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.



  • 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.

Haemorrhage Shock And Blood Transfusion Reduction In effective Circulating Blood Volume

Shock Clinical features:

Haemorrhage Shock And Blood Transfusion 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.

Haemorrhage Shock And Blood Transfusion Shock Treatment

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


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.


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



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.

Haemorrhage Shock And Blood Transfusion Haemorrhage Or Hypovolaemic Shock

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.


Neurogenic Shock Causes:

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


Blockade of sympathetic nervous system

Loss of arterial and venous tone

Peripheral pooling of blood.

Decrease in cardiac filling
Decrease in stroke volume.

Decrease in pulmonary blood volume.

Decrease in cardiac output.


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?.


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
Place local haemostatic agent into socket

Suture under gentle tension

Question 6. Describe indications and complications of blood transfusion.


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


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


  • 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.


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

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