symptoms of shock, early symptoms and signs of shock
Early symptoms: Conscious, but irritable, anxious or agitated. The complexion and skin are pale. The lips and nail bed are slightly bruised. Cold sweat, clammy limbs. May have nausea and vomiting. The heartbeat is fast and the pulse is still strong. The systolic blood pressure can be low or close to normal, or high due to increased catecholamine secretion, but it is unstable and the diastolic blood pressure increases, so the pulse pressure decreases.
Late symptoms: manifested as shortness of breath, can fall into a coma, systolic blood pressure below 8kPa (60mmHg), or even undetectable, no urine.
Related symptoms: decreased blood pressure, pale skin, clammy skin, weak pulse or even unable to clearly touch oliguria, irritability, blurred expression, indifferent expression, decreased cardiac output
Diagnosis of shock symptoms
(1) Clinical features
1. Clinical manifestations.
Mainly include blood pressure drop, systolic blood pressure drop below 12kPa (90mmHg), pulse pressure difference less than 2.67kpa (20mmHg), pale complexion, clammy limbs and cyanosis of the limbs, superficial vein collapse, weak pulse, general weakness, reduced urine output , Irritability, unresponsiveness, confusion, and even coma.
2. The pathogenesis of shock can be divided into early shock stage and shock stage, which can also be called shock compensation stage and shock suppression stage.
(1) Early shock (shock compensation period)
The patient is conscious, but irritable, and may be anxious or agitated. The complexion and skin are pale. The lips and nail bed are slightly bruised. Cold sweat, clammy limbs. May have nausea and vomiting. The heartbeat is fast and the pulse is still strong. The systolic blood pressure can be low or close to normal, or high due to increased catecholamine secretion, but it is unstable and the diastolic blood pressure increases, so the pulse pressure decreases. Urine output is also reduced. If the shock can be diagnosed and treated in time in the early stage of shock, the shock will get better soon, but if it cannot be treated effectively in time, the shock will develop further and enter the shock stage.
(2) Mid-shock (advanced shock), the clinical manifestations vary with the degree of shock.
In general, in moderate shock, in addition to the above-mentioned manifestations, the consciousness is still clear, the blood pressure is progressively lowered, the cardiovascular and cerebrovascular loss of self-regulation or the priority of the blood center is not centered, the coronary and cerebrovascular perfusion are insufficient, and the cardio-cerebral dysfunction occurs. Weak heartbeat, weakness, indifferent expression, unresponsiveness, confusion and even turning into a coma. The pulse is fast and fast, and it disappears when pressed slightly, the systolic blood pressure drops below 10.6kPa (80mmHg), the pulse pressure is less than 2.7kPa (20mmHg), the superficial veins collapse, thirst, and the urine output decreases to less than 20ml per hour. The initial stage of decompensation is still reversible after active treatment, but if the duration is longer, it will enter the shock refractory period.
(3) Late shock (late shock), can be manifested as shortness of breath, can fall into a coma, systolic blood pressure below 8kPa (60mmHg), or even undetectable, no urine.
① The blood pressure drops progressively, and it is still difficult to recover after giving blood pressure drugs. The rapid pulse rate decreases central venous pressure, central venous pressure decreases, the vein collapses, and circulatory failure occurs, which can cause death.
② There is no reflow of capillaries.
③Due to the continuous aggravation of microcirculation congestion, the occurrence of DIC and extensive cardiac damage. The former causes bleeding, may have skin
, Mucosal and internal organ bleeding, gastrointestinal bleeding and hematuria are more common; adrenal hemorrhage can lead to acute adrenal cortex failure; pancreatic hemorrhage can lead to acute pancreatitis. At the same time, heart failure, acute respiratory failure, acute renal failure, brain dysfunction and acute liver failure can occur.
(2) Diagnosis points
1. The diagnosis of shock is often based on the clinical manifestations of hypotension, microcirculation insufficiency, and compensatory hypersensitivity of sympathetic nerves. Diagnosis conditions:
① There is a cause of shock.
② Abnormal consciousness.
③The pulse rate is more than 100 beats/min, thin or untouchable.
④Cold and clammy limbs, positive skin pressure on the sternum (the refilling time after pressure is more than 2 seconds), skin pattern, pale or cyanotic mucous membrane, urine output less than 30ml/h or anuria.
⑤The systolic blood pressure is less than 10.64kPa (80mmHg).
⑥The pulse pressure is less than 2.66kPa (20mmHg).
⑦The systolic blood pressure of patients with pre-existing hypertension decreased by more than 30% compared with the original level.
A diagnosis can be established if it meets ①, and two of ②, ③, and ④, and one of ⑤, ⑥, and ⑦.
2. Shock is a clinical emergency, which can endanger the life of the patient, and should be treated symptomatically immediately after diagnosis.