Blood loss: types, definition, acceptable values, hemorrhagic shock and its stages, therapy. Hemorrhagic shock is a consequence of acute blood loss

Providing assistance with hemorrhagic shock follow the “three catheters” rule:

1) maintaining gas exchange (ensuring patency respiratory tract, oxygenation, mechanical ventilation);
2) replenishment of the central circulation (for this purpose, 2-3 peripheral veins or the main and peripheral vessels are punctured and catheterized;
3) catheterization Bladder(after hospitalization of the victim in the hospital).

Ensuring gas exchange.

Humidified oxygen is supplied through a mask at 100% concentration. During development respiratory failure(respiratory rate more than 35-40 per minute, decrease in oxygen saturation below 85%), as well as the unconscious state of the patient, transfer to artificial ventilation (ALV) with inhalation of 100% oxygen is indicated. Extended mechanical ventilation is carried out until hemodynamic parameters, diuresis, consciousness, and adequate breathing are restored.

The principles of therapy for hypovolemic shock should be formed in accordance with the main pathogenetic mechanisms of its development.

Elimination of BCC deficiency, which is achieved by powerful infusion therapy using crystalloid, colloid plasma substitutes and blood products. The volumes of infusion media and their combination largely depend on the stage of care medical care and the depth of the state of shock.

The total volume of infusion therapy should exceed the measured volume of BCC deficiency by 60-80%.

The ratio of crystalloid and colloidal solutions must be no less than 1:1.

The more pronounced the BCC deficiency, the more crystalloid solutions are required, and their ratio to colloids can be increased to 2:1. Although crystalloid solutions remain in vascular bed no more than 3 hours, initially initial stage treatment of shock, they perfectly replenish the blood volume and prevent dangerous shortage intracellular fluid. Colloids have a high hemodynamic effect and remain in the vascular bed for 4-6 hours.

Dextrans (polyglucin), hydroxyethylated starches (Refortan, Stabizol, HAES-steril) are more often used in daily dose from 6 to 20 ml/kg body weight, as well as hypertonic solutions of sodium chloride - 7.5% in a daily dose of 4 ml/kg; 5% - 6 ml/kg; 2.5% solution - 12 ml/kg.

The indicated dosages of hypertonic sodium chloride solution should not be exceeded due to the risk of developing a hyperosmolar state, hyperchloremic metabolic acidosis.

Simultaneous use of colloidal and hypertonic solutions allows you to prolong their stay in the vascular bed and thereby increase the duration of their action, reduces the total peripheral resistance.

Rapid replenishment of intravascular volume. Infusion-transfusion therapy (ITT) must be adequate in volume, rate of administration and quality (Table 8.4).

Table 8.4. Principles of circulatory system restoration in hemorrhagic shock.

Before the bleeding stops, the infusion rate should be such as to ensure the minimum permissible systolic blood pressure (for normotensive patients - 80 mm Hg, for hypertensive patients it is maintained at the level of diastolic blood pressure familiar to each patient).

After stopping the bleeding, the infusion rate increases (up to a jet) and is constantly maintained until blood pressure rises and stabilizes at a safe or familiar (normal) level for the patient.

In order to restore integrity cell membranes and their stabilization (restoration of permeability, metabolic processes etc.) use: vitamin C - 500-1000 mg; sodium ethamsylate 250-500 mg; Essentiale - 10 ml; troxevasin - 5 ml.

Disorders of the pumping function of the heart are eliminated by the administration of hormones, drugs that improve cardiac metabolism (riboxin, carvitin, cytochrome C), and antihypoxants. To improve myocardial contractility and treat heart failure, drugs that improve myocardial metabolism, antihypoxants are used: cocarboxylase - 50-100 mg once; Riboxin - 10-20 ml; mildronate 5-10 ml; cytochrome C - 10 mg, Actovegin 10-20 ml.

Heart failure may require the inclusion of dobutamine in the therapy at a dose of 5-7.5 mcg/kg/min or dopamine 5-10 mcg/kg/min.

An important link in the treatment of hemorrhagic shock is hormone therapy.

Drugs in this group improve contractility myocardium, stabilize cell membranes. IN acute period only allowed intravenous administration, after hemodynamic stabilization, switch to intramuscular injection corticosteroids. They are introduced into large doses: hydrocortisone up to 40 mg/kg, prednisolone up to 8 mg/kg, dexamethasone - 1 mg/kg. A single dose of hormones acute phase shock should not be lower than 90 mg for prednisolone, 8 mg for dexamethasone, 250 mg for hydrocortisone.

