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Toxic shock is extremely rare. But despite this, in most cases it carries a serious risk to human health.

This phenomenon can develop quickly and lead to negative processes in various organ systems, including the lungs, kidneys and liver.

ICD-10 code

A48.3 Toxic shock syndrome

Causes of toxic shock

The causes of toxic shock in most cases are associated with bacterial infection. They produce toxins, which lead to the development of toxic shock. Today they are quite common, but usually do not cause serious harm to the body. They can lead to throat or skin infections. All this can be easily eliminated and does not entail serious consequences. In rare cases, toxins enter the bloodstream and thus cause a strong immune reaction in people whose bodies do not fight them at all.

Streptococcal shock occurs during childbirth, influenza, chickenpox and surgery. It may develop against the background of minor cuts, wounds or bruises. Even the most ordinary bruises, which are not capable of disrupting the integrity of the skin, can cause the appearance.

Staphylococcal toxic shock occurs after prolonged use of tampons or after a surgical procedure. In many cases, it is almost impossible to prevent the development of this phenomenon.

Pathogenesis of infectious toxic shock

The pathogenesis of infectious toxic shock - at the level of small vessels is characterized by the fact that a large amount of toxins enters the circulatory system. They are secreted by saprophytic bacteria. This phenomenon leads to a sharp release of adrenaline and other biologically active substances. They can cause spasm of postcapillary venules and arterioles. The blood that circulates through the opened arteriovenous shunts cannot perform its direct function. Against this background, tissue ischemia and metabolic acidosis occur. Deterioration of circulation leads to tissue hypoxia; due to oxygen deficiency, anaerobic metabolism occurs.

At the level of organ systems, the pathogenesis of infectious toxic shock manifests itself in the form of blood deposition in capillaries and the release of its liquid part into the intercellular space. First, relative and then absolute hypovolemia occurs. A decrease in renal perfusion is possible. This leads to an excessive drop in glomerular filtration rate. The swelling that develops against this background causes acute renal failure. Similar processes occur in the lungs. That is why toxic shock carries considerable danger.

Symptoms of toxic shock

Symptoms of toxic shock develop quickly and rapidly. Moreover, all this is so fleeting that death can occur within 2 days.

The first signs of the “disease” include extremely severe consequences. So, there are sensations that are similar to the flu. Muscle pain, stomach cramps, headache and sore throat begin. The temperature may suddenly rise to 38.9. Vomiting and diarrhea are possible.

Over time, signs of shock appear. They are characterized by low blood pressure and rapid heart rate. Often all this is accompanied by dizziness, loss of consciousness, nausea, vomiting or dysphoria and confusion. Redness, similar to a sunburn, is possible. It can appear in several parts of the body or in separate places. This is mainly in the armpits or groin. There is severe pain at the site of infection. There is redness in the nasal passages and mouth.

Other symptoms include: conjunctivitis, blood poisoning, peeling of skin tissue and death of skin tissue. That is why toxic shock is extremely dangerous for humans.

Infectious-toxic shock

Infectious toxic shock is a sharp decrease in blood pressure. It occurs against the background of the negative effects of toxic substances produced by viruses or bacteria.

This type is often called septic shock, bacteriotoxic shock or endotoxic shock. This is an extremely nonspecific clinical syndrome. It occurs mainly in a number of infectious diseases due to metabolic, neuroregulatory and hemodynamic disorders caused by bacteremia (viremia) and toxemia.

It often occurs against the background of meningococcal infection, influenza, fever, typhoid and typhus, diphtheria, salmonellosis, dysentery and other dangerous infections. The mechanism of pathogenic disorders in this case is determined by the type of pathogen, the nature of the treatment, the intensity of the pathological processes occurring in the body (organ), their degree and other parameters. Toxic shock is a serious disorder in the body.

Toxic shock syndrome

Toxic shock syndrome is a relatively rare disease. It is characterized by an abrupt onset. All this has serious consequences for human life. This syndrome can progress rapidly. Therefore, first aid measures must be carried out immediately.

Toxic shock syndrome occurs due to infection with staphylococci and streptococci. Under normal conditions, they do not bother a person in any way. But under certain conditions they are capable of releasing toxins that enter the bloodstream and lead to severe inflammatory reactions.

The reaction of the immune system leads to phenomena that are characteristic of toxic shock syndrome. The streptococcal variety of the “disease” is typical in the postpartum period, with complications after an acute respiratory infection, as well as with damage to the skin.

Staphylococcal syndrome occurs due to a forgotten tampon in the vagina. Therefore, you need to carefully monitor your own health. Because toxic shock is an extremely negative phenomenon for the body.

Toxic shock from tampons

Toxic shock from tampons can be caused by a staph infection. This mainly occurs due to a forgotten tampon in the vagina. The disease can progress quickly and lead to serious consequences. In some cases, eliminating negative symptoms is not so easy, and sometimes it is simply impossible. Lethal outcome is observed in 8-16% of cases.

