Traumatic shock is a pathological condition that occurs as a result of blood loss and pain syndrome during trauma and poses a serious threat to the patient’s life. Regardless of the cause of development, it always manifests itself with the same symptoms. Pathology is diagnosed on the basis of clinical signs. An urgent stop of bleeding, anesthesia and immediate delivery of the patient to the hospital is necessary. Treatment of traumatic shock is carried out in the conditions of the intensive care unit and includes a set of measures to compensate for the violations that have occurred. The prognosis depends on the severity and phase of the shock, as well as the severity of the injury that caused it.
T79.4 Traumatic shock
Traumatic shock is a serious condition that represents the body’s reaction to acute trauma, accompanied by severe blood loss and intense pain syndrome. It usually develops immediately after injury and is a direct reaction to damage, but under certain conditions (additional traumatization) it may occur after some time (4-36 hours). It is a condition that poses a threat to the patient’s life, and requires urgent treatment in the intensive care unit.
Causes of traumatic shock
Traumatic shock develops in all types of severe injuries, regardless of their cause, localization and mechanism of damage. It can be caused by knife and gunshot wounds, falls from a height, car accidents, man-made and natural disasters, industrial accidents, etc. In addition to extensive wounds with damage to soft tissues and blood vessels, as well as open and closed fractures of large bones (especially multiple and accompanied by damage to arteries), traumatic shock can cause extensive burns and frostbite, which are accompanied by significant loss of plasma.
The development of traumatic shock is based on massive blood loss, severe pain syndrome, impaired function of vital organs and mental stress caused by acute trauma. At the same time, blood loss plays a leading role, and the influence of other factors can vary significantly. Thus, when sensitive areas (perineum and neck) are damaged, the influence of the pain factor increases, and when the chest is injured, the patient’s condition is aggravated by a violation of the function of breathing and oxygen supply to the body.
The trigger mechanism of traumatic shock is largely associated with the centralization of blood circulation – a condition when the body directs blood to vital organs (lungs, heart, liver, brain, etc.), diverting it from less important organs and tissues (muscles, skin, adipose tissue). The brain receives signals about a lack of blood and reacts to them, stimulating the adrenal glands to release adrenaline and norepinephrine. These hormones act on peripheral vessels, causing them to narrow. As a result, the blood flows away from the limbs and it becomes enough for the vital organs to work.
After a while, the mechanism begins to malfunction. Due to the lack of oxygen, peripheral vessels expand, so blood flows away from vital organs. At the same time, due to violations of tissue metabolism, the walls of peripheral vessels cease to respond to signals from the nervous system and the action of hormones, so there is no re-narrowing of the vessels, and the “periphery” turns into a blood depot. Due to insufficient blood volume, the work of the heart is disrupted, which further aggravates circulatory disorders. Blood pressure drops. With a significant decrease in blood pressure, the normal functioning of the kidneys is disrupted, and a little later – the liver and intestinal wall. Toxins are released from the intestinal wall into the bloodstream. The situation is aggravated due to the occurrence of numerous foci of dead tissues without oxygen and gross metabolic disorders.
Due to spasm and increased blood clotting, some of the small vessels are clogged with blood clots. This causes the development of DIC syndrome (disseminated intravascular coagulation syndrome), in which blood clotting first slows down and then practically disappears. With DIC syndrome, bleeding may resume at the site of injury, pathological bleeding occurs, multiple small hemorrhages appear in the skin and internal organs. All of the above leads to a progressive deterioration of the patient’s condition and becomes the cause of death.
Regardless of the causes, traumatic shock proceeds in two phases: erectile (the body tries to compensate for the violations that have arisen) and torpid (compensatory capabilities are depleted). Taking into account the severity of the patient’s condition in the torpid phase, 4 degrees of shock are distinguished:
- I (mild). The patient is pale, sometimes a little inhibited. Consciousness is clear. Reflexes are reduced. Shortness of breath, pulse up to 100 beats/min.
- II (moderate severity). The patient is sluggish, inhibited. The pulse is about 140 beats /min.
- III (heavy). Consciousness is preserved, the ability to perceive the surrounding world is lost. The skin is earthy gray, the lips, nose and fingertips are cyanotic. Sticky sweat. The pulse is about 160 beats/min.
- IV (predagonia and agony). Consciousness is absent, the pulse is not determined.
Traumatic shock symptoms
In the erectile phase, the patient is excited, complains of pain, may scream or moan. He is anxious and scared. Aggression, resistance to examination and treatment are often observed. The skin is pale, blood pressure is slightly elevated. There is tachycardia, tachypnea (increased breathing), trembling of the limbs or small twitching of individual muscles. The eyes are shining, the pupils are dilated, the gaze is restless. The skin is covered with cold sticky sweat. The pulse is rhythmic, the body temperature is normal or slightly elevated. At this stage, the body still compensates for the violations that have occurred. There are no gross violations of the activity of internal organs, there is no DIC syndrome.
With the onset of the torpid phase of traumatic shock, the patient becomes apathetic, lethargic, sleepy and depressed. Despite the fact that the pain does not decrease during this period, the patient ceases or almost ceases to signal about it. He no longer screams or complains, he can lie silently, moaning softly, or lose consciousness altogether. There is no reaction even with manipulations in the area of damage. Blood pressure gradually decreases, and the heart rate increases. The pulse in the peripheral arteries weakens, becomes threadlike, and then ceases to be determined.
The patient’s eyes are dull, sunken, pupils dilated, fixed gaze, shadows under the eyes. There is a pronounced pallor of the skin, cyanotic mucous membranes, lips, nose and fingertips. The skin is dry and cold, the elasticity of the tissues is reduced. Facial features are pointed, nasolabial folds are smoothed. The body temperature is normal or low (it is also possible to increase the temperature due to a wound infection). The patient gets chills even in a warm room. Convulsions, involuntary excretion of feces and urine are often observed.
Symptoms of intoxication are revealed. The patient is suffering from thirst, the tongue is covered, the lips are parched, dry. Nausea may occur, and in severe cases even vomiting. Due to the progressive impairment of the kidneys, the amount of urine decreases even with heavy drinking. Urine is dark, concentrated, with severe shock, anuria is possible (complete absence of urine).
Traumatic shock is diagnosed when the corresponding symptoms are detected, there is a fresh injury or other possible cause of this pathology. To assess the condition of the victim, periodic measurements of pulse and blood pressure are made, laboratory tests are prescribed. The list of diagnostic procedures is determined by the pathological condition that caused the development of traumatic shock.
Traumatic shock treatment
At the first aid stage, it is necessary to temporarily stop bleeding (tourniquet, tight bandage), restore airway patency, perform anesthesia and immobilization, and also prevent hypothermia. The patient should be moved very carefully to prevent repeated traumatization.
In the hospital, at the initial stage, resuscitators-anesthesiologists perform transfusion of saline (lactasol, Ringer’s solution) and colloidal (rheopolyglucin, polyglucin, gelatinol, etc.) solutions. After determining the rhesus and blood group, the transfusion of these solutions in combination with blood and plasma is continued. Provide adequate breathing using air ducts, oxygen therapy, tracheal intubation or ventilator. They continue anesthesia. Catheterization of the bladder is performed to accurately determine the amount of urine.
Surgical interventions are carried out according to vital indications to the extent necessary to preserve vital activity and prevent further aggravation of shock. Bleeding is stopped and wounds are treated, fractures are blocked and immobilized, pneumothorax is eliminated, etc. Hormone therapy and dehydration are prescribed, drugs are used to combat brain hypoxia, metabolic disorders are corrected.