Shock in children

Shock is a pathological process, accompanied by a progressive mismatch in the delivery and consumption of oxygen, leading to a violation of aerobic glycolysis and a decrease in the formation of ATP, with a deficit of which the cell function is disrupted. Clinically, the shock is manifested by generalized circulatory disturbances, with the progressive insufficiency of tissue perfusion being most common.

In children, the manifestation of shock is less clear than in adults, since they have effective compensatory mechanisms, and lowering of blood pressure often occurs only at a late stage, when the shock is no longer amenable to treatment. This is due to the physiological sympathicotonia of the child's organism, mediated by the high activity of the sympathoadrenal system. Early diagnosis and treatment of shock can save the child's life.

Classification of shock

There are many classifications of shock, according to the leading launch factor, the following types can be distinguished:

• hypovolemic;
• cardiogenic;
• obstructive;
• distributive (septic, anaphylactic, neurogenic).

Classification of shock

Symptoms of shock

Pathogenetic stages of central and peripheral circulation disorder in shock have clear clinical manifestations and can be detected in the shock of any etiology. However, the specific cause of the shock leaves an imprint on the relationship between the stages and the duration of each of them. At a certain stage, the shock of any etiology passes into a phase in which a vicious circle of pathological disorders may arise, exceeding the possibility of self-restoration of perfusion and oxygen saturation of tissues. At this stage, a chain of pathological phenomena of complex and insufficiently studied mechanisms of disturbances in the system of regulation of the aggregate state of blood up to thrombohemorrhagic syndrome occurs.

In the early compensated stage, the homeostatic mechanisms function to maintain the necessary perfusion of the "central" organs. At this stage, blood pressure, diuresis and cardiac function remain at a relatively normal level, but there are already symptoms of inadequate tissue perfusion. In the hypotensive stage there is a violation of circulatory compensation due to ischemia, damage to the endothelium, formation of toxic metabolites. This happens in all organs and systems. When this process causes irreversible functional losses, then a terminal or irreversible stage of shock is recorded. In clinical practice, along with the true irreversibility of shock, states are possible in which hidden causes can stimulate irreversibility. Elimination of them can allow to transfer patients into a category with "reversible" shock.

Symptoms of shock

Treatment of shock

Treatment of shock conditions in children aims to restore the delivery of oxygen to tissues and to optimize the balance between tissue perfusion and metabolic needs of tissues. To do this, it is necessary to improve blood oxygenation, increase cardiac output and its distribution, reduce tissue oxygen consumption and correct metabolic disorders. The program of intensive treatment of a patient in shock includes the following medical actions:

• replenishment of the BCC deficit and ensuring optimal pre- and post-loading;
• maintenance of contractile function of the myocardium;
• respiratory support;
• analgosediation;
• use of steroid hormones;
• antibiotic therapy;
• prevention of reperfusion injury;
• correction of violations of hemostasis (hypo- and hyperglycemia, hypocalcemia, hyperkalemia and metabolic acidosis).

Treatment of shock

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