Often this syndrome appears in women aged 15-30 years. Naturally, this is due to the use of tampons during menstruation. There have also been cases when the syndrome appeared in women who preferred vaginal contraceptives.

The development of the disease is provoked by Staphylococcus aureus. These microorganisms are always present in the mouth, nose, vagina and skin. Under unfavorable conditions, they cause serious harm to the body. There is a particular danger if a woman has a birth injury, irritation or scratches in the vagina.

It is necessary to understand that toxic shock develops much more rapidly than the flu. Therefore, a sharp increase in body temperature and vomiting should cause concern in a woman. Toxic shock requires emergency treatment.

Bacterial toxic shock

Bacterial toxic shock is sometimes also called septic shock. It can complicate the course of sepsis at any stage of its development. This phenomenon is an altered reaction of the body to the breakthrough of pyogenic microorganisms or their toxins into the blood.

This manifests itself in the form of high temperature, sometimes reaching 40-41 degrees. In this case, there is a stunning chill, which is characterized by severe sweating. It is possible that the temperature may drop to normal or subfebrile due to severe sweating.

The mental state changes sharply. A person feels anxiety, motor agitation, and in some cases psychosis. These symptoms manifest themselves simultaneously with a drop in blood pressure and oliguria or even preceding them. The pulse is frequent and reaches 120-10 beats per minute. The skin becomes pale, acrocyanosis is noted and breathing becomes more frequent. Urinary excretion is severely impaired. Toxic shock requires immediate elimination.

Infectious toxic shock with pneumonia

Different types of pneumonia have their own characteristics. Often it can develop against the background of previous diseases, as a complication. Infectious toxic shock is a very serious complication. More often it occurs against the background of bilateral pneumonia.

Toxic shock also develops in severe pneumonia, which is characterized by severe infiltration of the lung tissue. An incipient complication can be identified by early signs. So, lethargy or anxiety manifests itself. Usually these symptoms do not attract attention, which leads to a worsening of the situation. Over time, shortness of breath and tachycardia appear, and pallor of the extremities is also possible. The skin becomes dry and warm. Toxic shock requires immediate elimination.

Infectious toxic shock in children

Infectious toxic shock in children is a serious and dangerous condition. It can be caused by complex infectious diseases. The reason for this phenomenon lies in the entry into the blood of microorganisms and the toxins they release during their life processes.

Toxins actively develop in the body and lead to spasms of small vessels and capillaries. Mostly in children, this phenomenon occurs against the background of scarlet fever, diphtheria, dysentery and meningococcal infection. Everything actively develops in the first day. At the same time, there is a sharp increase in temperature, up to 41 degrees.

The child's condition remains extremely difficult. He experiences headache, vomiting, severe chills, seizures and confusion. The pulse weakens, the heart begins to beat faster. There is pallor of the mucous membranes and skin, and heavy sweating is possible.

Infectious toxic shock in a baby can develop due to infection through an abrasion or cut. Children should be warned against this and their wounds should be treated promptly with a special antiseptic. If negative symptoms occur, you should immediately consult a doctor. Self-medication in this case is inappropriate! If toxic shock is not addressed correctly, a fatal outcome in this case is not excluded.

Stages of infectious toxic shock

There are four types of stages of infectious toxic shock. So, the first “variation” was called the early reversible shock phase. It is characterized by a shock index of up to 0.7-1.0, tachycardia, muscle pain, abdominal pain, headache and disorders of the central nervous system. Feelings of anxiety, restlessness and depression are possible.

The second stage is called the late reversible shock phase. At this stage, a critical drop in blood pressure occurs (below 90 mm Hg), and the shock index reaches 1.0-1.4. The victim has a rapid pulse, lethargy and apathy. There is a violation of blood microcirculation. This can be determined visually by wet and cold skin, as well as its bluish color.

The third stage is the phase of sustained reversible shock. The victim's condition deteriorates sharply. The pressure gradually drops, and the heart rate increases significantly. The shock index reaches 1.5. The bluish color of the skin and mucous membranes increases. Signs of multiple organ failure appear.

The fourth stage is the most dangerous - the phase of irreversible shock. General hypothermia sets in, the skin is a sick, sallow color with bluish spots around the joints. It is impossible to eliminate toxic shock in this case.

Diagnosis of toxic shock

There are several types of diagnosis of toxic shock. Everything can be determined by the patient himself. Thus, the patient has a very “sad” and “heavy” appearance. The person is conscious, but he is pale, cyanotic, adynamic and lethargic.

The difference between central and peripheral body temperature is up to 4°C. Diuresis less than 0.5 ml/kg/hour. The Algover shock index is gradually increasing. It is possible to determine whether a person has toxic shock visually and with additional measurement of blood pressure and pulse.

