1. Prof. S.D. Khimich Vinnitsa National Medical University  LECTURE: SYNCOPE, COLLAPSE, SHOCK – CLINICAL COURSE AND TREATMENT

2. SYNCOPE (a fainting fit, a swoon) is a sudden and short-term loss of consciousness, caused by brain hypoxia.

4. The reason of syncope is the nervous system dysfunction that influences the vasomotor center and the CNS vessels. Even slight pains, fright, sight of blood, etc., can cause fainting fits.

5. Clinical manifestations of a fainting fit are: paleness of face, sickness, ringing in the ears, cold sweat, giddiness, weak pulse, dilation of pupils, shallow breathing and loss of consciousness. paleness of face, sickness, ringing in the ears, cold sweat, giddiness, weak pulse, dilation of pupils, shallow breathing and loss of consciousness. Fainting fits usually end quickly: in some seconds or minutes the patient recovers consciousness. Fainting fits usually end quickly: in some seconds or minutes the patient recovers consciousness.

6. A patient in the state of syncope should be laid down with his/her head lowered, his clothes should be unbuttoned at the collar and he/she should have as much fresh air as possible

7. To tone up the vasomotor and breathing centers it is useful give the patient to smell salammonia and to sprinkle his face with cold water. After the recovery of consciousness it is recommended lo have a drink of hot tea or coffee. The patient should remain in bed until all the symptoms of the fainting fit disappear.

8. COLLAPSE is a sharp and sudden lowering of arterial and venous blood pressure caused by acute vascular insufficiency. It is characterized by decrease in the blood vessels tone and diminishing of the circulating blood volume. Because of hypoxia, developing as the result of the collapse, the vital functions of the organism are suppressed. is a sharp and sudden lowering of arterial and venous blood pressure caused by acute vascular insufficiency. It is characterized by decrease in the blood vessels tone and diminishing of the circulating blood volume. Because of hypoxia, developing as the result of the collapse, the vital functions of the organism are suppressed.

10. Intensive pains, bleeding, septic states, and intoxications can cause collapse

11. Clinically collapse is similar to shock, but considering different ways the CNS is influenced, they should be distinguished When collapse develops, the patient’s skin suddenly grows pale and cyanotic and cold and sticky sweat appears, the pulse is weak and rapid, the breathing becomes shallow and fast. When collapse develops, the patient’s skin suddenly grows pale and cyanotic and cold and sticky sweat appears, the pulse is weak and rapid, the breathing becomes shallow and fast.

12. The blood pressure falls sharply, the temperature lowers, the patient suffers intensive weakness. The consciousness remains It is important to distinguish the collapse itself from the diseases that can cause its development: brain concussion, uremic of diabetic coma, shock, sepsis, etc. It is important to distinguish the collapse itself from the diseases that can cause its development: brain concussion, uremic of diabetic coma, shock, sepsis, etc.

13. Treatment The treatment of collapse is closely connected with the liquidation of its reason (stopping the bleeding, alleviating the pain, etc.). As to medicines, the drugs that influence the blood vessels are prescribed (strophantine, dopamine, adrenaline, mesatonum), as well as blood and blood substitutes transfusions, rest, warming of the body and oxygen therapy. The treatment of collapse is closely connected with the liquidation of its reason (stopping the bleeding, alleviating the pain, etc.). As to medicines, the drugs that influence the blood vessels are prescribed (strophantine, dopamine, adrenaline, mesatonum), as well as blood and blood substitutes transfusions, rest, warming of the body and oxygen therapy.

14. SHOCK SHOCK is an extremely grave disturbance of the organism functions that is manifested in the heavy suppression of the CNS functioning and progressing decrement of all physiological systems functioning. SHOCK is an extremely grave disturbance of the organism functions that is manifested in the heavy suppression of the CNS functioning and progressing decrement of all physiological systems functioning.

16. THE THEORIES OF THE DEVELOPMENT OF SHOCK ARE: the toxic theory the toxic theory the theory of plasma and blood loss the theory of plasma and blood loss neuro-reflex theory neuro-reflex theory

17. The classification of shock (I): According to the etiology of development there are: According to the etiology of development there are: hypovolaemic shock (traumatic, burn, operation, and hemorrhagic), hypovolaemic shock (traumatic, burn, operation, and hemorrhagic), anaphylactic, anaphylactic, cardiogenic and cardiogenic and septic shock. septic shock.

