Haemorrhage Shock And Blood Transfusion Long Essays

Haemorrhage Shock And Blood Transfusion Long Essays

Question 1. Classify shock. Describe the pathophysiology, clinical features and management of shocks.

Answer:

Shock:

• Shock is a condition in which circulation fails to meet the nutritional needs of the cells and fails to remove the metabolic waste products.
• It is characterized by hypoperfusion and severe dysfunction of vital organs.

Shock Classification:

1. Haematogenic or hypovolaemic shock.
   • Occurs due to loss of blood, plasma or body water and electrolytes.
   • Caused by haemorrhage, vomiting, diarrhoea, dehydration, etc.
2. Traumatic shock.
   • Caused by major fractures, crush injuries, bums, extensive soft tissue injuries and intraabdominal injuries.
3. Neurogenic shock.
   • Caused by paraplegia, quadriplegia, trauma to the spinal cord and spinal anaesthesia.
4. Cardiogenic shock.
   • Caused by injury to heart, myocardial infarction or congestive cardiac failure.
5. Septic shock.
   • Occurs due to gram-negative septicaemia.
6. Miscellaneous types – includes:
   • Anaphylactic shock.

Physiology: It can be described as 2 processes.

1. Reduced effective circulating volume.
   • May result either.
     • By actual loss of blood volume or
     • By decreased cardiac output.
2. Tissue anoxia.

Shock Clinical features:

Management: AIMS:

• To increase cardiac output.
• To improve tissue perfusion to vital organs.

Shock Treatment:

1. Maintenance.
   • Maintain patent airway and oxygen.
   • Head position – At low position with face turned to one side
2. Control of haemorrhage.
   • Done by elevation, compression bandages or by ligation of blood vessels.
3. Extracellular fluid replacement.
   • Nonsugar, nonprotein crystalloid is preferred.
   • Normal saline or ringer’s lactate should be started first.
4. Correct acid-base disturbance.
5. Drugs.

Question 2. Describe the pathophysiology, clinical features and treatment of septic shock.

Answer:

Septic Shock:

• Septic shock is caused due to release of endotoxin in blood mostly by Gram-negative organisms.
• Occurs in cases of severe septicaemia, peritonitis or meningitis.
• Pathophysiology.

Presence of gram-positive and gram-negative organism
↓
Local inflammation occurs
↓
Release of endotoxins from organism
↓
Activation of neutrophils, monocytes & macrophages.
↓
Release of inflammatory mediators.
↓
Cellular chemotaxis.
↓
Endothelial injury
↓
Activation of the coagulation cascade
↓
Massive fluid loss
↓
Septic shock

Septic Shock Clinical Features:

• Initially, chills and fever above 100oC occurs.

Septic Shock Types:

1. Early warm shock.
   • There is cutaneous vasodilation.
   • Body temperature increases
   • Cutaneous vasodilatation occurs.
   • Arterial blood pressure falls.
   • Cardiac output increases.
   • Skin remains warm, pink and well-perfused.
   • Pulse rate increases
2. Late cold shock.
   • There is increased vascular permeability
   • Cardiac output decreasing.
   • Hypovolemia occurs.

Read And Learn More: General Surgery Question and Answers

Septic Shock Treatment:

• Removal of septic focus.
  • Drainage of pus under anaesthesia.
  • Closure of perforation.
  • Resection of gangrene.
• Antibiotis.
  • Administered after antibiotic sensitivity tests.
  • Initial antibiotics are
    • Cephalothin – 6 – 8 gm/day IV in 4 – 6 divided doses.
    • Gentamicin – 5 mg/kg/day.
    • Clindamycin
• Fluid replacement.
  • Crystalloids such as isotonic saline as Ringer’s lactate may be used.
  • Blood transfusion – to maintain haemoglobin level to 10 mg%.
• Supportive care.
  • Oxygenation.
  • Mechanical ventilation.
  • Endotracheal intubation.
• Steroids.
  • Short-term, high-dose steroid therapy is used.
  • Initial dose of 15 – 30 mg/ kg body weight of methylprednisolone is given.
  • Same dose repeated within 4 hours.
  • Vasoactive drugs.
• Vasodilators such as phenoxybenzamine is used along with fluid replacement.
  • Inotropic agents such as isoproterenol is used to restore adequate circulation.
  • It produces mild peripheral vasodilation.
  • There is slight fall in BP.

Question 3. Describe the pathophysiology, clinical features and management of haemorrhage or hypovolaemic shock.

Answer:

Haemorrhage shock/Hypovolaemic shock: Such shock occurs due to sudden loss of blood volume or loss of fluid from the vascular space.

Pathophysiology:

Haemorrhage
↓
Loss of blood
↓
Decreased filling of right heart.
↓
Decreased filling of the pulmonary vasculature
↓
Decreased filling of left atrium and ventricle
↓
Decrease in stroke volume.
↓
Drop in arterial blood pressure

Hypovolaemic Shock Clinical Features:

• Depending on the degree of blood loss it can be described into three types.

