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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 ...

Pathophysiology Cellular As perfusion to the tissues is reduced, cells are deprived of oxygen and must switch from aerobic to anaerobic metabolism. The product of anaerobic respiration is not carbon dioxide but lactic acid. When enough tissue is underperfused...

Recognition and diagnosis of shock Shock may be profound and easily recognised or it may be - subtle and only diagnosed with directed clinical examination and cardiovascular and metabolic monitoring. Compensated shock As shock progresses, the body’s cardiovasc...