Chock

Question 1

How to approximate blood volune

Answer 1

8-9% of body weight in children (80-90ml/kg)

Normal adult blood volume= 7% of body weight.
In obese adults, 7% of ideal body weight. Using actual body weights leads to risk of overestimation

Question 2

Different classes of hemorrhagic chock

Answer 2

1. <15% blood loss. Ex person who donated blood.

2 15-30%. Uncomplicated hemorrhage, needing crystalloid fluid resuscitation.
BE -2 ->-6

3. 31-40%. Complicated hemorrhagic state requiring at least crystalloid infusion and possibly blood replacement.
   BE -6->-10
4. > 40 %. Preterminal event. Unless aggressive measures are taken, the patient will die within minutes
   Needs massive transfusion protocol.
   BE -10 or less

4

Question 3

Physiological changes with class I hemorrhage

Answer 3

<15% blood volume loss.
Minimal tackykardia
Normal BP, pulse pressure, RR. Base deficit 0 ->-2

Question 4

Physiological manifestation class II hemorrhage

Answer 4

Most stabilise initially by crystalloids.
Takycardia and takypnea. Decreased pulse pressure.

Subtle CNS signs ex hostility, fear, anxiety

Urinary output 20-30ml/hour in adults
Base deficit -2->-6

Question 5

Physiological manifestations of class 3 hemorrhage

Answer 5

Most require RBC and blood products
And definitive control of bleeding
Inadequate perfusion.
Marked takycardia and takypnea
Significant changes in mental status
Significant decrease in systolic BP
Base deficit -6-> -10

Question 6

Class IV hemorrhage physiological manifestations

Answer 6

Marked takycardia
Significantly decreased SBP
Very narrow pulse pressure or unmeasurable DBP.
Negligable urinary output
Markedly depressed mental state
Cold, pale skin
Base deficit -10 or more

Requires rapid transfusion and definitive control of bleeding

Question 7

How to stop bleedings in chock?

Answer 7

Angio-embolozation
Surgery
Direct pressure at site
Splint fracture
Torniquet
Pelvic binder or sheet

Question 8

How to prevent gastric distention in chock?

Answer 8

Gastric distention can cause hypotension or dysrythmia. Also increases risk of aspiration in unconscious patients.
Deconpress stomach with nasal or oral tube and begin suction

Question 9

Why do urine catheterization with chock?

Answer 9

Because of evaluation of renal perfusion and hematuria measurement (can point to retro peritoneal bleeding)

Question 10

Adequate urinary output during resucitation for adults and pediatric patients

Answer 10

0.5ml/kg/hr in adults
1ml/kg/hr for pediatric patients
Children <1 year 2ml/kg

Question 11

Vidare handläggning av rapid responders?

Answer 11

These patients quickly respons to the initial fluid bolus and become homedynamically normal.

NEXT:
No further fluid bolus or immediate blood administration needed
Keep fluid at maintenance rate
Keep typed and crossmatched blood available
Obtain surgical consultation and evaluation

Question 12

Further treatment of transient responders to initial fluid bolus

Answer 12

These patients respond to initia fluid bolus and then deteriorate as the speed is changed to maintenance level.
This suggests ongoing blood loss or inadequate resuscitation

Whats next?
Transfer blood and blood products-consider MTP

These patients need operative or angiographic hemorrhage control.

Lost 15-40% blood (class II-III)

Question 13

Next Step for minimal or no response to initial bolus?

Answer 13

Immediate definitive intervention
Initiate MTP

Question 14

To which degree should the fluids/blood be heated to

Answer 14

39 celsius