HEMORRHAGIC

SHOCK
By DR.SIDRA NIAZ
PG TRAINEE1st YEAR
ORAL AND MAXILLOFACIAL SURGERY
HEMORRHAGIC SHOCK
Hemorrhagic shock is a condition of reduced tissue perfusion, resulting in the inadequate
delivery of oxygen and nutrients that are necessary for cellular function.
PATHOPHYSIOLOGY
OF HEMORRHAGIC
SHOCK
Initial stage:

IV vol. Dec.BP fall

peripheral vascular resistance inc. INOTROPIC :
BP dec. BARORECEPTORSVagal tone dec. rate inc. Inc. force of muscle
contraction
catecholamines release
nonessential vascualr beds vasoconstriction
cardiac effect=+ve inotropic

l
 AT SIGNIFICANT BLOOD LOSS:
LOCAL
Endocrine system stimulateADHconservation of Na+ and water CHANGES
B.P dec. JUXTRAGLOMERULAR APPARATUS RENIN
ANGIOTENSIN 2 vasoconstriction -coagulation
Aldosteron ...water/Na conservation system
H+ ions sec. Inc (acidosis dec.) -platelet
adherence
Thus stable clot +
systemic
hypotension+
Local
vasoconstriction.
LETHAL TRIAD
HYPOTHERMIA

Especial care for?

HYPOTHERMIA
SHIVERING
Room temperature fluids
Complex ENZYMATIC actions: given during resisetstion
adds to lethal triad
temp.
pH
platelet function disturb
clotting factors disturb

ENTIRE COAGLUATION system paralysised+clotting

factors loss in heamarge
ACIDOSIS
O2 Decrease ,lactic acid (anaerobic respiration)acidosis(hypoxemia,hypoperfusion)
Ph fall 7.35
Brain traumarespiratory acidosis.

RULE OUT BY ?
 DILUTION
COAGLUPATHY
 Fluid and blood products following heamorragic shock
clotting factors dec.+ abnormal clotting cascade
start
GUIDELINES
 Every pt
should be
1 st Bleeders bleeding stop look for other bleeders treated as
Examination
hypothermia)
of entire body (keeping in mind hypotensiv
e pt. Initially
Warm fluids
Oxygen administration

B.P :
If brain trauma absent 80-90mm Hg until major
bleeding arrest
if brain trauma (GCS<8) MAP > or = 80mm Hg strictly
maintain
COAGULATION
TREATMENT
 Pt,APTT,Platelet,fibrinogen+serum lactate +/- base deficitsexcessive bleeding from
SHOCK
PT /APTT should be < 1.5 times than normal
Intial fibrinogen should be maintianed at 3-4 g/L
Severe bleeding if absent avoid plasma transfusion
Adminster TXA (Transimic acid) as soon as possible ,loading dose 1g I/V Infusion over 10
minutes followed by I/V Inf. Of 1g over 8 hours.
PLATELET:50 10 7 L maintain
if bleeding continue 100109 L
initial dose= 4-8 single platelet unit
 HB LEVEL
MAINTENANCE
 Hb should be maintained at 7-9 g /dL
Initially normal valuesmask massive bleed
Repeated Hb necessary
Dec. Hb presents severe bleeding + coagulopathy