Hemorrhagic shock is a consequence of acute blood loss. Hemorrhagic shock symptoms and treatment

AT medical terminology hemorrhagic shock is a critical condition of the body with a large blood loss, which requires emergency care. As a result, the blood supply to the organs decreases and multiple organ failure occurs, manifested by tachycardia, pallor of the skin and mucous membranes, as well as a fall blood pressure. With timely assistance not provided, the likelihood of a fatal outcome is very high. Read more about this condition and pre-hospital measures below.

What is hemorrhagic shock

This concept is in line with stressful state body with a sharp decrease in the volume of blood circulating in the vascular bed. In conditions of increased venous tone. In simple words this can be described as follows: the totality of the body's reactions in acute blood loss (more than 15-20% of the total amount). Some important factors about this condition:

Hemorrhagic shock (HSH) according to ICD 10 code R 57.1 and refer to hypovolemic states, i.e. dehydration. The reason is that blood is one of the vital fluids that support the body. Hypovolemia also occurs as a result traumatic shock and not just hemorrhagic.
Hemodynamic disturbances at a low rate of blood loss cannot be considered hypovolemic shock, even if it is about 1.5 liters. It doesn't lead to the same serious consequences, after all, compensation mechanisms are included. For this reason, only shock with sudden blood loss is considered hemorrhagic.

In children

There are several features of the GS clinic in children. These include the following:

It can develop as a result of not only blood loss, but also other pathologies associated with malnutrition of cells. In addition, in a child, this condition is characterized by more severe symptoms.
The loss of only 10% of the volume of circulating blood can be irreversible, when in adults even a quarter of it is easily compensated.

Sometimes hemorrhagic shock occurs even in newborns, which may be due to the immaturity of all systems. Other causes are damage to internal organs or umbilical vessels, placental abruption and intracranial bleeding. Symptoms in children are similar to characteristic features in adults. In any case, such a condition in a child is a signal of danger.

In pregnant women

During pregnancy, a woman's body physiologically adapts to many changes. This includes an increase in circulating blood volume, or BCC, by about 40% to ensure uteroplacental blood flow and prepare for blood loss during childbirth. The body normally tolerates a decrease in its amount by 500-1000 ml. But there is a dependence on the height and weight of the pregnant woman. For those who are smaller in these parameters, the loss of 1000-1500 ml of blood will be more difficult to bear.

In gynecology, the concept of hemorrhagic shock also has a place to be. This condition can occur with massive bleeding during pregnancy, during childbirth or after them. The reasons here are:

low-lying or prematurely detached placenta;
uterine rupture;
sheath attachment of the umbilical cord;
injury birth canal;
atony and hypotension of the uterus;
increment and tight attachment placenta;
inversion of the uterus;
coagulation disorder.

Signs of hemorrhagic shock

Due to a pathological disturbance of blood microcirculation, there is a violation of the timely supply of oxygen, energy products and nutrients. Oxygen starvation sets in, which increases as quickly as possible in pulmonary system, because of which breathing quickens, shortness of breath and arousal appear. Compensatory redistribution of blood leads to a decrease in its amount in the muscles, which may be indicated by pale skin, cold and wet extremities.

Along with this, metabolic acidosis occurs, when there is an increase in blood viscosity, which is gradually acidified by accumulated toxins. On the different stages shock may be accompanied by other signs, such as:

nausea, dry mouth;
severe dizziness and weakness;
tachycardia;
decrease in renal blood flow, which is manifested by hypoxia, tubular necrosis and ischemia;
blackout in the eyes, loss of consciousness;
decrease in systolic and venous pressure;
desolation of the saphenous veins on the hands.

Causes

Hemorrhagic shock occurs with the loss of 0.5-1 liter of blood along with a sharp decrease in BCC. The main reason for this is injuries with open or closed damage vessels. Bleeding may also occur after surgery, with the decay cancerous tumors in the last stage of the disease or perforation gastric ulcer. Especially often hemorrhagic shock is noted in the field of gynecology, where it is a consequence of:

ectopic pregnancy;
premature detachment of the placenta;
postpartum hemorrhage;
intrauterine death fetus;
injuries of the genital tract and uterus during childbirth;
vascular embolism with amniotic fluid.

Classification of hemorrhagic shock

When determining the degree of hemorrhagic shock and in general the classification of this condition, a complex of paraclinical, clinical and hemodynamic parameters is used. The main value is the Algover shock index. Depending on it, several stages of compensation are distinguished, i.e. the body's ability to restore blood loss, and the severity of the condition with HS in general with specific signs.

Stages of compensation

Signs of manifestation depend on the stage of hemorrhagic shock. It is generally accepted to divide it into 3 phases, which are determined by the degree of microcirculation disturbance and the severity of vascular and heart failure:

The first stage, or compensation (syndrome of small release). The loss of blood here is 15-25% of the total volume. The body redistributes fluid in the body, transferring it from the tissues to the vascular bed. This process is called autohemodilution. As for the symptoms, the patient is conscious, can answer questions, but he has pallor, a weak pulse, cold extremities, low blood pressure and an increase in heart contractions up to 90-110 beats per minute.
The second stage, or decompensation. In this phase, symptoms of oxygen starvation of the brain are already beginning to appear. The loss is already 25-40% of the BCC. Of the signs, there is a violation of consciousness, the appearance of sweat on the face and body, a sharp decline blood pressure, urinary restriction.
The third stage, or decompensated irreversible shock. It is irreversible when the patient's condition is already extremely serious. The person is unconscious, his skin is pale with a marble tint, and blood pressure continues to fall to a minimum of 60-80 millimeters of mercury. or even undefined. In addition, the pulse is not felt on the ulnar artery, it is slightly felt only on the carotid. Tachycardia reaches 140-160 beats per minute.

shock index

The division into stages of GS occurs according to such a criterion as the shock index. It is equal to the ratio of the pulse, i.e. heart rate to systolic pressure. The more dangerous the patient's condition, the greater this index. At healthy person it should not exceed 1. Depending on the severity, this indicator changes as follows:

1.0-1.1 - light;
1.5 - moderate;
2.0 - heavy;
2.5 - extremely severe.

