary to perform primary immobilization (ensuring the immobility of the injured limbs) using available means.
In the absence of such, the arms are wound to the body, and the leg to the leg.
Important! At a fracture spinal column It is not recommended to move the victim.
5. It is necessary to calm the injured person and cover him with some warm things to prevent hypothermia.
6. In the absence of abdominal injuries, it is necessary to provide the victim drinking plenty of fluids(warm tea).
Important! Under no circumstances should you adjust injured limbs yourself unless absolutely necessary to move the wounded person. Without eliminating the bleeding, you cannot apply a splint or remove traumatic objects from the wounds, as this can lead to death.
The arriving team of doctors begins to immediately provide medical assistance to the victim. If necessary, resuscitation (cardiac or respiratory) is performed, as well as blood loss replacement using saline and colloid solutions. If required, additional anesthesia and antibacterial treatment of wounds are performed.
Then the victim is carefully transferred to the car and transported to a specialized medical institution. While moving, blood loss replacement and resuscitation efforts continue.
Timely identification of signs of traumatic shock and promptly taken preventive measures make it possible to prevent its transition to a more severe stage even during the pre-medical period of providing assistance to the victim. That is, preventing the development of more serious condition in this case, we can call the first aid itself, provided quickly and correctly.
Traumatic shock is a general response of the body to excessive damaging traumatic effects and blood loss. In other words, this is an acutely developing and life-threatening pathological condition with progressive impairment of all vital functions important systems body.
If you stick to international classification shock (Marino R., 1998), traumatic shock should be considered as a combination of hypovolemic and vasogenic shock. However, this classification does not take into account the significance of the pain syndrome, which plays an important role in the formation of the shock state.
According to WHO, traumatic shock is one of the common reasons fatal outcome in victims under the age of 40 (mortality rate is up to 43%, and the formation of shock during injury is observed in almost every second victim).
Factors that determine the severity of the condition in severe trauma on prehospital stage:
Factors that determine the severity of the condition in case of severe trauma at the hospital stage:
Under the influence of the above factors, a pathological condition is formed, previously called a traumatic disease. Such conditions should be designated as acute multiple organ failure syndrome (MODS) as a result of traumatic exposure.
In response to a decrease in circulating blood volume (CBV) during severe injury, the sympathoadrenal system is sharply activated: the content of catecholamines (adrenaline, norepinephrine and dopamine) increases compared to the norm from 10 to 50 times.
This leads to spasm in the microcirculation system (metarterioles and precapillary sphincters), opening of arteriovenous anastomoses (A-B) and shunting of blood, i.e., its discharge from the arterial part of the microcirculation to the venous one without entering the capillary.
This process is called centralization of blood circulation. It is aimed at preserving the blood supply to essential vital important organs(brain and heart) by turning off less important organs and systems of the body from circulation. This is the first (own) mechanism for compensating for blood loss in severe trauma.
Relatively speaking, the purpose of hydrostatic pressure in the capillary is to displace the liquid part of the blood into the intercellular interstitial space, and colloid osmotic pressure (COP) is to bind water and keep it in the lumen of the vascular bed.
The direction of the flow of fluid and electrolytes depends on the prevalence of any of these two factors: in the arterial section - from the vascular bed to the intercellular space, in the venular section - from the intercellular space to the vascular bed.
In the phase of centralization of blood circulation, due to spasm of the metarterioles and precapillary sphincter, blood enters the capillary under low pressure, and throughout its entire length the COP is higher than hydrostatic pressure, which leads to the transition of interstitial fluid into the vascular bed and causes autohemodilution. This is the second intrinsic mechanism for compensating blood loss during traumatic shock (this mechanism replaces up to 45% of the lost intravascular volume within 1 hour after injury).
In some victims with severe trauma and massive bleeding, the centralization phase already at the prehospital stage is replaced by another, more severe phase of peripheral circulatory disorders - decentralization.
Reasons for the transition from centralization of blood circulation to decentralization:
As a result of decentralization, metarterioles and precapillary sphincters expand, blood enters the capillaries, which leads to its pathological deposition and sequestration in the expanded microcirculatory system. Hydrostatic blood pressure increases sharply (it is significantly higher than the COP), and the liquid part of the blood (up to 50%) migrates into the intercellular space, aggravating the existing hemodynamic disturbances.
