Shock Definition and Emergency Treatment Principles

Definition of Shock and Basic Principles of Emergency Treatment of Haemorrhagic Shock Shock is a life-threatening condition characterized by inadequate tissue perfusion and oxygen delivery to meet the metabolic demands of the body. This can lead to cellular dysfunction, organ failure, and ultimately death if not promptly managed. Haemorrhagic shock specifically occurs due to significant blood loss, leading to decreased circulating volume and subsequent cardiovascular collapse. Basic Principles of Emergency Treatment of Haemorrhagic Shock 1. Early Recognition:   Prompt recognition of signs and symptoms such as hypotension, tachycardia, altered mental status, and cool clammy skin is crucial. Early assessment of mechanisms of injury and rapid evaluation of vital signs aid in identifying patients at risk for haemorrhagic shock. 2. Control of Bleeding:    Direct pressure: Apply direct pressure to wounds to control external bleeding. Tourniquet application: Use tourniquets for severe extremity bleeding that cannot be controlled by direct pressure. Hemostatic agents: Apply hemostatic dressings or agents to promote clotting and control bleeding. 3. Fluid Resuscitation:    Rapid intravenous access: Establish large-bore peripheral intravenous lines or use intraosseous access if venous access is difficult. Fluid administration: Initiate crystalloid (e.g., normal saline or lactated Ringer's solution) or blood products (e.g., packed red blood cells, fresh frozen plasma) based on severity of shock and availability of resources. Goal-directed therapy: Aim to restore adequate tissue perfusion and maintain mean arterial pressure (MAP) to ensure vital organ perfusion. 4. Blood Component Therapy:   Transfusion protocol: Administer blood products in a balanced ratio (e.g., 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets) for patients requiring massive transfusion. Monitor coagulation parameters: Perform point-of-care testing (e.g., thromboelastography) to guide transfusion therapy and correct coagulopathy early. 5. Definitive Care:   Surgical intervention: Expedite surgical consultation and intervention for control of ongoing bleeding, especially in cases of major vascular injury or internal organ injury. Damage control surgery: Consider damage control techniques to control bleeding and prevent further physiologic deterioration before definitive repair. Blood Loss Expected from Orthopaedic and Soft Tissue Trauma Orthopaedic Trauma:  Fractures: Depending on the location and severity, fractures can result in significant blood loss. Long bone fractures, such as femoral fractures, can lead to substantial hemorrhage due to injury to major blood vessels and surrounding soft tissues.  Complications: Open fractures, where the bone penetrates through the skin, can also lead to substantial blood loss from injury to arteries, veins, and soft tissues. Soft Tissue Trauma:   Lacerations and Contusions: Superficial soft tissue injuries may result in minor bleeding that can usually be controlled with local measures. Internal Bleeding: Injuries involving deeper soft tissues, such as muscle or solid organs (e.g., liver, spleen), can lead to significant internal bleeding, requiring surgical intervention to control hemorrhage. Expected Blood Loss:  Classifications: Blood loss can be categorized based on volume: o Minimal: Typically less than 15% of total blood volume (less than 750 mL in adults). o Moderate: 15-30% of total blood volume (750-1500 mL in adults). o Severe: Greater than 30% of total blood volume (>1500 mL in adults), potentially requiring aggressive resuscitation and surgical intervention. Complications and Management:    Hypovolemic Shock: Rapid assessment and intervention are critical to prevent progression to shock and organ failure. Monitoring: Continuous monitoring of vital signs, urine output, and laboratory values (e.g., lactate levels) guides ongoing resuscitation efforts. Multidisciplinary Approach: Collaboration among trauma surgeons, emergency physicians, anesthesiologists, and blood bank personnel optimizes management and outcomes for trauma patients.