3rd year lecture Haemorrhage and shock.pptx

MBBS students

1. Shock & Haemorrhage Dr. Md. Nazmus Sakib Junior Consultant [email protected]

2. After any complication the surgeon may feel worry and concern for the patient (91.5%), guilt (64.6%), anxiety (68.3%) and disappointment (63.4%).

3. Shock Shock is a systemic state of low tissue perfusion that is in adequate for normal cellular respiration.

4. Classification Haemorrahgic / hypovolumic shock Cardiogenic shock Obstructive shock Distributive shock Endocrine shock

5. Haemorrhagic shock- haemorrhage, dehydration , diarrhoea, third spacing of fluid. Cardiogenic shock-myocardial infarction, cardiac dysrhythmia , blunt myocardial injury. Obstructive shock- decrease preload. Cardiac temponade , tension pneumothorax , pulmonary embolism.

6. Distributive shock-septic shock, anaphylaxis, spinal cord injury. Vasodilatation Low systemic vascular resistance Histamin release

7. Endocrine shock- combintion of cardiogenic , hypovolumic , distributive shock. Adrenal insufficiency

8. Effect of organ failure Cardiac- cardiovascular failure Lung- acute respiratory distress syndrome Kidney-acute renal insufficiency Liver –liver failure and coagulopathy Brain- cerebral swelling and dysfunction

9. Mild shock Moderate shock Severe shock

10. Haemorrhage Revealed haemorrhage Concealed haemorrhage Surgical haemorrhage Non surgical haemorrhage Primary haemorrhage Reactionary haemorrhage (within 24 hours) Secondary haemorrhage (7-14 days)

11. Class I : <15% Class II : 15-20% Class III : 30-40% Class IV : >40%

12. Causes of reactionary haemorrhage??? Within 24 hours Dislodgement of clot Normalization of blood pressure Vasodilation Slippage of ligature

13. Monitoring for patient in shock Minimum ECG Pulse oximetry Blood pressure Urine output Additional modalities Central venous pressure Invasive blood pressure Cardiac output Base deficit and serum lactate

14. Indication of blood transfusion Acute blood loss, to replace circulating volume and maintain oxygen delivery; Perioperative anaemia, to ensure adequate oxygen delivery during the perioperative phase; Symptomatic chronic anaemia, without haemorrhage or impending surgery.

15. Autologous transfusion

16. Complication of blood transfusion Single transfusion Incompatibility hemolytic transfusion reaction Febrile transfusion reaction Allergic reaction Infection ( bac , hepatitis, HIV, malaria) Air embolism Thrombophlebitis Transfusion related acute lung injury

17. Massive transfusion Coagulopathy Hypocalcaemia Hyperkalaemia Hyperkalaemia hypothermia

18. Blood substitute Biomimeic - hemoglobin based Abiotic – perfluoro carbon based