Thus, in the centralization phase, the volume of extracellular space (primarily interstitial) is significantly reduced, which requires its replacement with crystalloid solutions; in the phase of decentralization of blood circulation, infusion support should be aimed at increasing the COP of blood plasma (the use of colloidal solutions), facilitating the transition of fluid from the intercellular space into the vascular bed, thereby restoring the reduced volume of circulating blood.
In every fifth victim, breathing problems due to traumatic shock are determined by the following reasons:
Since the time of N.I. Pirogov clinical course shock is divided into two phases: erectile and torpid.
Shock I degree(mild shock) - shock index 1.0:
Shock II degree(shock moderate severity) - shock index 1.5:
Shock III degree(severe shock) - shock index 2.0:
Phase I- compensated shock: decreased blood pressure, tachycardia, cold skin.
Phase II- decompensated shock: cold skin, arterial hypotension, tachycardia. With continued blood loss, blood pressure drops below 100 mm Hg. Art., and heart rate 100 or more per 1 min. Heart rate/BP ratio (shock index) above 1.
To determine the amount of blood loss at the prehospital stage, the shock index according to Algover and Gruber is calculated (the ratio of heart rate and systolic blood pressure). Normally, the bcc is 7-8% of body weight.
A shock index of 0.5 (heart rate 60 per minute, systolic blood pressure 120 mm Hg) indicates normovolemia.
Shock index 1.0 (heart rate 100 per minute, systolic blood pressure 100 mm Hg) is observed with a loss of 20-30% of bcc.
A shock index of 1.0-2.0 (heart rate 120 per minute, systolic blood pressure 60 mm Hg) indicates a 30-50% deficit of blood volume.
Arterial hypotension is the most striking symptom of traumatic shock. Most often, arterial hypotension is associated with acute hypovolemia due to blood loss.
Blood loss of up to 10% of the bcc is not clinically manifested.
With blood loss of 15 to 20% of the bcc, pale skin, tachycardia, centralized blood circulation are noted, and blood pressure decreases slightly.
When the BCC decreases to 30%:. note cyanosis or severe pallor of the skin, tachycardia more than 120 per minute, decreased pulse pressure and central venous pressure, oliguria, a decrease in blood pressure by 20-30% of the patient’s normal level.
Blood loss more than 30%; BCC causes lethargy, disturbances of consciousness, and severe tachycardia; systolic blood pressure below 70 mm Hg. Art.
Central venous pressure (CVP) is the pressure in the central (close to the heart) venous lines. This indicator is only available for central venous catheterization.
The magnitude of CVP depends on the ability of the heart to “pump” blood from the venous bed to the arterial bed ( cardiac output), blood flow to the right heart (venous return) and circulating blood volume. Normally, the central venous pressure is 6-12 cm of water. Art.
An increase in central venous pressure indicates right ventricular failure or hypervolemia.
A decrease in central venous pressure indicates a decrease in venous return due to hypovolemia or pathological deposition of blood in the periphery due to decentralization of blood circulation. Reduction of central venous pressure in case of injury and blood loss to 2 cm of water. Art. indicates a BCC deficiency of up to 25%.
Intensive care traumatic shock at the prehospital stage consists of stopping bleeding, adequate pain relief and restoration of reduced blood volume.
In anesthesiology, there is a position: the more severe the patient’s condition, the more multicomponent anesthesia is indicated. Unfortunately, at the prehospital stage this situation is not feasible, even if assistance is provided by a specialized resuscitation and surgical team (RST), equipped with the necessary equipment and a set of medications.
This is due to many reasons, but the main ones are: the importance of urgent delivery of the victim to a hospital, the need not to “shade up” clinical picture intracavitary damage.
General requirements for pain relief:
Brief description of the drugs used for analgesia and anesthesia in traumatic shock.
Promedol indicated for trauma without breathing problems, isolated trauma to the extremities. At intravenous administration at a dose of 20 mg causes significant respiratory depression in all victims.
Fentanyl indicated for combined traumatic brain injury and chest injuries. When administered intravenously at a dose of 0.1 mg, it causes powerful analgesia within 20 s. The duration of pain relief is approximately 1.5 hours. It does not depress breathing and helps stabilize hemodynamics.
Ketalar(ketamine, etc.) administered intravenously at an initial dose of 1-2 mg/kg or 2-4 mg/kg intramuscularly; with intravenous administration, pronounced analgesia occurs after 15-30 s; duration of anesthesia 10-15 minutes. If it is necessary to continue analgesia, it is re-administered intravenously at a dose of 0.5-1.0 mg/kg. Does not depress breathing, helps increase blood pressure, and allows you to manage analgesia.