For the purpose of blocking mediators of aggression, improving the rheological properties of blood, preventing disorders in the blood coagulation system, stabilizing cell membranes, etc., they are currently widely used, especially in early stages treatment, anti-enzyme drugs such as trasylol (contrical, gordox) at a dose of 20-60 thousand units.

For the purpose of blocking unwanted effects on the part of the central nervous system, it is advisable to use narcotic analgesics or droperidol (taking into account the initial blood pressure). For systolic blood pressure values ​​below 90 mmHg - do not use.

The first priority when bleeding continues is to stop it immediately. To reduce the amount of blood loss, when a source is detected, primary (finger pressure, application of a tourniquet, pressure bandage, stopping with the help of instruments - applying a clamp to a bleeding vessel, etc.) and quickly resolving the issue of surgical (or final) stopping.

Parallel therapeutic measures for replenishment of blood volume, prevention and treatment of multiple organ failure syndrome ("shock" lungs, kidneys, disorders cerebral circulation, DIC syndrome), maintaining adequate macro-microcirculation, preventing infectious complications.

NB! Blood loss greater than 40% is potentially life-threatening.

Sakrut V.N., Kazakov V.N.

Hemorrhagic shock- response that develops with acute blood loss of more than 10% of the blood volume.

IN clinical practice V " pure form“it is observed in suicide attempts

(vein opening) ectopic pregnancy, interrupted by a ruptured tube, spontaneous rupture of the spleen, ulcer bleeding and so on.

Pathogenesis:

Acute blood loss®Reduced blood volume®reduced blood return to the heart®reduced cardiac output®centralization of blood circulation (blood supply is critical important organs to the detriment of peripheral tissues).®increasing hypoxia and acidosis®disorder of the functions of vital organs.

Erectile (excitement phase). Always shorter than the braking phase, characterizes initial manifestations shock: motor and psycho-emotional agitation, restless gaze, hyperesthesia, pallor skin, tachypnea, tachycardia, increased blood pressure;

Torpid (braking phase). The clinic of excitation is replaced by a clinical picture of inhibition, which indicates a deepening and aggravation of shock changes. Appears thready pulse, decreases arterial pressure to levels below normal until collapse, consciousness is impaired. The victim is inactive or motionless, indifferent to his surroundings.

The torpid phase of shock is divided into 3 degrees of severity:

I degree. Compensated (reversible shock): blood loss 15-25% of the bcc (up to 1.5 liters of blood).

Pallor, cold sweat, collapsed veins in the arms. Blood pressure decreases slightly (systolic blood pressure is at least 90 mm Hg), moderate tachycardia (up to 100 beats/min). mild stupor, urination is not impaired.

II degree. Decompensated (reversible) shock- blood loss in 25-30% of the bcc (1.5-2 liters of blood);

The patient is lethargic, cyanosis appears (signs of centralization of the blood circulation), Yuoliguria, muffled heart sounds. Blood pressure is sharply reduced (systolic blood pressure is at least 70 mm Hg), tachycardia is up to 120-140 per minute. stupor, shortness of breath, cyanosis, oliguria.

III degree. Irreversible shock: blood loss: more than 30% of the total blood volume;

Lack of consciousness, marbling and cyanosis of the skin, anuria, acidosis. stupor, tachycardia more than 130-140 beats/min, systolic blood pressure no more than 50-60 mm Hg. Art., no urine output.

Urgent Care:

1. Temporary stop of bleeding.

2. Puncture and catheterization of one to three peripheral veins;

3.Infusion therapy:

Plasma replacement solutions (10% hydroxyethyl starch, dextran sodium chloride, 7.5% sodium chloride - 5-7 ml per 1 kg of body weight) at a rate of 50 ml/kg/h/.

Continue jet transfusion of solutions until systolic blood pressure rises above the critical minimum level (80-90 mmHg).

In the future, the infusion rate should be such as to maintain the blood pressure level (80-90 mmHg).

If bleeding continues, blood pressure cannot be raised above 90 mmHg.

