Слайд 1By
VYAS KAVAN
163(2)
Haemorrhagic shock in obstetrics
Слайд 2DEFINITION
HAEMORHAGIC SHOCK IS THE CLINICAL SYNDROME THAT RESULTS FROM INADEQUATE
TISSUE PERFUSION (POOR BLOOD FLOW) WHICH LEADS TO HYPOXIA AND
ULTIMATELY CELLULAR DYSFUNCTION WHICH MANIFESTS AS LACTIC ACIDOSIS.
ITS DIFFERENT FROM HYPOVOLAMIC SHOCK BECAUSE , HYPOVOLAMIC SHOCK CAN OCCURE THROUGH ANY KIND OF FLUID LOSS FROM THE BODY , BUT HAEMORRHAGIC ISN’T.
Слайд 3CONTINUE
SO FIRST OF ALL..
BLOOD LOSS HAS MAINLY 2 EFFECTS ON
THE BODY
1 – FIRST, THERE IS A LOSS OF
VOLUME OF BLOOD WITHIN VESSEL TO BE PUMPED (HYPOVOLAMIC SHOCK)
2- REDUCED OXYGEN CARRYING CAPACITY OF BLOOD BECAUSE OF LOSS OF RED BLOOD CELLS(HAEMORRHAGIC SHOCK)
Слайд 4CONTINUE
SO ACC. TO SUCH CRITERIA
HAEMORRHAGIC SHOCK IS SUBSET OF HYPOVOLAMIC
SHOCK ANS IT TYPICALLY OCCURES WHEN THERE IS SIGNIFICANT BLEEDING
THAT ENSUES RELATIVELY QUICK.
Слайд 5ETIOLOGY
BLOOD LOSS DUE TO
TRAUMA
RETROPERTONEAL BLEED
OBSTETRIC HAEMORRHAGE
(A) ANTEPARTUM HAEMORRHAGE
(b) POSTPARTUM HAEMORRHAGE
(C) ECTOPIC PREGNANCY
Слайд 6ETIOLOGY CONT.
ANTENATAL CASUE
- PLACENTA PREVIA
- PLACENTAL ABRUPTION
-
UTERINE RUPTURE
POST PARTUM
- UTERINE ATONY
- LACERATION TO GENITAL TRACT
- CHORIOAMNIONNITIS
- COAGULOPATHIES
Слайд 7DIAGNOSIS
THERE ARE NO SPECIFIC LABORATORY TESTS FOR SHOCK
A HIGH
INDEX OF SUSPICION AND PHYSICAL SIGN OF INADEQUTE TISSUE PERFUSION
AND OXYGENATION ARE THE BSUSU FIOR INITIATING PROMPT MANAGEMENT
INITIAL MANAGEMENT OF THE UNDERLYING CAUSE.
Слайд 8CLINICAL PICTURE
FETAL HEART RATE CHANGES – INCREASED , DECREASED, OR
LESS FUNCTIONAL
RISING OR WEAK PULSE –TACHYCARDIA
RISIN RESPIRATORY RATE
– TACHYPNEA
SHALLOW OR IRREGULAR RESPIRATIONS – HUNGER FOR AIR
FALLING BLOOD PRESSURE- HYPOTENSION
Слайд 9CLINICAL PICTURE CONTINUE
DECREASED OR ABSENT URINARY OUTPUT – USUALLY LESS
THAN 30 ML/HR
PALE SKIN OR MUCUS MEMBRANES
CLOD, CLAMMY SKIN
FAINTNESS
THIRST
Слайд 10CONTINUE
PALLOR
SWEATING
CONFUSION
COLD CLAMMY EXTREMITIES
Слайд 11STAGES OF HAEMORHHAGIC SHOCK
1- COMPENSATED
2 – UNCOMPENSATED
3- IRREVERSIBLE
Слайд 12COMPENSATED
INTHIS STAGE , DEFENCE MECHANISM ARE SUCCESSFULL IN MAINTAINING
PERFUSION
PRESENTATION
1 – TACHYCARDIA
2- DECREASED SKIN PERFUSION
3- ALTERED MENTAL STATUS
Слайд 13 UNCOMPENSATD
DEFENCE MECHANISM BEGINS TO FAIL
PRESENTATION
- HYPOTENSION
-
MARKED INCREASE IN HR
- RAPID AND THREADY PULSE
-
AGITAION , RESTLESSNESS AND CONFUSION
Слайд 14IRREVERSIBLE
COMPLETE FAILURE OF COMPENSATORY MECHANISM
MARKED LOSS OF TISSUE PERFUSION
CAUSE CELLULAR DAMAGE AND DEATH EVEN IN THE PRESENCE OF
RESUSCITATION.
Слайд 15INITIAL MANAGEMENT
OXYGENATE THE PERSON WITH AROUND 6-8 LITERS OF OXYGEN
SECURE
AND MAINTAIN THE AIRWAY
APPLY ASSISTED VENTILATION IF NEEDED
RESTORE CIRCULATORY VOLUME
DRUG
THERAPY
EVALUATE RESPONSE TO THE CURRENT THERAPY
REMEDY THE UNDERLYNG CAUSE
Слайд 16CONTINUE
INFUSION AND TRANSFUSION
- BLOOD
- CRYSTALOID – NORMAL SALINE
- COLLOIDS-
HAEMACCEL , HUMAN ALBUMIN SOLUTION 4.5%
Слайд 17CONTINUE
PHARMACOLOGICAL AGENTS LIKE
1- VASOACTIVE DRUGS
2- INOTROPES
3- CORTICOSTEROIDS AND APART
ERYTHROPOETIN 40000U/WEEK
WITH IRON AND VIT-C IS GIVEN
ARE GIVEN
Слайд 18CONTINUE
THE ABOVE MENTIONED MEASUREMENTS WERE BASIC AND NOT TREAT SPECIFIC
SO LAPRATOMY FOR ECTOPIC PREGNANCY
SUCCTION EVACUATION FOR INCOMPLETE ABORTION
MANAGEMENT OF
UTERINE ATONY
- OPTIMISE UTERINE TONE
- SURGERY(BLYNCH SUTURES, BALLOON CATHETER ETC.
Слайд 19CONTINUE
REPAIR OF LACERATION
IN CASE OF UTERINE UPTURE
-- STOP OXYTOCIN
INFUSIION IF RUNNING
-- CONTINUE MATERNAL AND FETAL MONITORING
--
EMERGENCY LAPAROTOMY WITH RAPID OPERATIVE DELIVERY
-- CESAREN HYSTERECTOMY MAY NEED TO PERFORM IF HAEMORRHAGE IS NOT CANCELLED
Слайд 20MONITORING
THROUGHOUT ALL THE TREAMENT
MONITORING AS PER BELOW
IS REQUIRED
MONITORING OF SKIN TEMPERATURE
URINE OUTPUT SHOUD BE GREATER
THAN 30ML/HR
ARTERIAL BLLOD PRESSURE
CVP
PULSE EMYMETER AND ABG.