Side effects: psychomotor agitation, hallucinations, extrapyramidal disorders. To prevent these effects or reduce their severity, benzodiazepines are pre-administered intravenously at a dose of 0.2-0.3 mg/kg. Ketalar should not be used for traumatic brain injury.
Sodium hydroxybutyrate- a powerful narcotic drug with weak analgesic properties, an antihypoxant, has a positive effect on blood circulation, improves microcirculation, increases low blood pressure, and does not depress respiration. Indicated for severe traumatic shock requiring mechanical ventilation. Administered intravenously at a dose of 80-100 mg/kg. The duration of action of a single dose is 1.5-2 hours. With rapid intravenous administration, it can cause motor agitation and convulsions.
Tramal indicated for trauma without breathing problems, without damage to the chest. Administered intravenously at a dose of 100 mg, the analgesic effect develops after 30 s. Does not depress hemodynamics, but may cause vomiting and respiratory depression.
Benzodiazepines(seduxen, relanium, sibazon, midozolan, etc.) do not cause an analgesic effect, but reduce the emotional reaction to pain; do not depress breathing and help lower blood pressure. Prescribed at a dose of 0.2-0.3 mg/kg.
Buprenorphine- a powerful analgesic, administered intravenously at a dose of 0.3 mg, the analgesic effect develops after 20 s and lasts 2.5 hours. Does not depress breathing and blood circulation.
The choice of analgesics and narcotics depending on the severity of traumatic shock.
In severe shock with mechanical ventilation, tracheal intubation, muscle relaxants, sodium hydroxybutyrate in combination with ketalar or fentanyl (in RCB conditions) are indicated.
In case of I-II degree shock without respiratory distress, chest injury, spinal injury or combined TBI, promedol, or fentanyl, or tramal is indicated; combination with benzodiazepines is possible.
In case of shock I II degree with respiratory failure, chest injury, spinal injury or combined TBI, with cardiac contusion, if there are no indications for mechanical ventilation, fentanyl, ketamine or buprenorphine should be used.
With blood loss up to 1 liter and shock of 1st degree:
With blood loss of 1 liter or more, shock of II-III degree and decentralization of blood circulation:
Plasma-substituting solutions are divided into colloidal and crystalloid.
Colloidal solutions differ from each other in molecular weight: the larger it is, the longer the blood substitute circulates in the vessels.
High-molecular colloidal solutions (from 70,000 to 365,000 daltons): dextran-75, Shivadex-75, HAST-steril, refortan, stabizol, voluven-130.
Medium molecular colloidal solutions (from 40,000 to 70,000 daltons): polyglucin, polyfer, macrodex.
Low molecular weight colloidal solutions (from 8000 to 40,000 daltons): rheopolyglucin, rheomacrodex, gelofusin, polyoxyfumarin, hemodez.
TO combination drugs“low-volume resuscitation” includes hemostabil and hyperHAES.
Poliglyukin- a glucose polymer with a molecular weight of 55,000 daltons, contains a small amount of sodium salts, nitrogen, heavy metals, and ethanol. Circulates in the bloodstream from 3 to 7 days. On the 1st day, 45% of the dose is excreted through the kidneys, and the rest gradually breaks down into glucose. Increases blood COP, promotes the transition of interstitial fluid into the vascular bed.
Hydroxyethyl starch preparations- 5%, 6% and 10% solutions with a molecular weight from 60,000 to 365,000 daltons significantly increase the COP of blood plasma; at a dose of more than 10 ml/kg promote hypocoagulation. Contraindicated in decompensated chronic cardiovascular failure.
Reopolyglucin is a 10% low molecular weight dextran with a molecular weight of 25,000-40,000 daltons, improves rheology, reduces adhesion and aggregation of blood cells, improves renal blood flow, increases the COP of blood plasma, attracts interstitial fluid into the vascular bed. It has pronounced antithrombin activity and blocks the process of transition of fibrinogen to fibrin. The use of rheopolyglucin is indicated only after bleeding has stopped.
Gelatinol- colloidal 8% gelatin solution in isotonic solution sodium chloride. It is quickly removed from the vascular bed (in the first hours after removal). Increases bcc by attracting fluid from the intercellular space. Enhances platelet adhesion and aggregation in the microcirculation system.
Gelofusin- 4% solution of liquid gelatin in a multicomponent crystalloid solution. Improves microcirculation, helps normalize the acid-base state, water-electrolyte balance.
