Haemorrhagic shock in obstetrics презентация

DEFINITION
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.

CONTINUE
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)

CONTINUE
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.

ETIOLOGY
BLOOD LOSS DUE TO
TRAUMA
RETROPERTONEAL BLEED
OBSTETRIC HAEMORRHAGE
(A) ANTEPARTUM HAEMORRHAGE (b) POSTPARTUM HAEMORRHAGE
(C) ECTOPIC PREGNANCY

ETIOLOGY CONT.
ANTENATAL CASUE
- PLACENTA PREVIA
- PLACENTAL ABRUPTION
- UTERINE RUPTURE POST PARTUM
- UTERINE ATONY
- LACERATION TO GENITAL TRACT
- CHORIOAMNIONNITIS
- COAGULOPATHIES

DIAGNOSIS
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.

CLINICAL 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

CLINICAL PICTURE CONTINUE
DECREASED OR ABSENT URINARY OUTPUT – USUALLY LESS THAN 30 ML/HR
PALE SKIN OR MUCUS MEMBRANES
CLOD, CLAMMY SKIN
FAINTNESS
THIRST

CONTINUE
PALLOR
SWEATING
CONFUSION
COLD CLAMMY EXTREMITIES

STAGES OF HAEMORHHAGIC SHOCK
1- COMPENSATED
2 – UNCOMPENSATED
3- IRREVERSIBLE

COMPENSATED
INTHIS STAGE , DEFENCE MECHANISM ARE SUCCESSFULL IN MAINTAINING PERFUSION
PRESENTATION
1 – TACHYCARDIA
2- DECREASED SKIN PERFUSION
3- ALTERED MENTAL STATUS

UNCOMPENSATD
DEFENCE MECHANISM BEGINS TO FAIL
PRESENTATION
- HYPOTENSION
- MARKED INCREASE IN HR
- RAPID AND THREADY PULSE
- AGITAION , RESTLESSNESS AND CONFUSION

IRREVERSIBLE
COMPLETE FAILURE OF COMPENSATORY MECHANISM
MARKED LOSS OF TISSUE PERFUSION CAUSE CELLULAR DAMAGE AND DEATH EVEN IN THE PRESENCE OF RESUSCITATION.

INITIAL 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

CONTINUE
INFUSION AND TRANSFUSION
- BLOOD
- CRYSTALOID – NORMAL SALINE
- COLLOIDS- HAEMACCEL , HUMAN ALBUMIN SOLUTION 4.5%

CONTINUE
PHARMACOLOGICAL AGENTS LIKE
1- VASOACTIVE DRUGS
2- INOTROPES
3- CORTICOSTEROIDS AND APART
ERYTHROPOETIN 40000U/WEEK WITH IRON AND VIT-C IS GIVEN
ARE GIVEN

CONTINUE
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.

CONTINUE
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

MONITORING
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.