How do you calculate blood loss in shock?
In reality, the pulses are lost in that order (radial, then femoral, then carotid) but the SBP at which they disappear varies and is often lower than what ATLS advises. Thus the ATLS guide will tend to overestimate blood pressure. Show CLASSIFICATION OF STAGES OF HAEMORRHAGIC SHOCK An easy way to remember the categories is to think of the scores in a game of tennis: Love – 15 – 30 – 40 — game over (>40) These stages are described in ATLS as follows:
Unfortunately, the classic stages of hemorrhagic shock (a la ATLS) are of limited clinical relevance in the real world, because of:
Also, bradycardia (rather than tachycardia) is often seen in major haemorrhage:
LETHAL TRIAD AND ACUTE COAGULOPATHY OF TRAUMA/ SHOCK The lethal triad is:
These three factors both cause, and contribute to, acute coagulopathy of trauma/ shock (ACoTS) which leads to, and result from, major hemorrhage.
HYPOTHERMIA PREVENTION AND TREATMENT Prevent and treat hypothermia with the following:
DAMAGE CONTROL RESUSCITATION Damage control resuscitation (DCR) is a systematic approach to the management of the trauma patient with severe injuries that starts in the emergency room and continues through the operating room and the intensive care unit (ICU)
Permissive hypotension
Haemostatic resuscitation
Damage control surgery
CRYSTALLOID RESUSCITATION Traditional ATLS teaching is to initiate fluid resuscitation with 1-2 L of crystalloid such as normal saline or compound sodium lactate (Hartmann’s solution) Potential downsides of this approach include:
These downsides are part of the rationale for a haemostatic resuscitation approach to major haemorrhage in trauma. References and LinksLITFL
Journal articles and textbooks
FOAM and web resources
Critical CareCompendium …more CCC Chris NicksonChris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. How is blood loss measured?There are two ways of measuring blood loss: one is by direct measurement of collected blood (swabs, suction bottles, drainage bags, etc.), and the other is by indirect measurement. The latter reflects blood loss by assessment of haemoglobin concentration, haematocrit or the need for blood transfusions.
How much blood loss does it take to go into shock?Hemorrhagic, or hypovolemic, shock occurs when you've lost 20 percent or more of your total blood volume. Your symptoms will become more severe as the blood loss increases. You may experience: rapid breathing.
What is shock blood loss?Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
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