If the effect of infusion therapy is insufficient, IV drip of 0.2% norepinephrine solution - 1-2 ml or 0.5% dopamine solution - 5 ml, diluted in 400 ml of plasma replacement solution, prednisolone up to 30 mg/kg IV.

4. Oxygen therapy (during the first 15-20 minutes - 100% oxygen through a mask of an anesthesia machine or inhaler, subsequently an oxygen-air mixture containing 40% oxygen;

5. Pain relief;

6.Aseptic dressing;

7.Immobilization;

8.Transportation to hospital. Patients with bleeding from the nose, pharynx, upper respiratory tract and lungs are transported sitting, semi-sitting or on their side to avoid aspiration of blood. All others must be transported in a prone position with their head down.

IV.Features of care for patients with bleeding:

Monitoring compliance with bed rest (active movements can lead to recurrent bleeding); hourly measurement of blood pressure and pulse rate, monitoring the color of the skin and mucous membranes;

Controlled by acid-base balance, biochemical parameters, Hb, Ht, Er.

1. Stop bleeding;

2. Pain relief.

3.. Puncture and catheterization of 1 to 3 peripheral veins.

4. Infusion therapy.

5.Oxygen therapy: 40% oxygen.

6. Sterile bandage on the wound.

7.Immobilization.

8.Transportation to the hospital with the head down and legs raised - an angle of 20°.

Ways to stop bleeding:

1. spontaneous (as a result of the formation of a blood clot in a vessel)

2. temporary

3.final.

IN belt:

1. applying a pressure bandage

2. elevated position of the limb

3. finger pressure of the vessel

b) throughout (venous - below the wound, arterial - above the wound

4. digital pressing of large arteries to the bone.

5. maximum flexion or extension of the limb at the joint

6. application of an Esmarch hemostatic tourniquet or twist tourniquet

7. tight wound tamponade (wounds of the gluteal, axillary region)

8. Application of hemostatic clamps during the operation;

9. Inflatable Blackmore tube for esophageal bleeding;

10. Temporary bypass of large vessels with polyvinyl chloride or glass tubes to preserve the blood supply to the limb during transportation.

Patients with bleeding from the nose, pharynx, upper respiratory tract and lungs are transported sitting, semi-sitting or on their side to avoid aspiration of blood. All others must be transported in a prone position with their head down.

WITH final stopping methods bleeding :

1. mechanical

2. physical

3. chemical

4. biological.

Mechanical:

· ligation of the vessel (placing a ligature on the vessel) a) if it is impossible to ligate the vessel in the wound, b) if there is a threat of purulent melting of the vessel in the wound;

ligation of blood vessels throughout

twisting of the vessel

crushing of the vessel

· vascular suture (lateral, circular) (using devices for stitching using tantalum staples)

· suturing the vessel with surrounding tissues

· prosthetics and vascular plastic surgery (autovenous, synthetic prosthesis)

organ removal.

Physical:

1.Low t: a) an ice pack – for capillary bleeding;

b) when stomach bleeding– gastric lavage cold water with pieces of ice;

c) cryosurgery - local freezing of tissues with liquid nitrogen, especially during operations on parenchymal organs.

2.High t: a) a tampon soaked in hot saline to stop parenchymal bleeding; b) electrocoagulator; c) laser scalpel. d) ultrasonic coagulation

3. sterile wax (for surgery on the skull bones)

CHEMICAL method based on the use of medicinal chemicals. Both place and inside the body.

Hemorrhagic shock is a loss large quantity blood, which can lead to death. This is accompanied by tachycardia, arterial hypotension. With a large loss of blood, the patient experiences pale skin, lightening of the mucous membranes, and difficulty breathing. If it is not provided in a timely manner urgent Care, then the probability of the patient's death will be too great.

1 Causes of pathology

Hemorrhagic shock can occur even with a loss of 0.5 -1 liters of blood, if at the same time the amount of circulating blood volume (CBV) in the body sharply decreases. The rate of blood loss plays a huge role in all this. If shock occurs due to injury, and blood loss occurs slowly, then the body will have time to turn on compensatory resources. Lymph will enter the blood, and during this period Bone marrow switches completely to recovery blood cells. With such hemorrhagic shock, the likelihood fatal outcome quite low.