18. The classification of shock (II): In accordance with the gravity of symptoms 4 degrees of shock are distinguished: In accordance with the gravity of symptoms 4 degrees of shock are distinguished: I degree – state of moderate gravity; pulse rate 80- 100 per minute; arterial pressure 90/70 mm of mercury column (m.c.) I degree – state of moderate gravity; pulse rate 80- 100 per minute; arterial pressure 90/70 mm of mercury column (m.c.) II degree – grave state; pulse rate 100-140 per minute; arterial pressure 70/50 mm m.c. II degree – grave state; pulse rate 100-140 per minute; arterial pressure 70/50 mm m.c. III degree – very grave state: pulse is 120-160 per minute; arterial pressure 50/30 mm m.c. III degree – very grave state: pulse is 120-160 per minute; arterial pressure 50/30 mm m.c. IV degree – preagony: no reaction to external irritative factors; the pulse can be palpated with difficulty only on main vessels; arterial pressure 50 mm m.c. and lower. IV degree – preagony: no reaction to external irritative factors; the pulse can be palpated with difficulty only on main vessels; arterial pressure 50 mm m.c. and lower.

19. The classification of shock (III): According to the time of its development shock can be primary or secondary. According to the time of its development shock can be primary or secondary. (The primary shock develops at the time of injury or directly after it, its mechanism is neuroreflex. The secondary shock develops later and is caused by the intoxication with the tissue disintegration products).

20. In former times shock was subdivided into erectile and torpid forms, and at present it is generally accepted that they are not separate kinds of shock, but successive phases of one general pathologic process

21. Erectile phase begins directly after the injury, it is short-termed and manifests in pronounced motor and mental excitation, high pulse rate and mobilization of the endocrine system

22. The torpid phase is characterized by suppression of the nervous system and sharp decrease of all the vital functions of the organism.

23. The RESULT OF TREATMENT depends on its correct tactics and speed of the therapeutical measures The main tasks in the treatment of shock are: to normalize the nervous system functions, to restore normal haemodynamics, gas blood levels, and water and electrolyte balance. The main tasks in the treatment of shock are: to normalize the nervous system functions, to restore normal haemodynamics, gas blood levels, and water and electrolyte balance.

24. TERMINAL STATES Terminal states include: Terminal states include: preagonal states; preagonal states; agony; agony; clinical death. clinical death. (The shock of III-d and IV-th degree also belongs to the terminal states. ) (The shock of III-d and IV-th degree also belongs to the terminal states. )

25. PREAGONAL STATE PREAGONAL STATE is characterized by black-out consciousness, paleness of skin, pronounced acrocyanosis. The spasm of the peripheral vessels cases the increase of hypoxia, acidosis and metabolism disorders. Main reserves are preserved, the breathing is shallow, the pulse is thready, arterial pressure can’t be measured. PREAGONAL STATE is characterized by black-out consciousness, paleness of skin, pronounced acrocyanosis. The spasm of the peripheral vessels cases the increase of hypoxia, acidosis and metabolism disorders. Main reserves are preserved, the breathing is shallow, the pulse is thready, arterial pressure can’t be measured.

27. AGONY AGONY is characterized by the absence of consciousness, areflexy and expressed acrocyanosis. The pulse is palpated with difficulty only on the carotids, the heart tones are very weak, bradycardic. The breathing is arrhythmic, shallow and spasmodic. The pupils begin to dilate; the maximal dilation occurs in 90 seconds after the beginning of the brain anoxia. AGONY is characterized by the absence of consciousness, areflexy and expressed acrocyanosis. The pulse is palpated with difficulty only on the carotids, the heart tones are very weak, bradycardic. The breathing is arrhythmic, shallow and spasmodic. The pupils begin to dilate; the maximal dilation occurs in 90 seconds after the beginning of the brain anoxia.

29. CLINICAL DEATH: the respiration and cardiac activity are absent. The pupils are dilated and don’t react to light. The organism is in the state of minimal life activity, which lasts for 5 to 6 minutes. During this period the brain cells die, not all at the same moment. In 5 or 6 minutes clinical death turns into biological death, when the biological processes in the organism cease. the respiration and cardiac activity are absent. The pupils are dilated and don’t react to light. The organism is in the state of minimal life activity, which lasts for 5 to 6 minutes. During this period the brain cells die, not all at the same moment. In 5 or 6 minutes clinical death turns into biological death, when the biological processes in the organism cease.

30. INTENSIVE THERAPY during the terminal states should be directed at restoring the vital organs functions and at decreasing the tissue hypoxia.

31. The treatment of terminal states consists in: heart massage (direct or indirect); heart massage (direct or indirect); artificial lung ventilation; artificial lung ventilation; intra-arterial blood transfusion; intra-arterial blood transfusion; heart defibrillation; heart defibrillation; auxiliary artificial blood circulation. auxiliary artificial blood circulation.

32. RESUSCITATION DEPARTMENTS are organized in all big hospitals. They are situated near the operation blocks, are equipped with monitoring systems, and have express-laboratories. Only highly qualified personnel work in these departments.

33. Спасибо за внимание Thank for attention