SHOCK TREATMENT CONCERNS

10. HEMORRHAGE
Treatment concerns
What concerns us most, in this section are the effects, of the
loss of whole blood, from torn blood vessels in the injured part.
This hemorrhage may be external, if the skin has been torn (visible loss), or it is internal into body cavities or tissue spaces, and cannot be estimated.

10.1 The clinical state of shock, that follows, also depends
on, the rate at which blood is lost and this is dependent upon :

-The extent of injured area(number of torn vessels)
-Vessels injured, whether these are arteries where the loss is
much greater, or veins when the loss is much less, over time.
Injury may also be to the capillaries, with the least amount
of blood loss.

-The size of the blood vessels-major arterial injury can
produce extreme blood loss, over a short time eg.
injuries to the aorta.

10.2 The hemorrhage may occur immediately on receiving
injuries, or later when the initial clot formed at that time is dislodged.

Intravenous fluid delivery
Resuscitation of hemorrhagic shock or severe hypovolemia, requires two large bore (16 gauge or larger) intravenous lines, for rapid volume expansion.
Access may be achieved by peripheral vein catheterization.
Cut downs on the basilic, greater saphenous, or cephalic veins
Or percutaneous central venous access via subclavian, internal jugular, or femoral venous puncture.
The most important consideration for vascular access, is the choice of catheter and tubing. The rate of flow is proportional to, the fourth power of the radius of the canulla, and is inversely related to its length.
Thus a short large bore catheter connected to the widest administration tubing or direct insertion of beveled tubing via a cut down venotomy provides the most efficient restoring of circulating volume.


Treatment of hypo-volemic shock aims at two primary goals at the same time, they are;
-To re-expand the circulating blood volume and
- A surgical interventions, to control any further blood volume loss.

Adequate replacement of the circulating volume,
-Expands vessels & restores venous return, -
-This reestablishes ventricular filling.
These results in, improved left ventricular end diastolic volume,-> contractile function, and stroke volume improved
The cardiac output responds positively,- as cardiac output improves, this leads to systemic vascular resistance returning to normal- and tissue perfusion improves
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