Pediatric surgery. Traumatic shock therapy (most important)

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Pediatric surgery. Traumatic shock therapy (most important)

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5. Therapy of traumatic shock

In children, the classic picture of traumatic shock is rarely observed. The younger the child, the less pronounced are the differences between the erectile and torpid phases of shock. With the same probability, against the background of clinical signs of circulatory insufficiency, psychomotor agitation or lethargy can be found.

There are four degrees of severity of traumatic shock.

Light Shock (I). Most often observed with injuries of the musculoskeletal system (damage to more than two bones, excluding pelvic bone fractures), blunt abdominal trauma without damage to internal organs.

Within 3 hours from the moment of injury, the patient steadfastly maintains a shock clinic in the stage of centralization of blood circulation.

This stage is characterized by psychomotor agitation or depression, systolic blood pressure within the age norm or increased by 20 units, a decrease in pulse pressure, a tense pulse, tachycardia up to 150 beats / min, sometimes bradycardia.

Moderate shock (II) usually accompanies damage to the pelvic bones, extensive damage to soft tissues with significant crushing of tissues, traumatic amputations of one of the limbs, isolated injuries of the abdominal organs, trauma to the chest with fractures of the ribs.

During the first hour from the moment of injury, there is a rapid transition from the stage of centralization of blood circulation to the transitional stage.

In the transitional stage, the child's behavior is inhibited. Systolic blood pressure is reduced, but not more than 60% of the age norm. Pulse of weak filling, its frequency is more than 150 beats / min of the age norm.

Heavy Shock (III) typical for combined and multiple injuries of the chest and pelvis, for traumatic amputation of several limbs, for bleeding from large vascular trunks. During the first hour from the moment of injury, the stage of decentralization of blood circulation develops.

This stage is manifested in the fall of systolic blood pressure below 60% of the age norm. Diastolic blood pressure is not determined. The pulse is thready, tachycardia with a pulse rate of more than 150 beats / min. The skin is pale cyanotic.

Terminal shock (IV) with the clinic of the agonal state. The severity of the course of shock dictates the intensity of therapeutic measures and determines the prognosis.

Emergency operations for shock of any severity are indicated for abdominal trauma with damage to internal organs and bleeding; with traumatic brain injury with external bleeding or symptoms of cerebral compression; with a spinal injury with symptoms of spinal cord injury; with detachments and injuries of the limbs with a violation of the integrity of large vessels and nerve trunks; with thoracic injury with suspected injury to the heart; intrapleural bleeding; massive crushing of the lung tissue; open valvular or tension pneumothorax.

Authors: Drozdov A.A., Drozdova M.V.

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