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Hemorrhagic shock
Last reviewed: 29.11.2021
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The development of hemorrhagic shock is usually caused by hemorrhages exceeding 1000 ml, that is, a loss of more than 20% of the BCC or 15 ml of blood per 1 kg of body weight. Continuing bleeding, in which blood loss exceeds 1500 ml (more than 30 % BCC), is considered massive and poses an immediate threat to the life of a woman. The volume of circulating blood in women is not the same, depending on the constitution, it is: for normostenkov - 6.5% of body weight, for asthenics - 6.0%, for picnics - 5.5%, for muscular athletic women - 7% therefore absolute figures of BCC can vary, that it is necessary to take into account in clinical practice.
[Causes and pathogenesis of hemorrhagic shock
The causes of bleeding leading to shock in gynecological patients can be: a disrupted ectopic pregnancy, an ovarian rupture, spontaneous and artificial abortion, a frozen pregnancy, a bladder skeleton, dysfunctional uterine bleeding, a submucous form of uterine fibroids, trauma to the genital organs.
Whatever the cause of massive bleeding, the leading link in the pathogenesis of hemorrhagic shock is the disproportion between reduced bcc and the capacity of the vascular bed, which initially manifests as a violation of macrocirculation, ie, systemic circulation, then microcirculatory disorders appear and, as a consequence, develop a progressive disorganization metabolism, enzymatic shifts and proteolysis.
The system of macrocirculation is formed by arteries, veins and heart. The system of microcirculation includes arterioles, venules, capillaries and arteriovenous anastomoses. As is known, about 70 % of the total BCC is in the veins, 15% in the arteries, 12% in the capillaries, and 3 % in the heart chambers.
When blood loss is not more than 500-700 ml, i.e., about 10 % of BCC, there is compensation due to an increase in the tone of the venous vessels, the receptors of which are most sensitive to hypovolemia. At the same time, there is no significant change in the arterial tone, heart rate, tissue perfusion does not change.
Symptoms of hemorrhagic shock
Symptoms of hemorrhagic shock have the following stages:
- Stage I - compensated shock;
- II stage - decompensated reversible shock;
- III stage - irreversible shock.
Stages of shock are determined on the basis of evaluation of a complex of clinical manifestations of blood loss, corresponding to pathophysiological changes in organs and tissues.
Stage 1 hemorrhagic shock (small-shot syndrome, or compensated shock) usually develops with blood loss approximately corresponding to 20 % BCC (15 % to 25%). In this stage, compensation for the loss of bcc. Is carried out due to hyperproduction of catecholamines. The clinical picture is dominated by symptoms that indicate a change in cardiovascular activity of a functional nature: pallor of the skin, desolation of the subcutaneous veins on the hands, moderate tachycardia to 100 beats / min, moderate oliguria and venous hypotension. Arterial hypotension is absent or mild.
If the bleeding has stopped, then the compensated stage of the shock can last quite a long time. With unsettled bleeding, there is further deepening of circulatory disorders, and the next stage of shock comes.
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Treatment of hemorrhagic shock
Treatment of hemorrhagic shock is an extremely important task, for the solution of which the gynecologist should join forces with an anesthesiologist-resuscitator, and, if necessary, involve a hematologist-coagulologist.
To ensure the success of therapy should be guided by the following rule: treatment should begin as early as possible, be comprehensive, conducted taking into account the cause that caused bleeding, and the state of health of the patient that preceded him.
The complex of therapeutic measures includes the following:
- Gynecological operations to stop bleeding.
- Provision of anesthesia.
- Immediate removal of the patient from a state of shock.
All listed activities should be carried out in parallel, clearly and quickly.