hypovolemic shock
Introduction
Introduction to hypovolemic shock Hypovolemic shock is the massive loss of blood, plasma or body fluids in the body or blood vessels, resulting in a decrease in blood pressure and a microcirculatory disorder caused by a sharp decrease in effective blood volume. Such as severe diarrhea, severe vomiting, massive urination or extensive burns, loss of water, salt or plasma, esophageal varices, gastrointestinal ulcers cause massive internal hemorrhage, muscle contusion, fracture, hepatosplenic rupture caused by traumatic shock and large area Plasma extravasation caused by burns is hypovolemic shock. The main treatment is to quickly replenish the blood volume, quickly identify the cause and stop the bleeding or loss of fluid, and decide whether to use the booster according to the condition. Timely supplementation of blood volume, treatment of its cause and suppression of its continued blood loss, fluid loss is the key to the treatment of this type of shock. basic knowledge The proportion of illness: 0.032% Susceptible people: no special people Mode of infection: non-infectious Complications: shock
Cause
Cause of hypovolemic shock
Shock is a neuro-humoral factor disorder caused by various serious pathogenic factors (infective, traumatic, hypovolemic, cardiogenic and allergic) and acute microcirculatory disorders, and directly (or ) and syndromes that indirectly lead to extensive cell damage in vital organs.
Hypovolemic shock is caused by a sudden drop in blood volume, resulting in decreased blood pressure, decreased cardiac output, decreased central venous pressure, increased peripheral vascular resistance, and tachycardia. The common causes are as follows.
Blood loss (55%)
Blood loss caused by damage to skin, muscle, tissue, viscera and bone caused by impact, collision or chemical attack of external body, rupture of liver and spleen caused by trauma, rupture of ectopic pregnancy, massive bleeding of gastrointestinal tract, rupture of aneurysm Caused by major bleeding. Large area burns, infection with peritonitis, severe trauma, inflammatory exudation, etc., can also cause hypovolemic shock.
Dehydration (30%)
Hypovolemic shock occurs due to severe vomiting, diarrhea, gastrointestinal fistula drainage, intestinal obstruction, and diabetic ketoacidosis caused by various diseases.
Prevention
Hypovolemic shock prevention
Hypovolemic shock, mainly due to a large number of blood loss or loss of fluid caused by a sharp decrease in effective blood volume caused by blood pressure drop and microcirculatory disorders, so the first measure of treatment is to quickly stop bleeding and correct fluid loss. Therefore, bleeding or fluid loss caused by various reasons, such as traumatic bleeding should immediately bandage or oppress the wound to stop bleeding and immediately go to a nearby hospital for treatment, patients with severe disease should be promptly sent to hospitals with better medical conditions (ie can do all kinds of Hospitals with major surgery and blood transfusions are further diagnosed and treated to avoid delays.
Complication
Complications of hypovolemic shock Complications
As with traumatic shock, hemorrhagic shock is complicated by DIC (diffuse intravascular coagulation), and severe cases can cause death. Therefore, patients with shock need to be rescued in time.
1, bleeding: light can only have a few skin bleeding points, severe cases can be seen in a wide range of skin, mucosal ecchymosis or hematoma, typically large skin ecchymosis, visceral bleeding, bleeding at the wound site.
2, thrombosis related performance:
(1) skin thromboembolism: the most common, fingertip, toe, nose, auricle skin blemishes, skin plaque hemorrhagic necrosis, dry necrosis.
(2) renal thrombosis: oliguria, anuria, azotemia and other acute renal failure are the most common manifestations.
(3) Pulmonary thrombosis: acute lung failure can occur in patients with difficulty breathing, cyanosis, hemoptysis, and severe cases.
(4) Gastrointestinal thrombosis: gastrointestinal bleeding, nausea, vomiting and abdominal pain.
(5) cerebral thrombosis: irritability, lethargy, disturbance of consciousness, coma, convulsions, cranial nerve palsy and limb paralysis.
3, shock: acral chills, bruising, oliguria and blood pressure drop. DIC caused by vascular endothelial injury is more common.
4, hemolysis: due to microvascular disease, red blood cells through mechanical damage, deformation and rupture and hemolysis. Clinically, there may be jaundice, anemia, and hemoglobin.
5, the symptoms of the primary disease.
Symptom
Hypovolemic shock symptoms Common symptoms Cold sweat pulse Fine speed Gravity shock Irritability Restlessness Indifferent Breathing Shortness of blood pressure Bleeding
The main manifestations of hypovolemic shock are decreased CVP, decreased blood flow to the heart, and hypotension caused by decreased CO. Peripheral vasoconstriction caused by neuroendocrine mechanisms, increased vascular resistance and increased heart rate. And various tissue and organ dysfunction and lesions caused by microcirculatory disorders.
1. Dizziness, pale, cold sweat, cold and cold limbs.
2. Irritability or indifference, severe fainting, and even coma.
3. Pulse speed, blood pressure, shortness of breath, cyanosis.
4. Less urine, even no urine.
Examine
Examination of hypovolemic shock
1. If the process of blood loss is slightly longer, the movement of body fluid gradually increases, which will concentrate the blood, which is manifested by increased hemoglobin, increased hematocrit, and increased ratio of urea nitrogen to creatinine. If the process of blood loss is long, the amount of blood loss is large, especially the loss of free water is gradually increased, and serum sodium is also increased.
2. Central venous pressure (CVP) and pulmonary wedge pressure (PCWP) were reduced by central manometry, cardiac output decreased, venous oxygen saturation (SVO2) decreased, and systemic vascular resistance increased.
Diagnosis
Diagnosis and diagnosis of hypovolemic shock
Diagnose based on
1. A sudden large amount of blood loss or loss of body fluids in the body or outside, or a history of severe intake of fluid (water).
2. Have thirst, excitement, irritability, and then appear indifferent, confused and even coma.
3. Superficial veins collapse, skin color pale to purple, breathing fast.
4. The pulse is fine, the skin is damp and the body temperature drops.
5. Systolic blood pressure is lower than 12.0-10.6kPA (90-80mmHg), or blood pressure of hypertensive patients is decreased by more than 20%, capillary filling time is prolonged, and urine volume is reduced (our urine volume is less than 30ml).
6. Central venous pressure and pulmonary wedge pressure measurements help to monitor the degree of shock.