However, if blood loss occurs very quickly due to damage to the artery or aorta, then little or nothing can be done. Only rapid suturing of the vessels with the infusion of large volumes of donor blood will help. As a temporary measure, saline solution is used to prevent the body from weakening due to a lack of micronutrients and oxygen.

What emergency care is acceptable for significant blood loss? First of all you should call ambulance, then try to stop the bleeding, using all sorts of methods for this, from applying a splint to squeezing damaged arteries or veins.

It should be noted that a loss of 60% of bcc is fatal. In this case, blood pressure drops to almost 60 mmHg, and the patient loses consciousness (sometimes regaining consciousness only spontaneously, literally for a few seconds).

Blood loss of up to 15% is considered mild form hemorrhagic shock. At the same time, blood pressure does not even decrease, and subsequently the body fully compensates for the expended reserve (within 1-2 days).

2 Stages of the disease

Conventionally, doctors divide hemorrhagic shock into 4 stages, which differ in volume lost blood, symptomatic manifestation:

1. Blood loss from 5 to 15% of the bcc (that is, the total volume). It has a compressive nature. The patient may experience temporary tachycardia, which goes away on its own within a few hours after the bleeding stops.
2. Loss from 15 to 25% of bcc. At the same time, blood pressure drops slightly, and the first signs of pallor appear. This is especially noticeable on the mucous membrane oral cavity and lips. Occasionally, the extremities become cold as blood flows out to nourish the brain and other vital organs.
3. Blood loss up to 35%. Accompanied by a significant decrease in blood pressure and acute tachycardia. Already to this degree shock can cause signs clinical death- depends on the physiology of a particular patient.
4. Blood loss up to approximately 50% or higher. High probability of death. Paleness of the skin is observed throughout the body, sometimes accompanied by anuria, thread-like, almost completely absent pulse.

Conventionally, lethal hemorrhagic shock is also distinguished. The name is conditional. This is a loss of over 60% of the bcc. As a rule, even emergency care will not save the patient, since the body instantly begins to die from a lack of oxygen and nutritional components. The brain is damaged after only 2-3 minutes, the respiratory function, neural collapse and paralysis occurs. At the same time, the venous return of blood to the heart abruptly stops.

Accompanied by all this defensive reaction organism with secretion huge amount catecholamines (including adrenaline). This is done to speed up the contractions of the heart muscle, but because of this, vascular resistance increases and blood pressure drops.

It should be noted that in women, hemorrhagic shock occurs at lower blood volume losses. For example, stage 4 appears when they have already lost 30% of their blood volume (corresponding symptoms). Men, by their physiology, can withstand bleeding, during which 40% of the bcc is lost.

3 Disseminated intravascular coagulation syndrome

The so-called DIC syndrome is the most dangerous consequence hemorrhagic shock. In simple words, this is a situation in which blood comes into contact with oxygen and begins to actively clot while still in the vessels, in the heart. As you know, even a small blood clot leads to blockage of the arteries that supply blood and micronutrients into the brain. In the same situation, total thrombosis occurs, due to which the normal process of blood circulation is completely disrupted - it completely stops.

Hemorrhagic shock does not always lead to air entering the vessels. This occurs only with a strong decrease in blood pressure, at which the heart simply cannot resist the ingress of oxygen (previously this happened precisely due to the fact that the pressure in the vessels is slightly higher than atmospheric pressure).

Essentially disseminated intravascular coagulation- this is a violation of macrocirculation, which entails a stop of microcirculation and the gradual death of vital organs. The brain, heart and lungs receive the first blow. This is followed by ischemia and atrophy of all soft tissues.

4 Disease index

In terms of compensation, hemorrhagic shock is divided into 3 stages:

1. Compensated shock (that is, when blood loss occurs slowly or the volume is insignificant).
2. Decompensated reversible shock (the body does not have time to restore normal blood volume and properly regulate blood pressure, but the volume of lost blood is such that it is not fatal).
3. Decompensated irreversible shock (in such cases, doctors can do practically nothing to help. Whether the patient can survive depends only on his individual physiological qualities).

To separate the stages, doctors at one time introduced the so-called hemorrhagic shock index. It is calculated using the ratio (proportion) of heart rate (pulse) to systolic pressure. The higher the indicator, the greater the danger for the patient. A non-hazardous level is an index in the region of 1, a dangerous level is from 1.5 and above.