At the first stage, the patient's condition is serious. He is excited and in motor restlessness. The skin is pale, there is tachycardia, moderate shortness of breath and decreased diuresis. At the second stage, excitement is observed, which is eventually replaced by inhibition. In this case, the skin is pale, there is tachycardia, disseminated intravascular coagulation syndrome, hypoxia, hypokalemia and hypotension. At the third stage, severe cyanosis, impaired consciousness, drop in blood pressure, anuria and irreversible changes in organs. Toxic shock is life-threatening and must be treated immediately.

Treatment of toxic shock

Treatment of toxic shock includes a whole range of measures. The intensive therapy program for this disease consists of complete restoration of the body. The first step is to solve the main problems in the treatment of toxic shock. Then the fight against the source of infection in the body begins.

Next, exogenous and endogenous intoxication is eliminated. After a while, hypovolemia sets in and macrohemodynamic parameters stabilize. Then it is necessary to stop the mechanisms of auto-aggression and eliminate the deficiency of bioenergy.

It is important to improve microcirculation in a timely manner. In general, the main goals of therapeutic measures are to restore microcirculation and relieve disseminated intravascular coagulation. This is done by simultaneously persistent infusion therapy and intravenous administration of pharmacological drugs.

As noted above, treatment occurs in several stages and depends on the person’s condition. So, if shock occurs as a result of using tampons or contraceptives in a woman, you should immediately remove them from the body. Infected wounds are cleared of bacteria by scraping with a scalpel or scissors. To do this, the doctor gives an injection so that the damaged area is numb and the woman does not feel pain. This intervention is surgical treatment of the wound. Once the source of infection is removed, the patient will feel relief.

Hormones and antibiotics are actively used to destroy bacteria. Prednisolone and Dexamethasone are used as hormonal drugs.

Prednisolone is used to eliminate allergic reactions and the effects of toxic shock. It is used only with the permission of a doctor. It is used orally, by injection and topically. Orally - during or immediately after meals, 0.025–0.05 g per day (in 2–3 doses), then the dose is reduced to 0.005 g 4–6 times a day (or 2–3 times a day, 0.01 g ). In the form of injections - intramuscularly (the contents of the ampoule are dissolved in 5 ml of water for injection, heated to 35-37 ° C, 0.03-0.06 g of the drug each) and intravenously (0.015-0.03 g in a stream or drip). Locally - for anti-inflammatory and anti-allergic effects, 0.5% prednisolone ointment is used for skin diseases. The drug has some contraindications. It should not be used by elderly people or those who often suffer from herpes. Side effects such as water retention in the body, hyperglycemia, muscle weakness and amenorrhea cannot be excluded.

Dexamethasone. The product has anti-inflammatory, antiallergic, antishock, immunosuppressive and antitoxic properties. The drug is taken orally in the form of tablets in an amount of no more than 10-15 mg per day at the initial stage of treatment, followed by a reduction in the daily dose to 2-4.5 mg during maintenance therapy. The daily dose of the medication is divided into 3 doses. Maintenance small doses should be taken once a day, preferably in the morning. In ampoules, the product is intended for intravenous administration, intramuscular, perarticular and intra-articular. The recommended daily dose of Dexamethasone for these routes of administration is 4-20 mg. In ampoules, the medication is usually used 3-4 times a day for 3-4 days, followed by switching to tablets. The drug is used only with the permission of a doctor. It can cause side effects such as nausea, vomiting, and stomach pain. In more complex cases, the appearance of intracranial pressure, a tendency to develop infectious eye diseases and increased body weight cannot be ruled out. As for antibiotics, the most commonly taken are Vancomycin, Daptomycin and Linezolid.

Vancomycin. The drug is administered exclusively intravenously at a rate of no more than 10 mg/min. The duration of infusion should be at least 60 minutes. The daily dose for adults is 0.5 g or 7.5 mg/kg every 6 hours or 1 g or 15 mg/kg every 12 hours. If a person has impaired renal excretory function, the dosage regimen is adjusted. Under no circumstances should the drug be used during pregnancy, breastfeeding, or for people who have hypersensitivity to some components of the drug. It is possible that side effects such as nausea, vomiting and an allergic reaction may occur. In more complex cases, reversible neutropenia, anaphylactoid reactions and hyperemia occur.

Daptomycin. The drug is administered intravenously over at least 30 minutes. For complicated functions of the skin and soft tissues, 4 mg/kg once a day is sufficient for 1-2 weeks until the infection completely disappears. With bacteremia caused by Staph. aureus, including established or suspected infective endocarditis, the recommended dose for adults is 6 mg/kg 1 time/day for 2-6 weeks at the discretion of the attending physician. The drug may cause side effects. This manifests itself in the form of a fungal infection, mental disorders, nausea, vomiting and stomach pain. The appearance of hypersensitivity, swelling and chills is possible.

