Slaid 27 Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich )

1. I level – easy degree – blood loss is even to 10 – 12% of blood circulating volume (500 – 700 ml). Haemorrhage is causing little changes to hemodynamic. The general condition of patient is satisfactory. Pulse is slightly quickened, arterial pressure is normal (standart). Blood hemoglobin is rised above 100 g/l (10 g %). During capillaroscopy: background is rosy, 3 – 4 capillary loops with quick gomogenous bloodstream are determined.

Slaid 28 II level – middle degree - blood loss is even to 15 – 20 % of blood circulating volume (1000 – 1400 ml). Apparent bleeding is distinguished. The general condition is medium-scale difficalty. Limpness, dizziness, hyperhidrosis, syncope are observed. Coverlet is pale. Respiration is accelerated. Reflexes are decrease. Single vomiting or melena may be observed. Pulse become noticeably more rapid (90 – 100 per min.). Arterial pressure is decreased to 90 mm Hg. Leucocytosis, deviation of the differential count to the left are determined. Hematocrit is 0,38 – 0,32, hemoglobin is 80 – 100 g/l (8 – 10 g %). Quantity of urination is decreased.

Slaid 29 III level – heavy degree – blood loss is 20 – 30 % of blood circulating volume (1500 – 2000 ml). The general condition of patient is bad (grave condition). Paleness of skin, cold sweat is observed. Rapid vomiting and melena are determined. The bleeding is accompanied by syncope. Visible mucous membranes are colourless. The patient yawns, feels thirst. Pulse is rapid and thready. Arterial pressure is decreased to 60 mm Hg. Hematocrit is 0,30 – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). Oliguria is observed.

Slaid 30 IV level – massive blood loss – loss of blood is more then 30 % of blood circulating volume (more than 2000 ml). Plentiful bleeding with prolonged loss of consciousness may be observed. The general condition of patient is very grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.

Simultaneously blood loss more than 40% VCB (the volume of the circulating blood) is incompatible with life.

Slaid 31 Hemorrhagic shock – one of types of gypovolemic shock, its clinic appears, since blood loss of 25-30% of VCB. Allocate 3 stages of hemorrhagic shock:

Slaid 32 The I stage – the compensated reversible hemorrhagic shock (a syndrome of small emission) is caused by blood loss which is well compensated by changes of cardiovascular activity. The consciousness is kept, the patient is pale, the cold snap of extremities, hypodermic veins desolation, pulse of weak filling, BP (Blood Pressure) the normal. Oligouriya: diuresis is reduced half (norm of 30-40 ml/hour), Central Venous Pressure (CVP) is lowered or negative.

Slaid 33 The II stage – decompensated reversible shock – a spasm arteriols doesn't support normal haemo dynamics any more. Pulse rate to 120-140 beats per minute, the low pulse arterial pressure (the BP of systolic lower than 100 mm Hg). Pallor of integuments, short wind, cyanosis against pallor, an oliguriya (less than 20 ml/h). At the patient hypotonia due to manifestations of violations of an organ blood-groove in a liver, kidneys, heart, a brain progresses; acrocyanosis, short wind. Tones of heart deaf; "a shock lung".

Slaid 34 The III stage – irreversible hemorrhagic shock. It is characterized long (more than 12 h.) uncontrollable hypotonia, inefficiency of transfusion therapy, development of polyorgan insufficiency.

Дата добавления: 2015-11-14