Polyoxyfumarin - multicomponent composition with a molecular weight of 20,000 daltons, normalizes the acid-base state, energy metabolism at the cellular level (sodium fumarate improves the rheological properties of blood).
7.5% sodium chloride solution. Under the influence of the hypertonic component, water from the interstitial space quickly moves into the vascular bed, increasing the blood volume and contributing to an increase in blood pressure. Indicated for severe arterial hypotension. It is administered in a volume of 3-5 ml/kg over 2-4 minutes.
Combined drugs of “low-volume resuscitation”: hemostabil (10% dextran with a molecular weight of 40,000 and 7.5% sodium chloride solution) and hyperHAES (voluven-130 and 7.5’/. sodium chloride solution) - provide a rapid increase in BCC.
V. E. Marusanov, V. A. Semkichev
Traumatic shock is a pathological condition that threatens the life of the patient, which occurs due to severe injuries. Timely first aid for traumatic shock can save lives.
In this case, traumatic shock leads to:
The main reason for the development of traumatic shock is the rapid loss of a large volume of plasma or blood. For this type of shock, it is not the amount of blood loss that is important, but its speed, since the patient’s body does not have time to adjust and adapt. Therefore, a state of shock often occurs when injured large arteries. The severity of the shock increases severe pain and neuropsychic stress.
Also, injuries with damage to particularly sensitive areas (neck, perineum) and vital organs lead to the development of traumatic shock. The severity of shock in these cases is determined by the intensity of the pain syndrome, the amount of blood loss, the degree of preservation of organ function and the nature of the injury.
Shock may be:
Rapid blood loss leads to a sharp decrease in blood in the body. The patient’s blood pressure drops, tissues receive less oxygen, and other nutrients, intoxication is growing. The patient’s body tries to independently stabilize blood pressure and compensate for blood loss; substances that constrict blood vessels (dopamine, cortisol, adrenaline) are released into the blood. As a result, spasm of peripheral vessels occurs. This allows you to maintain pressure on the normal level. But peripheral tissues are poorly supplied with the necessary substances, which increases intoxication. Blood primarily goes to the heart, lungs, and brain, and the organs located in the abdominal cavity, skin and muscles do not receive enough nutrients.
But this mechanism stops working after a while. At almost complete absence oxygen, the vessels dilate again, and some of the blood enters here. As a result, the heart does not receive the required volume of blood and normal blood circulation is disrupted. The pressure drops. If it drops below a critical level, the kidneys fail (urine filtration decreases), and then the intestinal wall and liver. This leads to the fact that many microbes and their toxins enter the blood, and toxemia begins. The situation is aggravated by numerous foci of dead tissue resulting from a lack of oxygen, as well as a general metabolic disorder and acidification of the blood.
At in a state of shock the same symptoms are observed as with severe internal or external bleeding.
Traumatic shock goes through two phases of development: erectile (for some it may be absent or short) and torpid.
The erectile phase occurs immediately after injury. Manifests itself in speech and motor excitement, fear, anxiety. The victim is conscious. The person has impaired temporal and spatial orientation. The skin is pale, tachycardia is pronounced, breathing is rapid, blood pressure is normal or slightly elevated. In very severe injuries, the erectile phase may not be detected at all. Typically, the shorter this phase, the more severe the subsequent shock.
During the torpid phase, the victim is inhibited and lethargic. This is caused by inhibition of the nervous system, liver, kidneys, heart and lungs. The torpid phase is divided into 4 degrees of severity:
Clinically, it is not always possible to correctly assess the patient’s condition in the first minutes or hours after the injury occurs. Signs that indicate the presence of an irreversible condition in shock have not yet been studied. There are cases when it seems that a victim who has received an injury complicated by shock dies, but timely anti-shock therapy allows the person to be brought out of a serious condition.
First aid for traumatic shock primarily involves eliminating the causes that caused it. Therefore, it is necessary to relieve pain or reduce it, stop the bleeding that occurs and take measures to improve respiratory and cardiac activity. Before the doctors arrive, you can independently carry out a number of procedures that can improve the victim’s condition:
If the patient is conscious and has no abdominal injuries, then a small amount of alcohol (150 g) can be given. sweet tea, drink plenty of water (half a spoon baking soda, one teaspoon of ordinary salt per liter of water).
If first aid for shock is not provided in a timely manner, then its milder forms can turn into severe ones. Therefore, in the treatment of traumatic shock in victims, the main thing is to provide comprehensive assistance, which includes identifying violations of important body functions and taking measures to eliminate life-threatening conditions.