Linezolid. For adults, the drug is prescribed intravenously or orally 2 times a day, 400 mg or 600 mg once. The duration of treatment depends on the pathogen, localization and severity of the infection: for community-acquired pneumonia 600 mg - 10-14 days, hospital-acquired pneumonia 600 mg - 10-14 days, skin and soft tissue infections 400-600 mg depending on the severity of the disease - 14-28 days, enterococcal infections - 14-28 days. Taking the medicine incorrectly can cause side effects. They manifest themselves in the form of nausea, vomiting, stomach pain, headache and reversible anemia.

It should be noted that each case is in some way individual. Therefore, it is necessary to eliminate toxic shock only after examination by a doctor and identifying the stage of the “disease”.

Emergency care for infectious-toxic shock

Emergency care for infectious toxic shock should begin even before the person is hospitalized. Before the doctor arrives, you need to try to warm the person and put a heating pad on his feet. Then remove or unfasten tight clothing. This ensures access to fresh air.

Immediately after hospitalization, the person is transferred to the intensive care unit. Appropriate therapy is carried out here. Blood cultures are performed before antibiotics are prescribed. If possible, then all this is removed from the foci of infection.

The complexity and severity of the septic process requires treatment aimed not only at combating microorganisms, but also at eliminating metabolic disorders caused by intoxication and hypoxia. After vital functions are restored, the foci of infection are sanitized. For emergency care, use: intravenous drip administration of 200 mg of Dopamine, prednisolone at a dose of 10-15 mg/kg/day and oxygen inhalation. Further treatment depends on the condition. In any case, toxic shock must be eliminated immediately.

If a woman has experienced menstrual toxic shock syndrome, then she should stop using intrauterine devices, tampons and barrier contraceptives. Toxic shock is a serious disorder that can lead to disruption of the functions of organs and body systems.

Toxic shock prognosis

The prognosis for toxic shock is relatively favorable. The success of recovery in people who have suffered this complication depends on timely diagnosis and treatment.

It is important that emergency assistance is provided quickly and professionally. Antibacterial therapy must be adequate as well as successful. The main thing is that the sanitation of the main bacterial focus is carried out correctly and effectively.

Despite this, the mortality rate is high, but only in the first hours. If infectious toxic shock was caused by streptococcus, the mortality rate reaches 65%. The causes of death are heart failure, multiple organ failure and arterial hypotension. With timely and adequate care, the patient recovers completely in 2-3 weeks. You need to understand that prevention is much easier than cure. Toxic shock is a serious disorder that negatively affects many systems and organs of the human body.

It is important to know!

Any given patient with shock may have pathogenetic features of several types of shock. For example, a child with multiple trauma may initially suffer from hypovolemic shock caused by hemorrhage and may subsequently develop endotoxemia.

Infectious-toxic shock is a consequence of the negative effects of toxins on the human body. Toxic substances are formed due to the presence of viruses and bacteria in the body. With this pathology, there is a sharp decrease in blood pressure, which can lead to death. When infectious-toxic shock occurs, the functioning of the entire body is disrupted. Emergency medical attention is needed to prevent complications and death of the person.

Causes

Why can a child have this pathology?

• The main and only cause of infectious-toxic shock is the production of toxins by microorganisms.
• Protein toxins, which are large in size, are especially dangerous.
• Protein contains a large number of harmful enzymes that negatively affect other particles and molecules.
• Protein toxins that can trigger infectious-toxic shock include coccus bacteria.
• Coccus microorganisms include staphylococcus and streptococcus.
• Among staphylococci, aureus is the most dangerous. It produces proteins that can break down collagen.
• From another group of dangerous coccal bacteria, betahemolyzing streptococcus can be distinguished. It negatively affects blood cells.
• Diseases that provoke the occurrence of infectious-toxic shock include pneumonia, endocarditis and other diseases.
• When the immune system is active, coccal bacteria produce superantigens. This leads to the emergence of chemically active substances in the child’s body.
• These substances affect the expansion of capillaries and blood vessels, which leads to a sharp transition of blood. This provokes a sharp decrease in blood pressure and worsens the baby’s well-being.

Symptoms

A sharp deterioration in the condition of a child’s body can be determined by many signs.

• The baby's body temperature rises.
• Blood pressure drops sharply.
• A pinpoint rash appears on the palms and soles of the feet, which goes away within two weeks after effective treatment.
• The surface of the skin of the body becomes marble-red. Subsequently, the top layer of skin is torn away.
• Signs of dysfunction of other organs: nausea and vomiting, intestinal upset.

Diagnosis of infectious-toxic shock in a child

• The doctor will be able to diagnose the pathology in the child during the initial examination.
• To make an accurate diagnosis, the child undergoes laboratory tests.
• The baby needs to undergo a general urine and blood test, as well as a biochemical blood test. This is necessary to determine the cause of infectious-toxic shock.
• Upon admission to the hospital, a blood sample is taken from the child for bacteriological analysis. This will help identify the pathogen and determine its sensitivity to antibiotics.
• Additional examinations of internal organs are also prescribed.

