Hemorrhagic shock

Because of bleeding of various origins (trauma, surgery, internal damage), the volume of circulating blood (BCC) decreases. Depending on the intensity of loss of biological fluid, oxygen starvation increases, and if more than 500 ml of blood loss occurs, hemorrhagic shock occurs. This is a very dangerous condition, fraught with a fatal outcome due to the cessation of blood circulation in the brain tissue and lungs.

Classification of hemorrhagic shock

In addition to the intensity, in the case of blood loss, the rate of flow of biological fluid is of great importance. At a slow rate, the loss of even an impressive amount of blood (up to 1.5 liters) is not as dangerous as with rapid bleeding.

In accordance with this, the following stages of hemorrhagic shock are distinguished:

1. The first stage is compensated. The decrease in BCC is not more than 25%. As a rule, the victim is conscious, blood pressure is reduced, but moderately, the pulse is weak, tachycardia - up to 110 beats per minute. The skin is visually pale and slightly cold.
2. The second stage is decompensated. Blood loss reaches 40% of BCC. There is acrocyanosis, consciousness is disturbed, the pressure is greatly reduced, the pulse is threadlike, tachycardia - up to 140 beats per minute. Additionally, oliguria, dyspnea, coldness of extremities can be noted.
3. The third stage is irreversible. Hemorrhagic shock of severe degree has symptoms indicative of an extremely dangerous condition of the patient: complete loss of consciousness, marble color of the skin (pallor with well-visible outlines of blood vessels). The blood loss exceeds 50% of the total BCC. Tachycardia achieves 160 beats per minute, systolic pressure is less than 60 mm Hg. The pulse is very difficult to determine.

The last stage involves the use of emergency resuscitation methods.

Emergency care for hemorrhagic shock

After the call of the medical team, it is advisable to take such actions:

1. Stop bleeding, if it is visible, by all available means (burning, bandaging, pinching the wound).
2. Elimination of any objects that interfere with normal breathing. It is important to unfasten the tight collar, remove from the mouth cavity fragments of teeth, vomit, foreign bodies (often after a car accident), prevent the tongue from falling into the nasopharynx.
3. If possible, give people non-narcotic pain medications (Fortral, Lexir, Tramal), which do not affect blood circulation and respiratory activity.

It is not advisable to move the injured person, especially if the bleeding is internal.

Treatment of hemorrhagic shock during hospitalization

After assessing the patient's condition, measuring blood pressure, heart rate, breathing, consciousness stability, bleeding is prevented. Further activities:

1. Inhalation of oxygen by catheters (intranasal) or mask.
2. Providing access to the vascular bed. For this, the central vein is catheterized. With a loss of more than 40% of the bcc, a large femoral vein is used.
3. Infusion therapy with the introduction of crystalloid or colloidal solutions, if the bleeding is intense and abundant - erythrocyte masses.
4. Installation of the Foley catheter to control the hourly and diurnal urination (to assess the effectiveness of infusions).
5. Blood test.
6. Purpose sedative (sedative) and analgesic drugs.

When blood loss is more than 40% of the volume of a biological fluid, infusion therapy should be performed in 2-3 veins simultaneously, in parallel with the inhalation of 100% oxygen through an anesthetic mask. Also, injections of dopamine-containing drugs or epinephrine are needed.