Shock Hemorrhage & Blood Tranfusion
Shock Hemorrhage & Blood Tranfusion
Shock Hemorrhage & Blood Tranfusion
These mechanisms lead to injury of the capillary The cellular and humoral elements activated by the
endothelial cells, these in turn further activate the hypoxia (complement, neutrophils, microvascular
immune and coagulation systems. thrombi) are flushed back into the circulation
Damaged endothelium loses its integrity and where they cause further endothelial injury to
becomes leaky. organs such as the lungs and kidneys. This leads to
Spaces between the endothelial cells allow the fluid acute lung injury, acute renal injury, multiple organ
to leak out and tissue edema occurs, exacerbating failure and death. Reperfusion injury can currently
cellular hypoxia. only be attenuated by reducing the extent and
duration of tissue hypoperfusion.
iii. Systemic
Types of Shock
a. Cardiovascular
As preload and afterload decrease, there is a
1.Vasovagal Shock
compensatory baroreceptor response resulting
It is sudden dilatation of peripheral and splanchnic
in increased sympathetic activity and release of
vessels causing reduced cardiac output and
catecholamines into the circulation, this results in
shock. Often it may be life threatening due to hypoxia.
tachycardia and vasoconstriction (except in the
sepsis).
2.Hypovolemic Shock (Commonest Type)
b. Respiratory Hypovolemic shock is caused by a reduced circulating
The metabolic acidosis and increased volume; hypovolemia may be due to hemorrhagic or
sympathetic response result in an increased non hemorrhagic causes.
respiratory rate and minute ventilation to
increase the excretion of C02 (and so produce a i. Non - Hemorrhagic Shock
compensatory respiratory alkalosis). Due to:
Poor fluid intake (dehydration).
c. Renal Excessive water loss because of vomiting,
Decreased perfusion in the kidneys stimulates diarrhea, urinary loss.
renin angiotensin aldosterone axis, resulting in Evaporation and third spacing seen in bowel
further vasoconstriction and increased sodium obstruction or pancreatitis.
and water reabsorption by the kidney. Burns.
Tachycardia, hypotension, pulmonary edema, The underlying cause is treated like draining the
raised JVP, gallop rhythm are the features. pus, laparotomy for peritonitis, etc.
Ventilator support with ICU monitoring may
4. Obstructive Shock prevent the patient going for the next cold stage of
In obstructive shock there is a reduction of preload sepsis.
because of mechanical obstruction of cardiac filling.
Common causes of obstructive shock are: b.Hypodynamic Hypovolemic Septic Shock (Cold
Cardiac tamponade. Septic Shock)
Tension pneumothorax. Here pyrogenic response is lost.
Massive pulmonary embolism. Patient is in decompensated shock.
Air embolism. It is an irreversible stage along with MODS (multi
organ dysfunction syndrome) with anuria,
5.Distributive Shock respiratory failure (cyanosis), jaundice (liver
Distributive shock describes the pattern of failure), cardiac depression, pulmonary edema,
cardiovascular responses characterizing a variety of hypoxia, drowsiness, eventually coma and death
conditions including septic shock, anaphylaxis and occurs (irreversible stage).
spinal cord injury.
iii. Anaphylactic Shock (Vasodilation Due to
i. Neurogenic Shock Histamine Release)
It is usually due to spinal cord injury which causes Injections penicillins, anesthetics, stings
dilatation of splanchnic vessels. venoms, and shellfish may be having antigens
which will combine with IgE of mast cells and
ii. Septic Shock basophils, releasing large amount of histamine
Septic shock may be due to gram positive and SRS-A (slow releasing substance of
organisms, gram negative organisms, fungi, anaphylaxis). They cause bronchospasm,
viruses or protozoal origin. laryngeal edema, respiratory distress,
Gram -ve septicemia / Gram -ve septic shock is hypotension and shock. Mortality is 10%.
called as endotoxic shock. It occurs due to gram Rashes all over the body are commonly
negative bacterial infections commonly seen in: observed.
Strangulated intestines.
Peritonitis. Anaphylactic Shock (summary)
Gastrointestinal fistula. Sudden onset.
Biliary and urinary infections. Distributive shock pattern.
Pancreatitis. Bronchospasm, laryngeal edema.
Major surgical wounds, diabetic wounds and Generalized rashes and edema.
crush injuries. Hypotension, feeble pulse.
Mortality 10%.
Stages of septic shock To start adrenaline 100 ug IV, steroids, IV fluids,
oxygen with foot end elevation.
Ventilator in severe cases.
a. Hyperdynamic (Warm) Shock: Cardiac massage, defibrillation.
This stage is reversible stage.
Patient is still having inflammatory response and so
presents with fever, tachycardia, and tachypnea.
Pyrogenic response is still intact.
Patient should be treated properly at this stage.
Based on blood culture, urine culture (depending
on focus of infection) higher antibiotics like third
generation cephalosporins, aminoglycosides, and
metronidazole are started.
STBS
SHOCK HEMORRHAGE AND BLOOD TRANFUSION 4 39
g. Pulmonary Capillary Wedge Pressure (PCWP) Colloidal solutions: e.g. plasma protein fraction
It is a better indicator of both circulatory blood (PPF), dextran, gelatin (haemacel).
volume and left ventricular function.
It differentiates between left and right ventricular 4. Support Cardiovascular Function
failure, pulmonary embolus, septic shock and
ruptured mitral valve. a. Ionotropic Agents
They are most useful in reversing the effects of
h. Serial Blood Gases and Serum Electrolyte cardiac depressant drugs (including anesthetics), or
Measurements for tiding over a patient until a metabolic
disturbance can be corrected or a mechanical
i. ECG defect repaired.
Differentiates cardiogenic shock from other types and
will reveal arrhythmias. b.Vasodilator Therapy
It is useful in cardiogenic shock, in patients with
j. Chest X-Ray pulmonary edema associated with low cardiac
May differentiate between pulmonary embolism, output, and in shocked patients who remain
mediastinal trauma and cardiac tamponade. oliguric and vasoconstricted.