Traumatic shock is an extremely dangerous pathological reaction of the body, requiring first aid, the algorithm of which is unchanged from the factors that provoked the crisis.
Step 1. The main action that must be performed as quickly as possible when providing an emergency to medical care in case of traumatic shock: stop bleeding to prevent excessive blood loss.
Attention! Interrupt method heavy bleeding selected depending on its variety. In case of external bleeding caused by damage to the aorta, a rubber tourniquet should be applied or the injured vessel should be tightly clamped above the wound site. If it occurs venous bleeding, compression of the affected vessel occurs below the site of damage. If there is a suspicion of the development of internal parenchymal bleeding, any available container filled with ice water should be applied locally to the suspected area of injury.
Step 2. Main task: to overcome the pain shock that occurs when traumatic injuries body. For these purposes, before the arrival of the medical team, use any non-narcotic analgesic, for example, analgin.
Attention! Pain relief using narcotic analgesics and strong tranquilizers by injection is carried out exclusively medical workers after assessing the severity of the patient's condition.
Step 3. Urgent Care in case of traumatic shock, it should be aimed at maintaining the victim’s body temperature. To prevent hypothermia, it is necessary to cover the patient with a warm blanket.
Step 4. If the victim does not visually have external injuries and open fractures important measure in first aid for traumatic shock: place the victim’s body in an anti-shock position. The patient is placed with his back down on a flat, hard surface and raised lower limbs 25–30 cm, placing a hard cushion under your feet.
Step 5. Call an ambulance and monitor the victim’s blood pressure level.
If there is a critical drop in blood pressure values, if the patient remains conscious, the person should be given a slightly warm liquid to drink.
In case of traumatic shock, it is extremely important to promptly call a medical team to provide qualified first aid. If it is not possible to call an ambulance, the victim must be transported to the nearest medical institution.
Treatment of a critical condition is carried out in the intensive care unit. First of all, the pharmacological arsenal is used to stabilize blood pressure. For these purposes, infusion-transfusion therapy is carried out using solutions of colloids and crystalloids. In case of excessive blood loss, they resort to blood substitutes and plasma preparations. Intensive therapy for traumatic shock includes maximum assistance in eliminating pain. Very often in such situations, the only way out is to put the patient into a medical (artificial) coma to turn off consciousness.
Traumatic shock is a life-threatening condition that requires immediate, competent assistance.
Such a dangerous crisis occurs when the body is seriously damaged:
A huge role in the likelihood of maintaining body functions is not so much the volume of lost blood, but the rate of its loss. Even with a slight but rapid development of bleeding, the body’s ability to adapt to a critical situation is reduced; traumatic shock manifests itself quickly and requires emergency assistance.
Severe pain and intense mental stress that occurs after injury aggravate the course of traumatic shock and require medical attention.
Rapid blood loss and a decrease in plasma volume causes a sharp drop in blood pressure to critically low values, a deterioration in the supply of oxygen to organs, which leads to tissue hypoxia and subsequent cell death. 
The brain, trying to overcome the consequences of blood loss, engages defense mechanisms by releasing vasoconstrictor hormones into the blood, which provokes spasm and the formation of blood clots in the peripheral blood vessels. As a result of centralized blood supply, most organs do not receive enough oxygen and nutrients. Due to oxygen deficiency in tissues, metabolic products do not undergo oxidative transformations, which is why toxins and poisons accumulate in the body, causing global intoxication. No receipt nutrients due to a decrease in circulating blood volume, it causes intensive breakdown of fats and catabolism of proteins to ensure the viability of cells.
At the same time, the body's attempts to reduce the intensity of the pain syndrome due to maximum secretion chemicals– endorphins leads to an even greater decrease in blood pressure. The victim experiences mental retardation, muscle weakness with the parallel occurrence of severe tachycardia.
Traumatic shock can be primary or secondary. An early crisis occurs as an immediate immediate response to trauma. Late version develops within 24 hours after the moment of injury. Both types require medical attention, and overcoming the secondary crisis is much more difficult.
During traumatic shock, separate phases can be distinguished: erectile and torpid. Their duration varies depending on the compensatory characteristics of the victim’s body and the degree of damage. In some severe cases, the first phase may be completely absent: the victim instantly loses consciousness from severe pain. Often in such a situation, even promptly provided assistance cannot prevent death.
Symptoms of the erectile phase:
Symptoms of the torpid phase:
If there are signs of the torpid phase of traumatic shock, it is extremely important to provide emergency assistance as quickly as possible.
