Bleeding and Volume Replacement Therapy J. Mlek

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Transcript of Bleeding and Volume Replacement Therapy J. Mlek

  • Bleeding andVolume Replacement TherapyJ. Mlek

  • Casualty treatment call for medical helpvital functionscontrol of major external bleedinggeneral examinationprevention of secondary injuriesdetailed examination

  • Bloodin adults 40-50 ml/kg, in children 50-60 ml/kgoxygen and CO2 transportwater and mineral balancetransport of metabolitestransport of hormonesimmunity

  • Bloodred cells white cells thrombocytesplasma

  • Bleedingarterial, venous, capillary, mixedminor, majorlocalisationnormal, abnormal

  • Minor bleeding clean with waterapply antiseptic around the woundapply sterile dressing

  • Bleedingexternalinternalfrom body orificesmixed

  • Major external bleedinglay the victim down to supine positioncompress and elevate the bleeding site (if possible)pressure dressingmanual compressionpressure pointstourniquetdo not try to clean a large wound (remove only obvious debris)never remove a foreign body

  • Internal bleeding painsigns of injurysigns of shock

  • Internal bleedingpositioningcall for emergencynothing per os

  • Bleeding from body orificesmouthnose earhaemoptoeavomiting of bloodrectal bleeding/melaenavaginal bleeding

  • Volume replacement therapycrystalloid solutionscolloids solutionsvolume substituentsvolume expandersblood

  • Crystalloid solutionsadvantages no allergic reactionseasily availablelow effect on blood coagulationeasily mobiliseddisadvantagesmove quickly from blood vesselsno transport capacity for oxygen

  • Colloid solutionsdextransgelatinestarch

  • Colloid solutionsadvantagesstay longer in blood vesselsrapid volume replacement (molecular weight dependent)easily available

    disadvantagesallergic reaction possiblevarious effect on blood coagulationdifficulty in mobilisationno transport capacity for oxygen

  • Blood and blood productspacked red cellsfresh frozen plasmathrombocytesvarious factors

  • Risks of blood transfusionincompatibilityinfectionallergyfeveroverloadingbleeding problemsimmunity

  • Blood transfusion indicationpatients consenttaking blood sample to transfusion dept.cross match in TDcheck documentation and transfusion bag security testbiological test

  • Blood groups

  • Population O+ A+ B+ AB+ O A B AB Argentina[11]53.8%34.7%8.8%2.7%8.4%0.44%0.21%0.06%Australia[12]40%31%8%2%9%7%2%1%Belgium[13]38.1%34%8.5%4.1%7%6%1.5%0.8%Canada[14]39%36%7.6%2.5%7%7%1.4%0.5%Denmark[15]35%37%8%4%6%7%2%1%Finland[16]27%38%15%7%4%6%2%1%France[17]36%37%9%3%6%7%1%1%Hong Kong, China[18]40%26%27%7%

  • Human red blood cells before (left) and after (right) adding serum containing anti-A antibodies. The agglutination reaction reveals the presence of the A antigen on the surface of the cells.

  • TransfusionColecting blood sample from the patientTransfusion stationBlood groupCrossmatchingDeliveryWardCheck delivery listSafety testBiological testMonitoring Save blood pack for 24 hours

  • Indications for blood transfusionsacute hemorrhageanemiableeding disordershematological diseases

  • Acute bleeding

  • Shock

  • DefinitionAcute state in which tissue perfusion is inadequate to maintain the supply of oxygen and nutritients necessary for normal cell function, which results in widespread hypoxia.

  • Reasons for inadequate tissue perfusionA decreased circulating blood volume hypovolaemic shockA failure of the heart to pump effectively cardiogenic shock and obstructive shockA massive increase in peripheral vasodilatation neurogenic shockCombination septic shock, anaphylactic shock

  • Stages of shockInitial stage anaerobic metabolismCompensatory stage centralisation of circulationProgressive stage increased acidosis, leakage of fluid from the capillaries and formation of microthrombesRefractory stage

  • Classification of shockHypovolaemic shockCardiogenic shockAnaphylactic shockSeptic shock Neurogenic shock

  • Hypovolaemic shockHaemorrhage

    Plasma loss

    Extracelular fluid loss

  • Symptoms of hypovolemia according to blood loss

  • Estimated blood loss in trauma

  • Signs of haemorrhagic shockPale, cold, clammy skin, decreased capilary refill Rapid, weak and thready pulseThirstDecreased urine productionIncreased respiratory rateChange in mental status late sign

  • First aidPrevent further blood lossAntishock or autotransfusion positionActivation of emergency servicePrevention of hypothermiaPrevention of positioning traumaTreatment of other injuries, immobilisation of fracturesNil by mouth, no oral or i.m. medication

  • Medical treatmentIntravenous accessSurgery Fluid replacementArtificial ventilationPharmacological support of shock organsMonitoring: BP, P, SaO2, CPV, urine output

  • Cardiogenic shockHeart failure, cardiomyopathyDecreased cardiac outputFirst vasoconstriction, next vasodilatation due to acidosisPulmonary oedemaCold, clammy and cyanotic skinMortality 80 per cent

  • Anaphylactic shockSevere allergic reactionDegranulation of mast cellsVasodilatation, increased vascular permeability, oedema, bronchospasm

  • Septic shockBacteria or bacterial toxinsReleased histamine and other mediators of inflammationOxygen demand supply mismatchVasodilatationTachycardia, hypotension, fever of hypothermia

  • Neurogenic (spinal) shockLoss of sympathetic nerve activityMassive vasodilatation