Infectious-toxic shock: first aid, pathogenesis, causes
What it is? An infectious-toxic shock is called a critical, that is, a life-threatening condition that has arisen due to the ingestion of a certain number of living microorganisms into the human body.
Causes it to be absorbed into the human blood, the toxins that the microbe secretes, being alive( exotoxins), as well as those structures that are released when it dies( endotoxins).As a result, a violation of microcirculation and metabolism, leading to inadequate delivery or assimilation of oxygen by internal organs.
Because of this condition, there is a change( not necessarily - oppression) of the activities of all vital organ systems. Infectious-toxic shock requires the provision of emergency care with the continuation of human treatment in the intensive care unit and resuscitation.
Why does an infection-toxic shock develop, and what is it? The word "shock" in medicine is called a condition accompanied by a progressive disruption of the functions of vital organs as a result of a mismatch in the delivery of oxygen and its consumption. At the same time, a decrease in blood pressure, a violation of consciousness( both by the type of its oppression, and by the type of inadequacy, delusions) are recorded, the amount of urine released, the rhythm of breathing changes.
There is a hypovolemic shock that develops due to either blood loss, or fluid loss with diarrhea, vomiting;there is a shock anaphylactic, when the vessels are so dilated due to the action of the allergen that the volume of blood that was in them is no longer sufficient for normal blood supply to the organs.
Infectious-toxic shock can complicate the course of various diseases caused by a living pathogen, not its toxins( for example, botulism is caused by botulinum toxin, and this type of shock does not cause it).This condition can complicate not only infectious diseases such as dysentery, salmonellosis, meningococcal infection, anthrax or plague.
It can develop in surgical diseases( phlegmon, abscess, purulent pathology of internal organs, urinary tract), and in obstetrics( with pathological births, abortions).With any disease that is accompanied by the ingress of bacteria into the blood, it is possible to develop this type of shock.
The mechanism by which each of the types of bacteria causes this type of shock is individual, determined by the set of aggression factors available for various microorganisms.
Infectious-toxic shock develops when a large number of bacteria and their poisons enter the vascular bed. The most dangerous toxin is endotoxin( that is, the substance that is released after the destruction of the bacteria) of gram-negative bacteria. This endotoxin interacts with the cells of the lymphoreticular system. The latter synthesize a huge volume of chemicals - mediators, which trigger both fever and lowering blood pressure.
Endotoxin also binds to serum proteins. Leukocytes react to this complex, and they release a huge number of their mediators. Gram-positive flora does not have endotoxin, but there are specific antigens or other substances that, by reacting with immune cells and substances contained in human blood, result in the development of the same vascular response.
In response to the development of various mediators in the tissues of the body, the following reaction occurs: small capillaries spasmodic, because of this, direct arterio-venous messages are opened. Blood, bypassing the capillary bed, is sent from the arteries directly into the veins, turning off from the bloodstream.
Heart because of this begins to decline worse. In response, hormones are produced that increase blood pressure and delay sodium and fluid in the body. They also "include" anaerobic metabolism in order to optimize for a short time the blood supply and carbohydrate metabolism in the myocardium and brain. If at this stage the person is assisted, the shock ceases to develop further, self-compensatory mechanisms are included - irreversible violations of the internal organs do not occur.
If assistance does not appear, the development of shock continues. Hypoxia and pH shift in tissues stimulate the production of adrenaline and norepinephrine, which causes the vessels to narrow even more, the blood cells in them "stick together" and cease to fulfill their function. Prekapillyarov in tissues are expanding, and another 10% so needed by the body of blood is deposited in them, turning off from the total blood flow.
Under such conditions, the lungs can not provide normal gas exchange;to the heart there is not enough blood( although it is more difficult to push it through the blood vessels);the blood flow in the kidneys decreases - its most important structures die. The liver under the existing conditions can neither produce the necessary proteins, nor detoxify toxins;The level of glycogen in it decreases, the resultant glucose is used to maintain the functions of the brain and the heart muscle.
The pancreas begins to produce more insulin and glucagon, and also releases into the blood substances that are toxic to the myocardium. In the digestive tract: develops erosive gastritis, ischemia of the intestine leads to the movement of its normal flora into the blood, which can additionally cause the development of sepsis.
Because of the long existence of organs in this state, the accumulation of acidic products in the blood increases. This changes all vascular reactions of the body, worsens the blood supply, can lead to irreversible consequences and death of a person.
Anxiety, motor excitement of the person, moderate thirst, blanching of his skin, fever and heart rate increase is an occasion for calling the "First Aid".At this stage, a person can still drink warm water, it will be absorbed in the intestines, giving the body the extra amount of liquid that is needed now.
If time is lost, and you see that the person's skin has become pale, cold to the touch, his nails have acquired a somewhat bluish tint, and when pressing on the nail the white spot remains more than 3 seconds, the person became inhibited, his pulse is weak and frequent, the actions of the first non-medical help, such:
Causes it to be absorbed into the human blood, the toxins that the microbe secretes, being alive( exotoxins), as well as those structures that are released when it dies( endotoxins).As a result, a violation of microcirculation and metabolism, leading to inadequate delivery or assimilation of oxygen by internal organs.
