Intensive Care of Acute Poisoning - A. V. Hovenko 2010

General Characteristics of Acute Poisoning
Exotoxic Shock
Assessment of the Severity of Exotoxic Shock

Dynamic monitoring of clinical symptoms and hemodynamic parameters is of paramount importance for assessing the severity of Exotoxic Shock.

Based on The Cardiovascular system's response to intensive anti-shock therapy, taking into account the clinical condition and toxicological examination data, the following degrees of severity of exotoxic shock are distinguished.

Grade I shock — compensated shock. It is caused by a threshold or critical concentration of the chemical agent that caused the poisoning. Consciousness is preserved (in case of poisoning with sleeping pills, consciousness is absent). Victims are agitated or lethargic. The pulse is weak and rapid; Blood pressure is not lower than 90 mm Hg; moderate oliguria (up to 20 ml/h). Regardless of the severity of primary hemodynamic disorders, intensive anti-shock therapy yields positive results within 6 hours.

Grade II shock (subcompensated shock) is caused by critical concentrations of the toxic substance in the body. Consciousness may be preserved, but patients are severely lethargic and adynamic. Paleness and acrocyanosis, marked dyspnea, tachycardia, oliguria (less than 20 ml/h), and hypotension below 90 mm Hg are observed. Hemodynamic disorders are more pronounced; a tendency toward the restoration of hemodynamic parameters is observed after 6–12 hours or more against the Background of anti-shock measures.

Grade III shock — decompensated shock. It is caused by critical or fatal concentrations of a chemical substance. Despite intensive anti-shock therapy for 6–12 hours, positive dynamics are either absent or their indicators are unstable and poorly expressed.

Grade IV shock — irreversible exotoxic shock, caused by fatal concentrations of a toxic substance in the blood or critical concentrations persisting for a long time. The General condition of the patients is extremely severe. Coma develops. Blood pressure is below 70 mm Hg, extremities are cold and cyanotic, and oliguria is noted. Initial hemodynamic indices are at a critical level and, despite resuscitation and anti-shock measures, there is no positive dynamic or there is further progression of microcirculatory disorders. There is no Treatment effect or it is negligible.

The most valuable prognostic criterion in exotoxic shock is the response of the cardiovascular system to intensive anti-shock therapy.