5 Medical actions

The only thing a non-doctor can do in case of hemorrhagic shock is to stop the patient’s bleeding. Naturally, first of all it is necessary to establish the cause of the hemorrhage. If this is an open visible wound, then you should immediately use a tourniquet or at least a belt and squeeze the damaged vessel. This will reduce blood circulation and allow a few extra minutes to resolve hemorrhagic shock.

If it is impossible to determine the cause of blood loss, or if it is internal (for example, due to a ruptured artery), then it is necessary to begin administering blood substitutes as quickly as possible.

Only a qualified surgeon can directly eliminate bleeding. Primary manipulations with the patient are carried out either by a nurse or an obstetrician, if we are talking about significant blood loss during the birth of a child.

Hemorrhagic shock of an atypical nature is a rupture of feeding vessels. It is impossible to establish the exact cause without a medical examination. Accordingly, emergency care is the fastest delivery of a patient to a hospital or at least to an ambulance station - there are drugs there to support life in case of significant blood loss.

6 Possible consequences

The body's response to significant blood loss cannot be predicted in advance. Some people's neural system is disrupted, others simply feel weak, others instantly lose consciousness. And the consequences, it should be noted, largely depend on the amount of lost blood volume, the severity of the bleeding, and the physiology of the patient.

And timely infusion therapy does not always completely eliminate the consequences of severe blood loss. Sometimes this results in kidney failure or damage to the lining of the lungs, partial atrophy brain (some of its parts). It is impossible to predict all this.

After severe hemorrhagic shock (stages 2-4), long-term rehabilitation will be required. Speedy recovery is especially important normal performance kidneys, lungs, liver, brain. It may take 2 days to 4 weeks for new blood to be produced. To speed up this process, either donor blood, or saline solution.

If we are talking about childbirth in which hemorrhagic shock was caused, then it is quite possible that the woman will lose reproductive function because of surgical removal uterus, fallopian tubes. Therefore, doctors additionally prescribe enhanced psychological assistance. The obstetrician, in turn, monitors the strict implementation of the prescribed rehabilitation program.

Hemorrhagic shock in medicine refers to extensive blood loss, an unexpected release of blood from the blood vessels. This phenomenon usually develops quite rapidly and can lead to severe consequences, up to a tragic outcome. What are the signs to use to diagnose hemorrhagic shock, and what kind of help can those around them provide to a person with sudden bleeding?

Causes of hemorrhagic shock

Root causes of hemorrhagic shock - various damages, injuries, operations, etc.

For your information. According to medical statistics Hemorrhagic shock in obstetrics ranks first in frequency of occurrence.

Excessive acute blood loss occurs in expectant mothers in the following cases:

• gap fallopian tube- consequences of ectopic pregnancy;
• uterine rupture;
• some types of uterine bleeding;
• so-called acute fatty liver of pregnancy.

The consequences of this condition can be:

• development of cancer of the female genital organs;
• sepsis accompanied by tissue necrosis;
• ovarian apoplexy.

Hemorrhagic shock is also considered as a result of delayed or incorrectly selected therapy for such conditions/diseases as:

• cholera;
• diabetes;
• peritonitis;
• sepsis;
• cancer;
• osteomyelitis;
• long stay in an environment with elevated temperature air;
• pathology that provokes dehydration of the body, etc.

The following are considered indirect causes of shock:

• Incorrect assessment of bleeding characteristics - volume or speed.
• Incorrectly chosen method of replenishing lost blood.
• Incorrect/delayed error correction during blood transfusion.
• Late/incorrect choice of medications that can stop blood loss.

What determines the severity of the development of shock?

The basis of disruption of the body's vital functions during hemorrhagic shock is a sharp decline blood volumes distributed through the vessels. A decrease in the amount of blood provokes a spasm in these same vessels. The result is the transition of tissue fluid into the vascular beds, which contributes to the thinning of the blood and disruption of its microcirculation in the organs.

The lack of timely assistance threatens global failures of microcircular processes and jeopardizes human health and even life.

The intensity of blood loss depends on a number of determining factors:

• body endurance;
• immunity strength;
• state nervous system(it is directly involved in the control of vascular tone);
• heart pathologies, etc.

Hemorrhagic shock is a complex, requiring urgent help the patient's condition, with heavy or moderate blood loss. Achieving a critical state occurs as a result of failure of a multisystem or multiorgan type.