Complications

How dangerous is infectious-toxic shock for a baby? First of all, many internal organs and systems are damaged.

• Possible development of renal and adrenal failure.
• Pulmonary edema and difficulty breathing.
• Development of DIC syndrome.
• Liver damage and development of acute liver failure.
• Problems in the functioning of the circulatory system.
• The occurrence of cerebral edema.
• If medical care is not provided in a timely manner, the child may die. High mortality is observed with the development of streptococcus in a child’s body.
• If help was provided on time, the prognosis for recovery is favorable.
• The child recovers within 2-3 weeks after proper treatment.

Treatment

What can you do

The occurrence of a dangerous condition in a child requires emergency assistance.

• Parents or those around the baby should call an ambulance or take the victim to the nearest hospital themselves.
• Before the doctor arrives, the baby should be warmed up. You can put a heating pad under your feet.
• The child needs access to fresh air, so he should be freed from tight clothing.

What does a doctor do

What does a doctor do to cure an infectious-toxic shock in a baby?

• Urgent hospitalization in the intensive care unit is required.
• Immediate therapy is prescribed to eliminate respiratory failure. It is possible to connect a ventilator.
• Medicines to increase blood pressure are used.
• Adjustment of water and electrolyte balance is necessary.
• The source of infection is being sanitized.
• When the deadly symptoms are eliminated, the doctor prescribes treatment to eliminate the source of infection.
• Antibacterial drugs are used for this.

Prevention

How can you prevent the development of a dangerous condition in children? To do this, you should follow simple rules to maintain the health of the child.

• If infectious and bacterial diseases occur, they must be treated promptly. But you cannot self-medicate and use traditional medicine methods.
• In the presence of chronic diseases, further development and possible complications should be prevented.
• It is necessary to increase the efficiency of the immune system. For this, your child can take vitamins. But taking medications, including vitamin complexes, should occur after medical consultation.
• The child should be in the fresh air every day.
• Parents must provide him with adequate nutrition.
• The baby must follow a daily routine.
• His room should be regularly ventilated and wet cleaned.
• The child must undergo examinations in a timely manner. This will allow us to determine the onset of possible diseases at an early stage.
• A child should be taught a healthy lifestyle from early childhood. Parents can demonstrate light physical exercise.

In the article you will read everything about methods of treating a disease such as infectious-toxic shock in children. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn how untimely treatment of infectious-toxic shock in children can be dangerous, and why it is so important to avoid the consequences. All about how to prevent infectious-toxic shock in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of the disease infectious-toxic shock in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat toxic shock disease in children?

Take care of the health of your loved ones and stay in good shape!

Emergency care for infectious-toxic shock begins to be provided at the prehospital stage. The ambulance team stabilizes the hemodynamic state (blood pressure, pulse), stabilizes breathing and returns adequate diuresis. To do this, vasopressors are administered intravenously: 2 ml of a 0.2% solution of norepinephrine (norepinephrine) with 20 ml of saline or 0.5-1 ml of a 0.1% solution of epinephrine (adrenaline), and glucocorticosteroids: 90-120 mg of prednisolone intravenously or 8-16 mg of dexamethasone intravenously. Oxygen therapy and artificial ventilation are performed in cases of severe respiratory failure and respiratory arrest.

Hospitalization is carried out in the intensive care unit or intensive care unit where further emergency care is provided. Bladder catheterization is performed to monitor diuresis, subclavian vein catheterization and monitoring of the respiratory and cardiovascular system.

To maintain hemodynamics and vital functions of the body, use:

Inotropic agents:

200 mg of dopamine (5 ml of a 4% dopamine solution must be dissolved in 400 ml of a 5% glucose solution) is administered intravenously at a rate of 3-5 mcg/kg/min, followed by an increase to 15 mcg/kg/min;

40 mg of norepinephrine (norepinephrine) (2 ml of 0.2% norepinephrine solution dissolved in 400 ml of 5% glucose solution) is administered intravenously at a rate of 2 mcg/kg/min and then increased to 16 mcg/kg/min.

Glucocorticosteroids:

Prednisolone is used intravenously up to 10-15 mg/kg/day. Up to 120 mg is administered one-time and if a positive effect is observed, then after 4-6 hours the procedure is repeated.

Oxygen therapy:

Inhalation of humidified oxygen is performed at a rate of 5 l/min.

To correct hemorheological disorders the following is used:

Colloidal and crystalloid solutions:

400 ml of rheopolyglucin;

100 ml of 10% albumin solution;

400 ml 5% glucose solution

400-800 ml saline solution

The total volume of fluid should not exceed 80-100 ml/kg/day.