Because of this condition, there is a change( not necessarily - oppression) of the activities of all vital organ systems. Infectious-toxic shock requires the provision of emergency care with the continuation of human treatment in the intensive care unit and resuscitation.
What causes the state of
Why does an infection-toxic shock develop, and what is it? The word "shock" in medicine is called a condition accompanied by a progressive disruption of the functions of vital organs as a result of a mismatch in the delivery of oxygen and its consumption. At the same time, a decrease in blood pressure, a violation of consciousness( both by the type of its oppression, and by the type of inadequacy, delusions) are recorded, the amount of urine released, the rhythm of breathing changes.
There is a hypovolemic shock that develops due to either blood loss, or fluid loss with diarrhea, vomiting;there is a shock anaphylactic, when the vessels are so dilated due to the action of the allergen that the volume of blood that was in them is no longer sufficient for normal blood supply to the organs.
Infectious-toxic shock can complicate the course of various diseases caused by a living pathogen, not its toxins( for example, botulism is caused by botulinum toxin, and this type of shock does not cause it).This condition can complicate not only infectious diseases such as dysentery, salmonellosis, meningococcal infection, anthrax or plague.
It can develop in surgical diseases( phlegmon, abscess, purulent pathology of internal organs, urinary tract), and in obstetrics( with pathological births, abortions).With any disease that is accompanied by the ingress of bacteria into the blood, it is possible to develop this type of shock.
The mechanism by which each of the types of bacteria causes this type of shock is individual, determined by the set of aggression factors available for various microorganisms.
Pathogenesis of infectious-toxic shock
Infectious-toxic shock develops when a large number of bacteria and their poisons enter the vascular bed. The most dangerous toxin is endotoxin( that is, the substance that is released after the destruction of the bacteria) of gram-negative bacteria. This endotoxin interacts with the cells of the lymphoreticular system. The latter synthesize a huge volume of chemicals - mediators, which trigger both fever and lowering blood pressure.
Endotoxin also binds to serum proteins. Leukocytes react to this complex, and they release a huge number of their mediators. Gram-positive flora does not have endotoxin, but there are specific antigens or other substances that, by reacting with immune cells and substances contained in human blood, result in the development of the same vascular response.
In response to the development of various mediators in the tissues of the body, the following reaction occurs: small capillaries spasmodic, because of this, direct arterio-venous messages are opened. Blood, bypassing the capillary bed, is sent from the arteries directly into the veins, turning off from the bloodstream.
Heart because of this begins to decline worse. In response, hormones are produced that increase blood pressure and delay sodium and fluid in the body. They also "include" anaerobic metabolism in order to optimize for a short time the blood supply and carbohydrate metabolism in the myocardium and brain. If at this stage the person is assisted, the shock ceases to develop further, self-compensatory mechanisms are included - irreversible violations of the internal organs do not occur.
If assistance does not appear, the development of shock continues. Hypoxia and pH shift in tissues stimulate the production of adrenaline and norepinephrine, which causes the vessels to narrow even more, the blood cells in them "stick together" and cease to fulfill their function. Prekapillyarov in tissues are expanding, and another 10% so needed by the body of blood is deposited in them, turning off from the total blood flow.
Under such conditions, the lungs can not provide normal gas exchange;to the heart there is not enough blood( although it is more difficult to push it through the blood vessels);the blood flow in the kidneys decreases - its most important structures die. The liver under the existing conditions can neither produce the necessary proteins, nor detoxify toxins;The level of glycogen in it decreases, the resultant glucose is used to maintain the functions of the brain and the heart muscle.
The pancreas begins to produce more insulin and glucagon, and also releases into the blood substances that are toxic to the myocardium. In the digestive tract: develops erosive gastritis, ischemia of the intestine leads to the movement of its normal flora into the blood, which can additionally cause the development of sepsis.
Because of the long existence of organs in this state, the accumulation of acidic products in the blood increases. This changes all vascular reactions of the body, worsens the blood supply, can lead to irreversible consequences and death of a person.
First aid for infectious-toxic shock
Anxiety, motor excitement of the person, moderate thirst, blanching of his skin, fever and heart rate increase is an occasion for calling the "First Aid".At this stage, a person can still drink warm water, it will be absorbed in the intestines, giving the body the extra amount of liquid that is needed now.
If time is lost, and you see that the person's skin has become pale, cold to the touch, his nails have acquired a somewhat bluish tint, and when pressing on the nail the white spot remains more than 3 seconds, the person became inhibited, his pulse is weak and frequent, the actions of the first non-medical help, such:
- call an ambulance;
- clothes to remove or undo;
- put the person so that the head end of it was raised by 10-15 °;
- wrap the patient;
- under the feet put a heating pad;
- ensure the flow of fresh air.
- setting of the intravenous catheter and the urgent beginning of drip introduction of solutions;
- increase in the percentage of oxygen supplied to a person using a mask, nasal cannula;
- intravenous introduction of hormones-glucocorticoids( "Prednisolona", "Dexamethasone");
- transportation of the patient to the hospital.