Hypovolemic Shock Treatment & Management

Hypovolemic Shock Treatment & Management

Classify hemorrhages. Management of hypovolemic shock. Complications of blood transfusion.

Answer.

Classification of Hemorrhage

Depending upon the nature of the vessel involved:

Arterial hemorrhage:

• Bright red, jet out.
• Pulsation of the artery can be seen.
• It can be easily controlled as it is visible.

“Hypovolemic Shock Fluid Resuscitation Strategies”

Venous hemorrhage:

• Dark red.
• It never gets out but oozes out.
• Difficult to control because the vein gets retracted, nonpulsatile.

“Hypovolemic Shock And Organ Perfusion”

Capillary hemorrhage:

• The red color, never jets out, slowly oozes out.
• It becomes significant if there are bleeding tendencies.

Depending upon the timing of the hemorrhage:

• Primary hemorrhage: Occurs at the time of surgery.
• Reactionary hemorrhage: Occurs after 6 to 12 hours of surgery. Hypertension in postoperative period, violent sneezing, coughing, or retching are the usual causes.
• Secondary hemorrhage: Occurs after 5 to 7 days of surgery. It is due to infection which eats away the suture material, causing sloughing of the vessel wall.

“Early Recognition Of Hypovolemic Shock Symptoms”

Depending upon the duration of the hemorrhage:

• Acute hemorrhage: Occurs suddenly, e.g. esophageal varices bleeding.
• Chronic hemorrhage: Occurs over some time, e.g. hemorrhoids/ piles.

Depending upon the nature of bleeding:

• External hemorrhage or reversal hemorrhage,e.g. epistaxis, haematemesis.
• Internal hemorrhage or concealed hemorrhage,e.g. splenic rupture following injury.

Based on the possible intervention

• Surgical hemorrhage: Can be corrected by surgical intervention
• Non-surgical hemorrhage: It is diffused and oozes due to coagulation abnormalities and disseminated intravascular coagulation.

“Hypovolemic Shock Management Protocols”

Complications of Blood transfusion

The following are the complications of blood transfusion:

• Febrile reactions: It is the most common complication due to impurities like pyrogens in the blood or the infusion set.
  • Headaches, fever, chills, rigors, tachycardia, and nausea are the features.
  • Transfusion is temporarily stopped or the flow is slowed down with the administration of the antipyretic drug to reduce fever.
  • Often transfusion of that unit needs to be discontinued.
• Allergic reaction: Urticaria and allergy to specific proteins in the donor’s plasma can occur.
  • Usually, it is mild and is treated with steroids and antihistaminics.
  • In severe urticaria that unit of blood is discarded; new washed RBCs and platelets are used.

“Prehospital Care For Hypovolemic Shock”

• Acute hemolytic reactions: It is the most dangerous complication. It is due to ABO incompatibility.
  • Usually, it is nonfatal but occasionally can be fatal.
  • It is commonly due to technical errors at different levels. It amounts to criminal negligence in a court of law.
• Transfusion-related graft versus host disease: This very serious, very rare complication occurs due to recognition and reaction against host tissues by infused donor lymphocytes. lt is common in immunosuppressed, lymphoma, and leukemic patients.
  • Any type of blood product including leukocyte-reduced blood can cause the condition.
  • Features are pancytopenia, toxic epidermal necrosis, and liver dysfunction with more than 90% mortality. It is difficult to treat.
• Congestive cardiac failure: It occurs if especially large quantities of whole blood are transfused in chronic severe anemia, pregnancy, elderly patients, in patients who have cardiac problems.