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Blood substitutes Blood substitutes are an attractive alternative to the costly process of donating, checking, storing and administering blood, especially given the immunogenic and potential infec tious complications associated with transfusion. There are sev...

Classification of shock There are numerous ways to classify shock, but the most common and most clinically applicable is one based on the initiating mechanism. All states are characterised by systemic tissue hypoperfusion, and di ff erent states may coexist with...

Clinical consequences of shock Unresuscitatable shock Patients who are in profound shock for a prolonged period of time become ‘unresuscitatable’. Cell death follows from cellu lar ischaemia and the ability of the body to compensate is lost. In the heart ther...

Complications of blood transfusion Complications from blood transfusion can be categorised as those arising from a single transfusion and those related to massive transfusion. - Complications from a single transfusion Complications from a single transfusion in...

Conduct of resuscitation Resuscitation should not be delayed in order to definitively diagnose the source of the shocked state. However, the timing and nature of resuscitation will depend on the type of shock and the timing and severity of the insult. Rapid...

Cross-matching To prevent transfusion reactions, all transfusions are preceded by ABO and rhesus typing of both donor and recipient blood to ensure compatibility . The recipient’s serum is then mixed with the donor’s cells to confirm ABO compatibility and to t...

Damage control resuscitation Damage control resuscitation (DCR), also known as haemo - static resuscitation, is a paradigm that prioritises haemorrhage control in patients who are still actively bleeding. The rationale is that no aspect of the shock state /un...

Degree of haemorrhage and classification The adult human has approximately 5 litres of blood (70 /uni00A0 mL/kg for children and adults, 80 /uni00A0 mL/kg for neonates). Estimation of the amount of blood that has been lost is di ffi cult, inaccurate and usually...

Definitions Revealed and concealed haemorrhage Haemorrhage may be revealed or concealed. Revealed haemorrhage is obvious external haemorrhage, such as exsanguination from an open arterial wound or from massive haematemesis from a duodenal ulcer. Concealed haemo...

End points of resuscitation It is much easier to know when to start resuscitation than when to stop. Traditionally , patients have been resuscitated until they have a normal pulse, blood pressure and urine output. However, these parameters are monitoring organ...

FURTHER READING Cole E, Weaver A, Gall L et al . A decade of damage control resusci - tation: new transfusion practice, new survivors, new directions. Ann Surg 2019; 273 (6): 1215–20. Duchesne JC, McSwain NE Jr, Cotton BA et al. Damage control resuscitation...

HAEMORRHAGE RESUSCITATION The conduct and goals of resuscitation change depending on whether the patient is actively bleeding. In this case, the resusci tation focuses on achieving rapid haemostasis and maintaining the ability of the blood to clot. This para...

HAEMORRHAGE Uncontrolled bleeding will lead to a hypovolaemic shock - state, or haemorrhagic shock. While haemorrhage and shock often coexist, they are not the same. Patients who are actively bleeding may not yet be in shock. Conversely , patients may be in sh...

Identify haemorrhage External haemorrhage may be obvious, but the diagnosis of concealed haemorrhage may be more di ffi cult. Any shock should be assumed to be hypovolaemic until proven otherwise and, similarly , hypovolaemia should be assumed to be due to haemo...

Indications for blood transfusion Blood transfusions should be avoided if possible, and many previous uses of blood and blood products are now no longer considered appropriate. The indications for blood transfusion are as follows: /uni25CF Acute blood loss, t...

INTRODUCTION Shock is the most common cause of death of surgical patients. Death may occur rapidly because of a profound state of shock or may occur later because of the consequences of organ ischaemia and reperfusion injury . It is important therefore t...

Learning objectives To understand: The pathophysiology of shock • The different patterns of shock and the principles and • priorities of resuscitation Appropriate monitoring and end points of resuscitation • Learning objectives To understand: The pathophysiolo...

Monitoring The minimum standard for monitoring of the patient in shock is continuous heart rate and oxygen saturation moni - toring, frequent non-invasive blood pressure monitoring and hourly urine output measurements. Most patients will need more aggressive ...