Treatment of already developed traumatic shock should be early, successive and complex. The time factor is crucial in assisting the victim in a state of shock: the earlier the assistance is provided, the more favorable the outcome.
In terms of organization, it is advisable to divide the assistance in case of shock in peacetime into the following stages: the scene of an accident, an ambulance, a hospital.
At the scene, prophylactic anti-shock measures are carried out, and in cases of terminal conditions and clinical death, a set of measures for resuscitation is carried out (see. Revitalizing the body).
The main task of ambulance workers is the quickest delivery of the victim to the hospital, where there are conditions for providing full assistance. In specially equipped machines, in addition to these measures, it is possible to use oxygen therapy, anesthesia with nitrous oxide, intravenous and intraarterial administration of blood-substituting and anti-shock fluids, dressing on wounds, tracheostomy, artificial respiration.
In the hospital, shock therapy should be pathogenetic and differentiated depending on the phase and degree of shock, the nature of the injury, the individual characteristics of the victim. In addition to the general condition of the victim at the time of the survey, it is necessary to consider the mechanism of injury, the nature and severity of injuries.
There are several groups of anti-shock measures. 1. Painkillers: the fight against pain is carried out through the use of intravenous drugs and anesthetics (nitrous oxide with oxygen in a 1: 1 ratio), by introducing into the hematoma a 2% solution of novocaine in the amount of 10-30 ml with closed fractures.
When pleuropulmonary shock shows vagosympathetic (cervical) blockade (see Novocainic blockade), with abdominal – cervical and pararenal, with shock caused by fractures of the pelvic bones, the Shkolnikov blockade.
Novocainic blockade is shown in any phase of shock and with any degree of severity. Radical removal of the source of pain impulses is achieved by appropriate surgical intervention – surgical treatment of the wound, reposition and fixation of bone fragments at a fracture, restoration of integrity or removal of the damaged organ. However, the provision of operational assistance is often more profitable to postpone until the victim is removed from shock. When crushing tissue and crush syndrome, the damaged part of the body should be covered with ice. The hemostat is a source of painful irritations, therefore it is necessary to remove it and make a final stop of bleeding as soon as possible. The removal of the harness, if it is not performed under general anesthesia, must be preceded by a circular novocainic blockade of the limb above the harness.
2. Activities aimed at combating circulatory disorders. A powerful tool for first and second degree shock is drip and jet intravenous blood transfusion (see) and antishock fluids under the control of venous pressure. In case of shock, third and fourth degree, in a number of cases, the blood pressure under the influence of intravenous fluids increases slightly and does not increase for a short time or at all. Intravenous transfusion of large doses of blood may even worsen the patient’s condition due to overload of the right heart, a symptom of which is increased venous pressure. If the victim has a systolic blood pressure below 60 mm Hg. Art. or as a result of intravenous jet transfusion of 500 ml of blood, systolic blood pressure does not rise to 60-70 mm, then it is necessary to proceed to intra-arterial infusion of blood or anti-shock fluid under a pressure of 200 mm Hg. Art., fractional doses of 40-50 ml in 3-5 minutes., All up to 250 ml.
To stabilize hemodynamics in traumatic shock, blood substitutes are also used – polyglukin, polyvinyl, polyvinylpyrrolidone, which have a persistent pressor action. They can be used both intravenously and intraarterially.
Medicinal substances stimulating the central nervous system and blood circulation (camphor oil, corazol, cordiamine, caffeine, strychnine, etc.) and adrenomimetic substances (adrenaline, ephedrine, noradrenaline, etc.) are widely used. Medicinal substances (except camphor oil) for traumatic shock of the third and fourth degree, it is advisable to administer intravenously, since the absorbability of the subcutaneous tissue and muscles in such patients is sharply slowed down. Substances that increase vascular tone, it is advisable to enter only if the bloodstream is full, as can be judged by the level of venous pressure. When myocardial fibrillation occurs, a defibrillator is used. When cardiac arrest is indicated, an indirect heart massage is indicated.
3. Activities aimed at combating respiratory disorders. To eliminate hypoxia while maintaining active respiration, oxygen is supplied through a mask of an anesthetic apparatus in the form of an oxygen-air humidified mixture with an oxygen content of up to 50%. In case of violation of active breathing, first of all it is necessary to make sure that the airways are passable. After that make intubation and adjust mechanical artificial respiration (see) by means of devices or a bag of the narcotic device. Intubation tube can be in the glottis no more than six hours. If during this time active respiration is not restored, then the tracheostomy and the continuation of mechanical artificial respiration through the tracheostomy is shown. In cases of accumulation of fluid in the respiratory tract, it is necessary to periodically perform suction from the bronchi with the introduction of soda solution and antibiotics to the tracheostomy simultaneously with a total volume of no more than 3-5 ml. Mechanical artificial respiration for some types of damage (traumatic brain injury, multiple rib fractures) is applied for many hours and days. In the event of abnormal respiration, Lobelin and Corconium are injected intravenously.
4. Activities that normalize metabolism. In the room where they assist the patient in a state of traumatic shock, it should be warm, but the air temperature should not exceed 20-22 °. Enhanced heating of the patient leads to the expansion of the capillaries in the periphery, which contributes to a drop in blood pressure.
In connection with a sharp imbalance of vitamins in shock, ascorbic acid, nicotinic acid, and vitamins from complex B should be administered. To eliminate acidosis in shock, oral administration of sodium citrate is indicated, intravenous administration of 300–400 ml of 4.5% sodium bicarbonate solution.
In connection with the dysfunction of the endocrine system in shock, the use of deoxycorticosterone acetate, ACTH, pituitrin, norepinephrine is indicated.