Hemorragic Shock,causes ,signs and management , Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes information associated with general trauma - shock.
Different types of shock:
Hypovolemic shock: occurs due to low blood volume. Need to give fluids to the trauma patients. The heart rate will be increased and the most reliable early clinical finding is tachycardia.Give the patient 2 liters of bolus ringer’s lactate solution (RL) followed by reevaluation of the vital signs. Patient will have increased heart rate. Patient will have increased systemic vascular resistance. Patient will be cold and clammy.
Cardiogenic shock:
•Poor pump function of the heart.
•There will be decreased cardiac output and decreased peripheral resistance.
Obstructive shock
•Cardiac tamponade and pulmonary embolism have the same features.
Septic shock
•Decreased peripheral resistance. Vasodilation.
•As seen in patients with septic shock and necrotizing fasciitis.
Neurogenic shock
•Occurs in patient with acute spinal cord injury.
•There will be impaired sympathetic response to the heart and blood vessels.
•Circulation collapse with hypotension and bradycardia. Mark the bradycardia is very important!
•There will decrease systemic vascular resistance and warm skin.
•Treatment is swanz Ganz monitoring for careful fluid intake and gives pressors.
•Neurogenic shock is not a spinal shock where the bulbocavernosus is out with loss of all spinal cord function and reflexes below the level of the lesion.
•Neurogenic shock is hypotension and bradycardia.
Hemorrhagic shock
•The initiation of resuscitation is based on the degree of hemorrhage
•Start by giving 2 liters of crystalloid fluids (usually ringer’s lactated) with two lines.
•Reevaluate the vital signs.
•The patient may have rapid response, transient response, or no response.
•If the patient has a transient response, then the patient is considered to be class 3 or class 4.
•The patient should get blood. O negative blood will be given immediately. Type-specific blood transfusion will take about 10 minutes. Cross-matching blood transfusions will take 60 minutes.
•If the patient is in shock and bleeding what do you give? Give the patient blood.
What is the ratio of blood given? 1:1:1Ratio
•Packed RBC=1
•Fresh frozen plasma =1
•Platelets=1
Hepatitis B carries the highest risk of viral transmission with blood.
The terrible trauma triad is:
1.Hypothermia 2.Coagulopathy 3.Acidosis
These are three life-threatening conditions that may become worse by surgery and anesthesia.
Head injury patient
•Patient with head injury will run into the problem of episodic hypotension intra-operatively which causes significant increase in mortality.
•All efforts should be made to avoid hypotension during surgery.
Patient with AP pelvis
•Can place a pelvic binder and “close the book” to help with hypotension and hemorrhage.
Lateral compression
•Look for another source of bleeding if the patient continues to be unstable despite any effort of resuscitation
•Give the patient 4 units of blood.
•If the patient has pelvis fracture and shock and the patient is not improving, do angiography and embolization for a possible major arterial bleed in the pelvis (such as the superior gluteal artery).
How do you know if the patient is resuscitated?
Can be done in several ways. Two ways that usually come on exams:
1-Base deficit from -2 to +2. The base deficit is a direct measure of metabolic acidosis and indirect measure of the blood lactate level.
2-Serum lactate level (normal is less than 2.5). some sources use normal less than 2. The blood lactate is the end point of anaerobic metabolism. The blood level of lactate reflects a global hypoperfusion that is directly proportionate to the oxygen deficiency.
Both correlate well with organ dysfunction, mortality and adequacy of resuscitation.
For the purpose of an exam, you need to measure two things for adequacy of resuscitation:
1-Blood lactate
2-Base deficit


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