Collapse

see also: Etymology of Collapse

The term collapse indicates in a general way a collapse ( to collapse means “to disappear” in English). The verb corresponding, “ collaber ”, is used in general to indicate a soft object and hollow which deflates and whose walls stick.

In Medicine, one uses the collapse term precisely to indicate a fall of the pressure of a body liquid which creates a “collapse” of a hollow and soft body. Most of the time, it is used to indicate the cardiovascular collapse (falls of the blood pressure). When it is prolonged, the collapse can involve a state of shock (= cellular suffering due to the deficit of contribution out of oxygen to the cell). A state of shock always does not begin with a collapse (for example, concept of shock " chaud" sepsis), but the prolonged cellular suffering, in particular myocardic, generally leads to the collapse (concept of shock " froid"). Nevertheless, in practice, the concepts of collapse and shock are often recut, the collapse (falls of blood pressure) which can be regarded as the first stage leading to the shock (cellular suffering).

Cardiovascular collapse

The cardiovascular collapse , is a collapse of the blood pressure, it is when the blood pressure systolic is lower than 80 mmHg (blood Pressure lower than 8). Classically the causes can be gathered in 4 categories:

by loss of liquids (Shock hypovolemic): Dehydration, Bleeding (hemorrhagic Shock), Diarrhea, Burn S…
by failure of the cardiac pump (Shock cardiogenic): important Infarction, diseases of the cardiac muscle or its valves…
by Allergy (Shock anaphylactic): by relarguage in the blood of substances dilating the arteries (Vasodilatation) and thus making fall resistances and consequently the blood Pressure.
by Infection (septic Shock), of mechanism close to the allergic collapses.

This situation causes a reflex of safeguarding of the vital functions:

the body concentrates blood towards the interior of the body, in order to irrigate the important bodies (Cœur, Poumon S, Cerveau) and to limit the losses of Chaleur; there is thus a Vasoconstriction on the level of the skin (the peripheral blood-vessels are closed);
the cardiac rhythm and the rate of respiration accelerate in order to improve the surge of Oxygène towards the important bodies.

The most obvious clinical signs are:

palenesses, in particular on the level of the mucous membranes (lips, inner face of the eyelids):
if one presses on the nails, those spend time with recolorer (more than two seconds);
fast pulse (superior with 120 beats per minute) and slipping by (the radial pulse or is badly not perceived);
feeling of thirst and anguish.
appearance of bluish trails on the skin, generally on the level of the knees, but also on the level of the belly (the marblings )

One evaluates sometimes the circulatory state by the index of shock , which is circulatory frequency divided by the systolic blood-pressure: in the event of cardiovascular collapse, the frequency increases and the tension decreases, therefore the index increases.

Assumption of responsibility

The cardiovascular collapse, although being a phenomenon of defense, will cause in oneself a vital distress which can lead to the death. The first gestures consist, after suppression of the aggression (protection, stop of the hemorrhages…),

to seek a Hemorrhage hidden by clothing or the position of the victim, and the to stop if necessary;
to lengthen the victim if possible (attention with the possible traumatisms) in order to facilitate the blood circulation (in position upright or sat, blood goes towards the feet);
to reassure it (even if it is unconscious) to make slow down the cardiac rhythm;
and to cover it to prevent cooling.

In spite of the feeling of felt thirst, it is necessary to prohibit with the victim boire or to eat: indeed, on the one hand that could complicate a future anesthesia, on the other hand, if the person falls unconscious, that can endanger its breathing (the stomach can empty and fill the lungs). One can be possibly satisfied to wet the lips and the language of the victim (using a brumisator or of a wet handkerchief).

To the level first-aid worker, one will bring also the person under oxygen inhalation (9 L/min for an adult, 6 for a child and 3 for a nourisson). In absence of suspicion of traumatism and if the person is conscious, one for a long time recommended to raise the lower extremities (“sloping Décubitus”, position known as “of Trendelenburg”), in order to bring back blood towards the “noble” bodies (heart, lungs, head), but this technique not having proven its effectiveness, it is not recommended any more in France. However, this position remains the standard in other countries like Germany.

At the medical level, one poses a peripheral venous Voie (Garde veins) in order to bring a perfusion of liquids which will make go up the blood pressure and stop the collapse. That is valid for all the collapse except those of cardiogenic origin. One benefits from this way to inject drugs vasopresseurs (i.e. which make go up the pressure of blood, in particular by causing a Vasoconstriction), or tonicardiaques which will stimulate the Cœur and will increase by this skew, its flow. In certain cases, the setting of shock-proof pants was proposed, i.e. pants which will compress the lower extremities and will make go up blood towards the noble bodies.

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