Circulation
Assessment of:
- cardiovascular compromise &
- control of bleeding
Shock? - Skin pallor, tachycardia, altered consciousness
Look for any: External bleeding source or Internal hemorrhage?
Types of shock
Treatment: Circulation- Initial management
-
External haemorrhage- compression dressing ? tourniquet
-
IV access- two peripheral catheters (upper limb), rapid infusion
-
Other IV access: - Saphenous vein ‘cut down’,
- central venous line
-
ECG monitoring
-
Blood samples- typing, x-match, haematology, biochem., pregnancy test (female), ABGs.
-
Initial resuscitation: - 1-2 L of Ringer’s lactate or NS (room temp.) - Packed red blood cells (PRBC), if no response - Foley’s catheter: urine output - 0.5 mL/kg/hour in adult
-
Search for source of blood loss: CXR, X-ray pelvis, FAST (focused abdominal sonography in trauma).
-
Fracture pelvis: pneumatic antishock garment or a bed sheet wrapped around the pelvis may be applied
-
Limb fractures- splint
-
Control bleeding :
- Surgical interventions,
- angioembolization,
- pelvic stabilization.
Evaluation of fluid resuscitation
- BP and pulse rate
- Urine output (0.5ml/kg/hour)
- Mental status and skin color/temperature
- CVP
- Acid/base status
Rapid responders - Management decisions
- Hemodynamics return to normal after resuscitation
- Hemodynamics remain stable even after reducing infusion to maintenance rate.
- Probably bleeding has stopped spontaneously
- Obeservation: Continued evaluation for source of bleeding
- May still need surgery
Transient responders - Management decisions
- Decompensate once fluid resuscitation is slowed down.
- ? Ongoing bleeding or inadequate resuscitation.
- Increase fluid resuscitation.
- Blood transfusion (type specific or O negative)
- Surgical intervention ??
Non-responders - Management decisions
-
Fail to respond to fluid and blood resuscitation.
-
Cause: Major blood loss (>40%) & ongoing loss
- Intervention
- Immediate surgical intervention or
- ? Non-hemorrhagic shock (cardiogenic)
- Echocardiography
- CVP