SHOCK TREATMENT OPTIONS & CHOICES

11. TREATMENT OF SHOCK(Causative & General)
- Take into consideration the etiological classification discussed above, you will have diagnosed the underlying causative factor, and correction undertaken rapidly.
-The general treatment measures include.

11.1. Oxygen Inhalation Check Airway : This has special reference
to wounds of the chest. If oxygenation is deficient and
patients are cyanosed, it may need to be combined with
Intermittent positive pressure ventilation with 100% O2
After intubations.

11.2. Infusion + Transfusion
Two large bore infusion
lines are started in
Severe shock 1-2 liter
of Ringer's lactate are
infused, if blood is
Lost fully cross
Matched whole blood is
Of great importance in
cases. In the group of
cases which do not
respond to intravenous
blood transfusion O group packed cells can be given. The
recommended fluid requirements are given in table.

Disadvantages of Blood
-Grouping and cross matching takes time
-Stored blood has high potassium,fragments of platelets,and WBC
-Blood maybe infected with malaria,HIV,HBV
-Viscosity of blood in microcirculation may require fluids other than blood

Selection of Fluid
The most cost effective approach is with rapid infusion of isotonic (Normal) saline or a balanced salt solution.
-Infusion of 2 to 3L of crystalloid over 10 to 30 min should restore adequate intravascular volume in most cases as the result of fluid input and distribution.
-In patients with hemorrhagic shock, restoration of blood volume with crystalloid usually requires at least three times the estimated blood loss.
• If blood pressure does not improve after rapid administration of 21 of crystalloid, this suggests that blood loss is in excess of 1500ml, or there is ongoing active bleeding, or, alternatively, another cause of shock must be considered.
• Volume resuscitation in hemorrhage should include simultaneous blood transfusion, either as fully cross matched blood, type specific blood, or, in some circumstances, O-positive or O-negative packed cells.
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