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shock,any condition in which the circulatory systemcirculatory system,
group of organs that transport blood and the substances it carries to and from all parts of the body. The circulatory system can be considered as composed of two parts: the systemic circulation, which serves the body as a whole except for the lungs, and the
..... Click the link for more information. is unable to provide adequate circulation to the body tissues, also called circulatory failure or circulatory collapse. Shock results in the slowing of vital functions and in severe cases, if untreated, in death. It may be caused by inadequate pumping by the heart, by reduction of the blood volume due to dehydration or to loss of blood or plasma, or by reduced blood pressure resulting from dilation of the blood vessels. Inadequate pumping may occur as a result of various kinds of heart disease. Blood loss may result from injuries or from such internal conditions as bleeding ulcers. Burns produce extensive plasma loss from blood vessels into the burned area; crush injuries may result in loss of blood and plasma into the injured tissues. Dilation of blood vessels may be caused by injury to the nervous system, or by pain or emotional stress. Faintingfainting
, temporary loss of consciousness caused by an insufficient supply of oxygen to the brain. It can be concurrent with any serious disease or condition, such as heart failure, hypertension (high blood pressure), arrhythmia, hemorrhage, injury to the
..... Click the link for more information. is a form of shock brought about by a sudden reduction of the blood supply to the brain. Symptoms of shock include weakness, pallor, cold and moist skin, and thirst. The arterial blood pressure is reduced, the pulse is weak and rapid, and the surface veins of the limbs may collapse. Emergency aid for shock victims includes maintaining a clear breathing passage, administering oxygen, controlling bleeding, and keeping the patient warm and in a supine position with legs elevated. Therapy may include blood or plasma transfusion to restore the normal circulation, as well as treatment of the underlying cause of shock. The term shock is also applied to a variety of other conditions such as electric shockelectric shock,
effect of the passage of a current of electricity through the body. Fatality may result from shocks of from 1 to 2 amperes and 500 to 1,000 volts. However, the effect of electric shock on the body depends not only on the strength of the current, but on such
..... Click the link for more information. , allergic shock (see anaphylaxisanaphylaxis
, hypersensitive state that may develop after introduction of a foreign protein or other antigen into the body tissues. When an anaphylactic state exists, a second dose of the same protein (commonly an antibiotic such as penicillin, or certain insect venoms) will
..... Click the link for more information. ), and emotional shock. See first aidfirst aid,
immediate and temporary treatment of a victim of sudden illness or injury while awaiting the arrival of medical aid. Proper early measures may be instrumental in saving life and ensuring a better and more rapid recovery.
..... Click the link for more information. .
a packed conical pile of hay or straw, usually put together where the harvesting takes place. The hay is collected from the fellings when they have a moisture content of 25 to 40 percent and is dried completely in shocks over a period of two to three days. Then the hay shocks are stacked into ricks in the open field, under an awning, or in a barn. About 0.75–2 centners are used to make a rick in areas with a damp climate, and about 2.5–4 centners in dry areas. Hay bucks and harvester-stackers are used to collect the hay into shocks. Gathering straw into a shock is done simultaneously with the combine harvesting of cereals; for this operation the combines are equipped with straw collectors.
a sudden life-threatening condition resulting from severe injury and characterized by progressive impairment of all the physiological systems of the body. The main characteristic of shock is the failure of capillary circulation in the tissues owing to impairment of cardiac output and arterial and venous tonus, capillary dysfunction, and changes in the rheological properties of blood. Shock can be brought on by an injury, burns, surgery (traumatic shock, burn shock, surgical shock), incompatible blood transfusion (hemolytic shock), anaphylaxis (anaphylactic shock), functional cardiac disorders (cardiogenic shock), ischemia of tissues and organs, and excessive loss of blood. The condition was described in detail by the French surgeon H. F. Ledran (1737) and by the Russian physician N. I. Pirogov (1870), who described the symptoms of the erectile phase (brief transient excitement) and torpid phase (subsequent sharp functional inhibition) of shock. The clinical manifestations of shock vary considerably. Progressively increasing extreme weakness and a progressive drop in blood pressure are the most characteristic.
Many aspects of the mechanisms underlying the development of shock still remain unclear. From the neuroreflex viewpoint, the various dysfunctions are due to numerous pain impulses that produce sharp excitation and subsequent inhibition of the nervous system, including the vital centers of the medulla oblongata. From the hemodynamic viewpoint, the decrease in the volume of circulating blood, which leads to peripheral circulatory insufficiency, is the principal factor. From the toxemic viewpoint, shock is caused by the entry into the blood of biologically active substances of tissue origin that interfere with the local and systemic blood flow. It is reasonable to assume that each of these factors plays a part: the primary abrupt activation of the central nervous system by extreme nerve impulses (or toxic substances) increases the amount of catecholamines released into the blood, causing a redistribution of the volume of circulating blood—spasms of the blood vessels of the skin, muscles, kidneys, and abdominal cavity accompanied by the increased flow of blood through arteriovenous anastomoses with maintenance of the circulation in the heart and brain (centralization of the circulation). This period of shock is clinically manifested by pallor and clamminess of the skin, contraction of the pupils, cold perspiration on the face, decreased urine flow, and moderately rapid breathing. The blood pressure is normal or slightly lowered.
“Centralization” of the circulation under conditions of extremely severe and prolonged injury becomes the principal mechanism of circulatory failure and further aggravation of the patient’s condition. The decreased flow of blood to the tissues leads to the accumulation of the products of anaerobic metabolism, biogenic amines, kinins, and other substances. Upon entering the bloodstream, these products, along with other humoral factors, such as increased concentration of some hormones and reduced partial pressure of oxygen, further disrupt the regulatory functions of the nervous system.
The chief factors in the pathogenesis of shock in its late stages are hypoxia, decreased vascular tonus, dysfunction of the tissue microcirculation, and gross derangement of cell metabolism, which results in injury to the cell membranes. The transfer of intravascular fluid to the tissues causes a decrease in the volume of circulating blood. This stage is marked by cyanosis, rapid pulse, lowered blood pressure, and dilatation and slow reaction of the pupils.
The subsequent stage of shock is complicated by congestion in small blood vessels, intravascular agglutination of the erythrocytes, decreased blood flow to the heart, acute cardiac insufficiency, and functional impairment of the vital organs. This stage is clinically manifested by gray cyanosis, thready pulse, abrupt drop in blood pressure, rapid, shallow breathing, dilatation of the pupils, and unconsciousness.
In cases of shock, emergency therapeutic measures are undertaken, chosen according to the cause of the shock, stage of its development, and severity of the patient’s condition. Other measures include the administration of pain relievers, keeping the patient warm, the transfusion of blood and blood substitutes, the administration of oxygen, and the injection of hormones, vitamins, and cardiovascular and other agents.
The term “shock” is also applied to persons in an unusual mental state or persons with severe emotional disturbances (mental, or emotional, shock).
REFERENCES“Problemy reaktivnosti i shoka.” Trudy 1-i Vsesoiuznoi konferentsii patofiziologov. Moscow, 1952.
Petrov, I. R., and G. Sh. Vasadze. Neobratimye izmeneniia pri shoke i krovopotere. Leningrad, 1966.
Weil, M. H., and H. Shubin. Moscow, 1971. Diagnostika i lechenie shoka. (Translated from English.)
Cannon, W. B. Traumatic Shock. New York-London, 1923.
Shires, G. T. Shock. Philadelphia, 1973.
S. A. DOLINA and T. M. OKSMAN