Violation of the modulation of blood cells is organic in nature; the pathology prevents the penetration of essential substances into the body tissues. nutrients. There are also problems with constant access to oxygen and energy products. With hemorrhagic shock, there is no possibility of normal elimination of toxins and harmful, polluting elements from the body. Develops over time oxygen starvation. Its intensity is determined by the specific rate of loss of the main nutrient fluid. This type of shock occurs when the body loses approximately 500 milliliters of blood or more. Such a difficult condition can cause the patient’s death, development anaphylactic shock, problems with pulmonary or brain activity. Blood circulation in the lungs or brain is disrupted, which causes the subsequent manifestation of all the described problems.

Prerequisites for the development of shock

The main prerequisite for the manifestation and subsequent development of a state of shock is the receipt of serious traumatic injuries leading to blood loss. In such cases, open and closed damage vessels of the blood circulation. Another reason can be considered heavy bleeding, which are caused by diseases of the uterus, stomach and intestinal organs, perforated ulcers. In addition, the described situations can become consequences of the development of cancerous formations, this is especially typical for the final stages of cancer.

The pathogenesis of hemorrhagic shock has a central link in the form of failures of the systemic circulation in the large or small circle. Decreasing rapidly total blood circulating in circles. Respectively, natural forces of the entire organism are unable to independently resist the current negative situation. Nerve receptors at muscle endings transmit impulses that cause disorders normal operation heart and vascular failures. Breathing quickens, blood circulation is centralized, biological fluid increases circulation in space internal organs. Over a period of time, there is a gradual isolation of all organs and systems from the blood supply processes of the entire body. In the lung system, the total volume of oxygen produced sharply decreases, which can lead to death.

Shock symptoms

Medical experts distinguish the following main symptoms of the development of a state of shock:

1. The patient's mouth becomes very dry.
2. Attacks of severe nausea appear and subsequently spread.
3. The person begins to feel severe dizziness and a feeling of weakness.
4. The vision becomes dark, and in some cases there is even loss of consciousness.
5. A compensatory distribution of blood occurs, its total amount in the muscles decreases, and the skin in various parts of the body turns pale as a result. It may also acquire a serous tint, which is especially typical for specific cases of loss of consciousness.
6. Over time, the limbs gradually become moisturized and acquire a sticky tint from the protruding sweat.
7. There is a disruption in blood circulation in the kidney area, which can lead over time to hypoxia, as well as other unpleasant disorders.
8. The patient has severe shortness of breath, breathing function is severely impaired.
9. Heart rhythms become erratic and excessive arousal appears.

Such symptoms allow specialists to diagnose the described condition. Pathology requires immediate identification, this is required in order for there to be real opportunity avoid death.

Classification

Classification of the condition under consideration is possible according to a number of characteristics. Below are some of them.

According to the degree of blood loss

By stage of development

The stages of development of the described syndrome are directly related to the stages of the described blood loss. When blood loss reaches 15%, initial stage hemorrhagic shock. The patient is fully conscious and is just beginning to feel weak. Subsequently, as the volume of blood lost increases general state the person deteriorates significantly. The second stage of development begins, followed by the third. When the level of blood loss reaches 45%, tachycardia indicators reach 160 pulses per minute. Loss of consciousness and central nervous system disorders are possible. Subsequent disturbances in the processes of normal blood circulation can cause irreversible loss of plasma, coldness of the extremities, and permanent stupor. Respiratory system disorders increase sharply. Last stage the development of the described state of shock suggests the need for urgent hospitalization.

According to the Algover shock index

The rate of blood loss is critical when it is necessary to determine hemorrhoidal shock using the Algover index. The division of the index by systolic blood pressure, the indicator of which in the normal state of affairs cannot be lower than one, is accepted as an indicator.

According to the described index, the following categories of distribution degrees are accepted:

1. Mild degree, the index takes values ​​from 1 to 1.1.
2. Moderate severity, the index value in this case is taken to be 1.5.
3. Heavy variety. The index in this case is taken to be equal to a value not lower than two.
4. Extreme severity. The indicator of the described index value is assumed to be above 2.5.

Blood loss is the main indicator of the considered level of hemorrhoidal shock. Depending on the total volume of blood lost, the value of the coefficient by which the Algover index is determined changes.