Hypovolaemic Shock Management:

1. Resuscitation.
   • Maintain airway with adequate ventilation and oxygenation.
   • Lower the head with jaw support.
2. Immediate control of bleeding.
   • Raise the footend of the bed.
   • Use of compression bandages.
3. Extracellular fluid replacement.
   • Ringer’s lactate, Ringer’s acetate or normal saline supplemented with 1-2 ampules of sodium bicarbonate is used.
   • 1000 – 2000 ml solution is given within 45 min intravenously.
   • Blood transfusion done if required.

Question 4. Describe neurogenic shock and its management.

Answer:

Neurogenic Shock Causes:

• Paraplegia.
• Quadriplegia.
• Trauma to spinal cord
• Spinal anaesthesia.

Pathophysiology:

Blockade of sympathetic nervous system
↓
Loss of arterial and venous tone
↓
Peripheral pooling of blood.
↓
Decrease in cardiac filling
i
Decrease in stroke volume.
↓
Decrease in pulmonary blood volume.
↓
Decrease in cardiac output.
↓
Shock

Neurogenic Shock Clinical Features:

• Skin remains warm, pink and well-perfused.
• Urinary output – normal.
• Heart rate-rapid.
• Blood pressure – decreased

Neurogenic Shock Management:

1. Elevation of the legs to correct peripheral pooling of blood.
2. Fluid administration to increase cardiac output.
3. Use of vasoconstrictor drug.
   • It increases BP and myocardial activity.

Question 5. Classify haemorrhage and its management and Describe the causes, clinical features, How will you manage a case of primary haemorrhage after a dental extraction?.

Answer:

Haemorrhage: Haemorrhage is defined as escape of blood from blood vessels.

Haemorrhage Classification:

1. According to the source:
   • External haemorrhage.
     • Seen externally.
   • Internal haemorrhage.
     • Not seen externally, it is hidden,
     • Example: GIT bleeding.
   • Arterial haemorrhage.
     • It is haemorrhage coming out of artery.
     • It is bright red in colour.
   • Venous haemorrhage.
     • It is haemorrhage coming out of vein.
     • It is dark red in colour.
   • Capillary haemorrhage.
     • It is haemorrhage coming out of capillary
     • It is bright red in color and it oozes out
2. According to the time of appearance:
   • Primary haemorrhage.
     • Occurs at the time of injury.
   • Reactionary haemorrhage.
     • Occurs within 24 hours of injury.
     • Secondary haemorrhage.
   • Occurs after 7-14 days of injury.

Haemorrhage  Management:

• To stop blood loss.

1. Rest.
   • Use of sedative and analgesics.
   • Morphine is administered IM/IV.
   • Inj. Pethidine is better than morphine.
2. Position of patient.
   • Head end of bed is raised in haemorrhage oc- curing after thyroidectomy.
   • Foot end of bed raised in case of haemorrhage from varicose veins.
3. Pressure and packing.
   • Use of sterile gauze pieces and pressure bondage.
   • At home, it can be done by clean linen cloth.
4. Operative methods.
   • Haemorrhage can be controlled by.
     • Use of artery forceps.
     • Ligation of blood vessels.
     • Smaller vessels are coagulated with diathermy.
     • Bigger vessels are sutured
     • In case of oozing blood-following is used
       • Oxycel or gelatine sponge.
       • Gauze soaked in adrenaline (1:1000)
       • Bone wax for bleeding occurring from the bone.

Haemorrhage  Causes:

• Bleeding disorders.
• Low platelet count
• Anticoagulant medication.
• Broken or ruptured blood vessels.
• Severe trauma
• After surgery.
• After childbirth.

Haemorrhage  Clinical Features:

• Blood loss
• Increased pulse rate
• Thready pulse
• Low blood pressure
• Pallor Restlessness
• Deep respiration
• Cold and calmmy extremities
• Empty veins
• Low urinary output.

Management of Primary Haemorrhage:

1. Post-extraction bleeding.

Removal of clots with gauze
↓
Placement of gauze pad or tea bag over socket.
↓
Patient is instructed to bite over it for 1 hour
↓
Repeated 2-3 times.
↓
Prevent disruption of clot

2. If bleeding continues.

Anaesthesize the area
↓
Curette the socket
↓
Remove existing clot and freshen the bone
↓
Irrigate with normal saline
i
Place local haemostatic agent into socket
↓
Suture under gentle tension

Question 6. Describe indications and complications of blood transfusion.

Answer:

Blood Transfusion: It is the process of transferring blood or blood-based products from one person into circulatory system of another.

Blood Transfusion Indications:

• Acute haemorrhage – external or internal.
• Certain major operations – like radical mastectomy.
• In deep burns.
• Preopera lively in anaemic patients.
• Postoperatively in septicaemia.
• In anaemia.
• In severe malnutrition.
• In coagulation disorders like hemophilia.
• In treatment of erythroblastosis foetalis.
• During chemotherapy of malignant diseases.