Antithrombins:

Unfractionated heparins are administered: the first dose is 5000 units intravenously, then 3-4 times a day is administered subcutaneously at a rate of 80 units/kg/day.

Antienzyme therapy:

1000 IU/kg/day Contrical or 5000 IU/kg/Sutgordox is administered intravenously 3-4 times a day, dissolved in 500 ml of saline.

Also, after emergency care for infectious-toxic shock, you should switch to bacteriostatic antibiotics (erythromycin, lincomycin) or reduce the dose of the antibiotic that was previously used to treat the disease that caused the shock.

118. Basic and the most urgent measure for the treatment and prevention of progression of hemorrhagic shock should be considered the search for the source of bleeding and its elimination.

The second fundamental action that decides the issue of preserving the patient’s life is the speed of restoration of blood volume. The infusion rate is determined by the most accessible indicators - blood pressure, heart rate, central venous pressure and minute diuresis. Moreover, in the case of ongoing bleeding, it should advance the rate of blood flow by approximately 20%.

Such a speed of solution administration can be achieved only if there is reliable access to the central venous vessels using a large-diameter catheter. Therefore, catheterization of the subclavian or jugular vein is included in the range of emergency measures.

We should not forget about the simultaneous catheterization of preferably two peripheral vessels, necessary for long-term, strictly dosed administration of drugs, as well as the installation of a catheter in the bladder.

(Option 2): To eliminate fluid loss during compensated shock (the initial stage of hypovolemic shock), an isotonic sodium chloride solution and a 5% glucose solution are prescribed, a 5% albumin solution - 10 ml/kg, rheopolyglucin - 10-15 ml/kg. kg.

In case of subcompensated and compensated shock, the total volume of colloids should be at least a third of the infusion volume, and crystalloids - 2/3.

In the case of decompensated (that is, the most severe) hypovolemic shock, emergency surgical correction of hemodynamic disorders includes injections of a 5% albumin solution, a 6% rheomacrodex solution and plasma-substituting solutions: a 6% hemacel solution, a 6% plasmasteril solution, a 6% solution hydroxyethyl starch or hydroxyethylamylopectin, 5% solution of jellyfundol.

The crystalloid volume should include sodium bicarbonate and glucose-salt solutions. It is not recommended to administer potassium chloride outside the hospital due to the risk of hyperkalemia.

If shock progresses, moving into the subcompensated and then into the decompensated stage, and therapy does not give the proper effect, sympathomimetics are prescribed (dopamine - 1-5 mcg/kg per minute).

119. Emergency care for an attack of bronchial asthma.

1. It is immediately necessary to remove causally significant allergens or minimize the patient’s interaction with him.

2. Provide access to fresh air, unbutton the patient’s clothes.

3. Give one of the drugs that has a bronchospasmolytic effect: Berotec N, salbutamol, Berodual. 1-2 doses are administered using a metered-dose aerosol inhaler or through a nebulizer (the interval between inhalations is 2 minutes).

4. You can give the patient 1 tablet of aminophylline.

5. If there is no effect, repeat inhalation after 20 minutes.

120. Status asthmaticus does not respond for treatment with inhalers. To treat status asthmaticus, it is necessary to regularly use aerosols and parenteral antibiotics such as epinephrine and prednisone. Also used to treat status asthmaticus are parenteral terbutaline, magnesium sulfate, which helps relax the muscle tissue around the airways, and a leukotriene inhibitor, which has an anti-inflammatory effect. During an attack of status asthmaticus that is not responding to regular asthma medications, you may also need a ventilator to help your lungs and airway muscles work. In this case, a breathing mask or breathing tube is used, which is inserted into the nose or mouth. These aids are temporary, the need for them disappears as soon as the acute attack passes and lung function is restored. It is possible that after such an attack you will need to spend some time in the intensive care unit.

To avoid the need for urgent hospitalization, it is necessary to begin treatment for asthma at the first, even minor, signs and symptoms of status asthmaticus.

121pneumothorax. First aid: stop bleeding and the flow of air into the pleural cavity by applying a tight, airtight bandage. Naturally, it will not be sterile, since improvised means will be used, but the cleanest available must come into direct contact with the wound. It would be nice to add a plastic film or oilcloth on top of the bandage for a more convincing seal.

To make breathing easier, the injured person should be placed in an elevated position, again using available means. This must be done carefully so as not to cause additional suffering.

If you faint, bring a strong-smelling product to your nose. Ammonia is not always at hand. It can be replaced by perfume, nail polish remover, gasoline, finally. For pain, give analgin, aspirin, if available. And wait for the ambulance doctor to arrive.

Health care

An X-ray examination will give an objective picture of the lesion. Normally, the ribs and lungs with a characteristic pulmonary pattern are clearly visible on the x-ray. You can also judge the degree of displacement of the heart and second lung. With pneumothorax, a thickening of the pulmonary pattern in the compressed lung is visible, and the presence of gas is indicated by the absolute transparency of the lateral chest (there is no pulmonary pattern).