Diagnostic measures

The duration of the bleeding process and the level of blood lost are the main indicators for diagnosing the shock condition in question. Difficulties often arise with insufficient assessment of the volume of lost fluid and, as a result, delays in starting therapy occur.

Mandatory diagnostic measures in the situation under consideration are the following:

• the total volume of blood lost in the body is clarified as efficiently as possible; it is correlated with the exact, calculated volume;
• determined exact condition activity of the central nervous system, its mental and reflex functions;
• the general condition of the skin at the current time is assessed, their color is taken into account, various shades, changing the color scheme;
• The exact value of the shock index is calculated:
• calculation in progress final value hourly and minute diuresis.

The final stage of the diagnosis is an accurate assessment of the severity of the patient's condition. A structural diagnosis is made taking into account all the above factors. A subsequent strategy for providing effective medical care is being formed.

First aid

Principles of first aid for such in a state of shock involve identifying the source of bleeding and its gradual elimination. Gynecological practice involves indispensable surgical intervention in such cases.

Subsequently, a speedy recovery is considered necessary. normal process blood circulation Simultaneously, catheterization of two main vessels located on the periphery should be performed. If the victim's condition is critical or close to it, it is necessary to perform intra-arterial injection of solutions.

All these measures are aimed at maintaining the proper level of oxygen consumption by the body’s tissues. Metabolism in them is maintained at the proper level. Extended artificial ventilation organs of the body and lungs, precise maneuvering of gas systems and adequate pain relief are performed.

Means to stop bleeding:

Basics of treatment of hemorrhagic shock

The basis of therapy for hemorrhagic shock is stopping bleeding and taking everything necessary measures to eliminate the possibility of subsequent development of this condition.

Therapeutic measures

Infusion therapy is used actively in order to fully restore plasma volumes in the human body, which will help prevent dangerous complications and negative processes. To do this, it is recommended to use the following means:

• installation of plasma substitutes, in the manufacture of which bases from hydroxyethyl starch were used;
• crystalloid-type solutions are prescribed for use;
• colloidal solutions are used;
• doses of donor blood are poured in;
• drugs are used to constrict blood vessels, necessary for high-quality relief of their spasms.

Therapy methods

IN medical practice The following common methods of treating the shock condition in question are used:

1. Elimination of hypovolemia and the procedure for restoring lost blood circulation volume.
2. Carrying out detoxification.
3. High-quality microcirculation and guaranteeing cardiac output.
4. Stabilization of the initial values ​​of bipolarity and the ability of blood to transport oxygen.
5. Bringing in normal condition and subsequent maintenance of diuresis at the proper level.
6. Prevention of the condition in question.

All therapeutic techniques under consideration are used only by experienced specialists in their field in medical institutions.

Preparations and means

Protein substances. Albumin in the form of solutions of concentration from 5% to 20%. Responsible for a qualitative increase in pressure and promotes the flow of fluids into the bloodstream. The increase in total plasma volume is facilitated by the use of protein proteins.

Plasma in dry and liquid states. It is transfused in compliance with safety regulations to prevent leaks and taking into account the established Rh factor. Dry plasma is diluted with physiological solution. Transfusion is carried out using organic and inorganic elements as blood substitutes.

Donor blood in canned form. When eliminating the consequences of a shock, blood transfusion and the use of appropriate solutions are not enough. It also requires the use of whole blood from a donor, to which coagulating substances are added.

Possible complications

Cardiac cessation is possible in case of large blood loss. In some cases there may be pathological changes conditions also after surgical intervention and incorrectly performed therapy. Liver failure and hypoxia may develop as a result of a decrease in hemoglobin levels in the blood. An increase in the level of breathing is accompanied by the development pulmonary failure. At renal failure There have been cases of blood clotting disorders and other similar problems.

Prevention

Properly performed prevention is extremely important to prevent future similar situation. Prevention of hemorrhagic shock includes the following measures:

• prescribing particularly risky factors for signs of bleeding;
• qualified and high-quality care for victims at any stage with adherence to the prevention of complications due to bleeding;
• readiness medical personnel to any emergency measures on patient rehabilitation;
• coordinated implementation of all actions at all therapeutic stages;
• availability and bringing to full readiness of all necessary tools and medications to carry out the necessary activities.

Preventive measures may vary in the nature of implementation and degree of complexity depending on the nature of the development of the victim’s condition.