Blood Transfusion Complications:

1. Transfusion reactions:
   • Incompatibility
     • Causes:
       • Incompatible transfusion.
       • Transfusion of hemcolyzed blood.
       • Transfusion of old blood.
     • Clinical features:
       • Fever, rigor.
       • Headache.
       • Nausea, vomiting.
       • Pain in the loins.
       • Tingling sensation in the extremities.
       • Feeling of tightness of chest
       • Dysponea.
       • Diminished urinary output.
       • Haemoglobunuria.
       • Jaundice
     • Treatment:
       • Stop the transfusion immediately.
       • Administration of 4 fluids.
       • Alkalization of blood with 10 ml of isotonic solution of sodium lactate and simultaneously 10 ml of saturated solution of sodium bicarbonate 4.
       • Use of 80 -120 mg frusemide IV to provoke diuresis.
       • Antihistamine and hydrocortisone may be prescribed.
   • Pyrexial reactions.
     • Causes:
       • Lack of sterilization
       • Infected donor’s apparatus
       • Iniected blood transfusion,
       • Rapid transfusion,
       • Presence of sulphur compounds in rubber tubing.
     • Clinical Features:
       • Pyrexia.
       • Rigor, chills.
       • Restlessness.
       • Headache.
       • Increased pulse rate.
       • Nausea and vomiting.
     • Treatment:
       • Stop transfusion immediately.
       • Cover the patient with blanket.
       • Antipyretic and antihistaminic drugs are injected.
   • Allergic reaction:
     • Cause:
       • Allergic reaction to plasma product
     • Features:
       • Mild tachycardia.
       • Urticarial rash.
       • Fever
       • Dysponea
       • Circulatory collapse.
     • Treatment:
       • Stop transfusion
       • Administer 10 mg chlorpheniramine.
   • Sensitization to leucocytes and platelets:
     • Use of antipyretics, antihistamines and steriods.
2. Transmission of diseases:
   • Diseases transmitted ae.
     • Serum hepatitis
     • AIDS
     • Bacterial infections.
3. Reactions caused by massive transfusion:
   • Acid base imabalance – alkalosis.
   • Hyperkalaemia.
   • Citrate toxicity.
   • Hypothermia.
   • Failure of cogulation.
4. Complications of over-transfusion:
   • Congestive cardiac failure occurs.
5. Other complications:
   • Thrombophlebitis
   • Air embolism.

Question 7. Define shock. Describe the pathophysiology and classification of shock. Discuss management of hypovolaemic shock

Answer:

Shock Definition: Shock is a condition in which circulation fails to meet the nutritional needs of the cells and fails to remove the metabolic waste products

Pathophysiology

• Reduced effective volume
  • It may result either
    • By actual loss of blood volume or
    • By decreased cardiac output
• Tissue anoxia
  • Reduction in effective circulating blood volume
  • Reduced venous return
  • Decreased cardiac output
  • Decreased oxygen supply
  • Tissue anoxia
  • Cellular injury
  • Release of inflammatory mediators
  • Results in shock

Shock Classification

• Haematogenic or hypovolaemic shock
• Traumatic shock
• Neurogenic shock
• Cardiogenic shock
• Septic shock
• Miscellaneous
  • Anaphylactic shock

Management of hypovolemic shock

• Resuscitation
  • Maintain airway with adequate ventilation and oxygenation
  • Lower the head with jaw support
• Immediate control of bleeding
  • Raise the foot end of the bed
  • Use of compression bandages
• Extracellular fluid replacement
  • Ringer’s lactate, Ringer’s acetate or normal saline supplemented with 1-2 ampules of sodium bicarbonate is used
  • 1000-2000 ml solution is given within 45 min intravenously
  • Blood transfusion done if required

Question 8. What are blood components? Write in detail about the indications, contraindications and complications of blood transfusion.

Answer:

Blood components

• There are four main components of blood
  • Plasma
  • Red blood cells or erythrocytes
  • White blood cells or leukocytes
  • Platelets

Blood transfusion

• Indications
  • Acute haemorrhage
  • Major surgery
  • Deep burns
  • Pre-operative and post-operative in anaemia
  • In malnutrition
  • In coagulation disorders
  • In erythroblastosis fetalis
  • During chemotherapy in malignant diseases
• Contraindications
  • Infections
  • Aortic stenosis
  • Angina
  • Significant cardiac or pulmonary disease
  • Coronary heart disease
  • Cyanotic heart disease
  • Uncontrolled hypertension
• Complications
  • Transfusion reactions
    • Incompatibility
    • Pyrexial reactions
    • Allergic reactions.
  • Transmission of diseases
  • Reactions caused by massive transfusion
    • Acid base imbalance
    • Hyperkalaemia
    • Citrate toxicity
    • Hypothermia
    • Failure of coagulation
• Complications of over transfusion
  • Congestive cardiac failure
• Other complications
  • Thrombophlebitis
  • Air embolism