What surgeons do: An open pneumothorax is converted to a closed one by suturing the wound.

The gas is then sucked off, restoring negative pressure.

Measures are taken to combat shock by administering painkillers.

They combat a sharp decrease in blood pressure due to blood loss with blood transfusions, and the resulting shock with medications that stimulate the vascular and respiratory centers.

Valvular pneumothorax is converted to closed pneumothorax by excision of the valve.

Then the gas is evacuated using a special apparatus.

Thousands of people suffer from severe infectious diseases every year. In addition, many experience the effects of intoxication. Naturally, not all of these consequences may be fatal with appropriate treatment. However, infectious toxic shock is considered a very dangerous condition that requires immediate help.

General characteristics of the pathology

When the disease develops, the entire body suffers. The fact is that it is attacked by a huge amount of toxins that are produced by harmful microorganisms or bacteria. In this case, there is a strong decrease in blood pressure, which can lead to the death of the patient.

It should be noted that infectious-toxic shock causes disruption of all body systems: cardiovascular, respiratory, nervous and others. An immediate response makes it possible to save a human life. The chances of recovery increase. Naturally, further treatment must be carried out in a hospital hospital.

What contributes to the occurrence of the disease

Infectious-toxic shock is caused by a fungus, virus or bacteria. Sepsis, which, in turn, is provoked by minor infections (sore throat, pharyngitis, tonsillitis), can contribute to the development of this pathology. Diabetics, people with poor blood clotting and other chronic diseases are highly susceptible to this pathology.

Very often, the development of shock is helped by pneumonia. In this case, the human immune system is suppressed by the disease and the toxins produced by the virus quickly enter the blood, spreading throughout the body.

How does pathology develop?

Infectious-toxic shock develops very quickly. Due to the disruption of blood microcirculation in the tissues, a sufficient amount of oxygen does not enter the cells. Naturally, in this case, a huge amount of breakdown products is formed, which quickly spread throughout the body.

It should be noted that, having been subjected to severe intoxication, the body’s immunity can take quite a long time to recover. Treatment in a hospital will last at least 1-2 weeks, depending on the degree of development of the pathology, the general condition of the patient and the effectiveness of therapeutic measures. It must be said that ITS can be repeated many times, so you need to be extremely careful to avoid such a situation.

Prognosis and features of disease prevention

In principle, if treatment is effective, then the patient’s chances of survival and recovery increase significantly. Naturally, after discharge the person will require long-term rehabilitation and recovery. Doctors may still have to deal with the effects of toxic shock. However, it should be noted that in the first hours after the development of the pathology, the mortality rate is very high, so you cannot delay seeking help.

As for preventive measures, they are quite simple to follow. For example, try to give up bad habits that undermine your immunity. It is advisable to cure any inflammatory process quickly and completely. Take vitamin complexes that will help strengthen your defenses.

You should not rely on self-medication, because in this case it will not help. There is not a single herb that could cope with complex damage to the body. Try to walk in the fresh air, relax, get good sleep, and eat right.

If you feel unwell after recovery, be sure to consult your doctor. To prevent the disease from recurring, you need to try to follow the advice of specialists. Pay close attention to your health.

Infectious-toxic shock is the body’s reaction to the massive penetration of pathogenic microorganisms and the results of their vital activity into the blood. The pathology is mistakenly confused with the septic form. Home treatment in this case is impossible. The patient should be taken to the hospital immediately. Treatment is carried out in the intensive care unit, massive antibiotic therapy and connecting the patient to a ventilator are indicated.

Infectious-toxic shock is a life-threatening condition. It is associated with impaired blood circulation.

In the international classification of diseases ICD-10, this syndrome is assigned code A48.3. The combined category unites different types of pathologies.

The pathogenesis of infectious-toxic shock consists in the activation of specific mediators of the inflammatory process - cytokines under the influence of bacterial agents. The immune state of the body changes, blood circulation processes are disrupted, and tissues do not receive the necessary nutrients. Bacterial toxic shock is the body’s reaction to the action of waste products of pathogenic flora.

Mortality due to ITS, even in emergency care, ranges from 70 to 90% of cases.

How to detect shock in time

It is possible to determine the state of infectious-toxic shock without the help of a medical professional by the characteristic symptoms. What to pay attention to:

• previous trauma, bacterial infection;
• development of seizures;
• pyretic body temperature values;
• rapid breathing;
• agitation and disturbance of consciousness;
• a sharp and uncorrectable decrease in pressure;
• the appearance of rashes in appearance resembling a sunburn;
• loss of consciousness, coma.

At the everyday level, one symptom is enough to suspect the development of infectious-toxic shock. You need to call an ambulance.

