Syndrome of collapse

The collapse is acute vascular failure due to the affection of the vascular tone primary or secondary origin.

Etiology

• toxicosis, acute infections;

• profuse blood loss;

• dehydratation;

• myocardial infarction;

• embolism of the pulmonary artery;

• disordered vasomotor innervation of central origin;

• after taking some drugs;

• metabolic disorders.

Pathogenesis. Collapse develops due to upset central nervous regulation of the vascular tone. Diminished vascular tone disturbs normal distribution of blood in the body: the amount of deposited blood increases, especially in the vessels of the abdominal organs, whereas the volume of circulating blood decreases. The stroke volume of blood decreases and arterial and venous pressure diminish as well.

Clinical features

A collapse characterizes by giddiness, darkening in the eyes, noise in the ears, weakness, then often by loss of consciousness.

Objective examination. Pallid skin with a marble shade, cold sweat, cold limbs, decreasing of body temperature, accelerated and superficial respiration. The heart sounds are decreased, tachycardia, small, accelerated and thread pulse, decreased arterial and venous blood pressure.

Syndrome of shock

Shock is the clinical syndrome that develops when there is critical impairment of tissue perfusion to some organs.

Classification according to pathophisiological picture

1. Hypovolemic shock secondary to any condition provoking a major reduction in blood volume;

- internal/external hemorrhage;

- severe burns; acute pancreatitis;

- dehydration.

2. Normovolemic shock secondary to capillary damage, arteriovenous shunting and inappropriate vasodilatation:

• septic shock;

• anaphylactic shock.

3. Cardiogenic shock, caused by any form of severe heart failure:

• myocardial infarction;

• acute massive pulmonary embolism;

• heart tamponade due to pericardial enfusion.

Classification according to etiology

• infections,

• toxic,

• anaphylactic,

• hemorrhagic,

• cardiogenic,

• burn.

Pathogenesis. The syndrome of shock is characterized by widespread failure of the capillary system caused by a complex interaction of hemodynamic and toxic factors. Loss of capillary integrity reduces oxygen delivery to the tissues, disturbs local metabolism, and allows fluid to extravasate into the interstitial space. Generalized cell death and further capillary damage occur due to the combined effects of ischemia, acidosis, and the release of toxic metabolites including catecholamines, angiotensin II, and cytokines such as the interleukins and tumor necrosis factor.

Clinical features

• weakness, cyanosis, pallid skin, cold extremities;

• cold clammy skin;

• drowsiness, confusion, irritability;

• rapid shallow respiration;

• tachycardia (> 100 beats per minute);

• thready pulse;

• hypotension (systolic BP <100mmHg);

• oliguria (urine output < 30 ml/hour);

• multi-organ failure.

Complications of shock:

• muscle damage;

• peripheral gangrene;

• visual and cerebral impairment;

• respiratory distress syndrome;

• myocardial dysfunction;

• jaundice, impaired liver function;

• acute renal failure;

• disseminated intravascular coagulation/consumption coagulopathy.