An algorithm for making a differential diagnosis was developed in the USA in 1981. Diagnostic signs of the pathological syndrome:

• temperature above 39.5 degrees;
• systolic pressure below 90 mm Hg. Art. against the background of tachycardia with a heart rate of 90 beats per minute;
• rash localized on the feet and palms. After 2 weeks, the skin begins to peel off;
• multiple organ failure – involvement of more than 3 body systems in the process. There may be hyperemia of the mucous membranes of the body, kidney and liver failure, combined with damage to the central nervous system.

Clinical tests determine leukocytosis, excess bilirubin and transaminases, and water-electrolyte imbalance.

In what cases does it develop?

Infectious toxic damage does not occur spontaneously. It is always preceded by bacterial infection, trauma, surgery, in obstetrics - childbirth with a complicated pregnancy, abortion (in 99.9% of out-of-hospital cases of termination of pregnancy) or complications of the postpartum period.

Factors contributing to the development of infectious-toxic shock:

• extensive wounds, including closed ones;
• burns;
• presence of surgical intervention in the recent past;
• complication of childbirth;
• sinusitis, inflammatory processes in the respiratory system;
• HIV infection;
• intravenous injections of narcotic substances;
• typhoid fever.

Degrees of infectious-toxic shock

There are 3 degrees of infectious-toxic shock. Degrees of ITS and characteristic symptoms

Patient management tactics depend on the stage of development of the shock state. The mechanism for providing assistance is prescribed in WHO protocols. In practice, a clear distinction is only important for patients with intestinal infections.

Can bacterial toxic shock occur with pneumonia?

Pneumonia is a serious disease of the respiratory system caused by damage from bacterial flora, viruses, as a hypersensitivity reaction of the body.

The culprits for the development of pneumonia are Staphylococcus aureus, pneumococcus, and some types of streptococci.

The vital activity of pathogenic organisms is accompanied by the production of toxins that participate in pathogenesis and require bacteria to protect against other microorganisms. Such protein compounds cause infectious-toxic shock in pneumonia.

The entry of pathogenic flora into the systemic bloodstream is possible either through the lung tissue, or if the rules of asepsis are not observed during medical procedures, when installing a catheter.

First aid for shock

Emergency care for infectious-toxic shock is prescribed in the guidelines and recommendations of the World Health Organization and the Ministry of Health of the Russian Federation.

General techniques do not depend on the cause of ITS. They are standard in surgical practice, gynecology, and pediatrics. The result of treatment depends on the age, severity of the patient, the presence of chronic diseases, causes of ITS, response to drug therapy, and the degree of damage to internal organs.

In children

If infectious-toxic shock develops in a child, you should call an ambulance. Before the ambulance arrives, first aid must be provided.

Parent actions:

1. Give an antipyretic – ibuprofen, paracetamol.
2. Opening the windows will reduce the likelihood of developing hypoxia.
3. Remove clothing that restricts movement.
4. If possible, give your baby hot tea. Definitely with sugar, the body needs glucose.
5. Lay on the bed, legs in an elevated position.

The ambulance team delivers the child to the intensive care unit. Infusion administration of medications should be started at the stage of transporting a small patient.

Corticosteroid drips are started at the hospital. If the condition improves, the re-infusion is carried out after 6 hours, in the absence of positive dynamics - 30 minutes after the first dose.

Be sure to carry out procedures to prevent dehydration and, after stabilizing the baby’s well-being, transfer to the infectious diseases department. Further, the patient’s management tactics depend on the reasons that caused the infectious-toxic type of shock.

The scheme for providing emergency care to adult patients is similar to the tactics for managing children in a state of infectious-toxic shock.

Responsibilities of an emergency physician:

• conduct a clinical examination of the patient;
• record temperature, pressure, heart rate;
• ensure air flow, optimally supply oxygen;
• install catheters in the main blood vessels (anatomy of the subclavian veins), the bladder - to control diuresis;
• start infusion of medications.

At the intensive care unit, measures are taken to stabilize the patient and antibiotic therapy with broad-spectrum drugs is started.

When determining the causative agent of infection, use highly specialized medications.

Additionally, detoxification measures and intestinal sanitation are carried out. Parenteral nutrition is indicated. Next, treatment of infectious-toxic shock is carried out taking into account the reasons that caused the pathology.

How dangerous is the pathological condition?

The consequences of infectious-toxic shock, even with high-quality treatment and the absence of complications, are quite severe. Long-term stay on a ventilator, on parenteral nutrition. The patient's prognosis is influenced by the fact of failure or disruption of the functioning of one or another organ during a state of shock.

Mortality from ITS remains high at the current stage of medical development. If the first manifestations are detected, the patient should be urgently taken to the clinic.

Shock of an infectious-toxic type is a complication, a consequence of poor-quality or independent treatment. For any bacterial diseases and no positive dynamics within 3 days, you should consult a doctor. It will protect you from possible troubles and loss of health, and in some cases, life.