Severity

The classification of HS severity is based on the shock index and the amount of blood lost. Based on these criteria, there are:

First mild degree. The loss is 10-20% of the volume, its amount does not exceed 1 liter.
Second middle degree. Blood loss can be from 20 to 30% up to 1.5 liters.
Third severe degree. Losses are already about 40% and reach 2 liters.
The fourth extremely severe degree. In this case, losses already exceed 40%, which is more than 2 liters in volume.

Diagnosis of hemorrhagic shock

The basis of diagnosis for the presence of HSH is the determination of the amount of blood loss and the detection of bleeding with the degree of its intensity. Assistance in this case consists of the following activities:

clarification of the volume of irretrievably lost blood to compare it with the calculated BCC and the size of infusion therapy;
determination of the condition of the skin - temperature, color, nature of the filling of peripheral and central vessels;
tracking changes in key indicators, such as blood pressure, heart rate and respiration, the degree of blood oxygen saturation;
observation of minute and hour diuresis, i.e. urination;
shock index calculation;
X-ray assessment of the circulatory and respiratory organs;
measuring hemoglobin concentration and comparing it with hematocrit to rule out anemia;
echocardiography;
study of the biochemical composition of blood.

Determining the amount of blood loss

The main criterion for diagnosing HS is the determination of the volume of blood loss. It is difficult to tell exactly how much blood has gone from a person losing consciousness. To determine this quantity, special methods from two groups:

Indirect. These methods are based on a visual assessment of the patient's condition by examining the pulse, skin color, blood pressure, respiration.
Direct. They consist in certain actions, such as weighing napkins soaked in blood, or the patient himself.

Main indicator indirect methods determining the volume of blood lost is the shock index. Its value can be determined by the signs observed in the patient. After that, the specific value of the shock index is correlated with the approximate volume of blood lost, to which it corresponds. This method can be used on prehospital stage. In stationary conditions, the patient is urgently subjected to laboratory research taking his blood for analysis.

Disseminated intravascular coagulation syndrome

by the most dangerous complication hypovolemic shock is disseminated intravascular coagulation syndrome or DIC. It is manifested by a violation of macrocirculation, as a result of which microcirculation stops, which leads to the death of vital organs. The heart, lungs and brain are the first to suffer. Then soft tissues atrophy and ischemia appears. DIC is a condition where, upon contact with oxygen, the blood begins to clot even in the vessels. Because of this, blood clots are formed, which disrupt the circulation process.

Emergency care for hemorrhagic shock

Before medical assistance depends on the cause of the HS. In the event of this condition due to injury, blood loss occurs slowly, so the body responds quickly, including compensatory resources and restoring blood cells. In this case, the risk of death is very low. If the cause of blood loss is damage to the aorta or artery, then only vascular suture and infusion can help here. a large number donor plasma. As a temporary measure, a saline solution is used that does not allow the weakening of the body.

Action algorithm

First aid for hemorrhagic shock, which a non-physician can provide, is to stop the bleeding. To do this, you need to know its reason:

With an open visible wound, it is necessary to use a belt or tourniquet to transfer the damaged vessels. As a result, blood circulation will decrease, but this will only give a few extra minutes. The patient must lie down. He should give plentiful drink and warm with warm blankets.
If it is impossible to determine the cause of blood loss, or if internal bleeding it is required to immediately begin the introduction of blood substitutes. Only a surgeon can deal directly with the elimination of bleeding.
In case of rupture of supply vessels - install exact reason without pre-medical examination it is forbidden. In this case, you need to urgently call an ambulance.

Treatment of hemorrhagic shock

Treatment of HS is aimed at eliminating the cause of bleeding. Indication for surgical intervention is a GSh of the second degree. After that, the following medical measures:

mechanical release of the oral cavity and nasopharynx to eliminate breathing problems;
anesthesia with medicines that do not affect blood circulation and respiration;
combating circulatory disorders, including dehydration, by introducing blood substitutes or blood products through catheterization of the subclavian vein;
stabilization of diuresis and maintaining it active at a level of approximately 50-60 ml per hour.

Volume of blood to be transfused

To replenish blood volumes, specialists inject blood substitutes or donated blood, because solutions and plasma may not be enough. Which way to treat depends on the amount of blood loss. In this case, doctors use the following rules:

with blood loss of less than 25% of the total volume of circulating blood, it can be limited to the infusion of blood substitutes;
small children or newborns are additionally infused with an erythrocyte mass, which is half the volume;
with a decrease in BCC to 35%, the use of erythrocyte mass and blood substitutes is indicated, which are taken in a ratio of 1: 1;
a prerequisite is the excess of the volume of transfused fluids over blood loss by 15-20%;
severe shock with a decrease in the volume of BCC by 50% is compensated by blood substitutes with erythrocyte mass (2: 1), the value of which is twice the amount of lost blood.

Possible consequences

It is difficult to say exactly about the development of specific consequences after significant blood loss. They depend on the massiveness of bleeding, the amount of BCC lost and the physiology of the patient himself. Someone has a disruption of the neural system, others have only weakness, although there are cases with an instant loss of consciousness. Possible consequences include:

kidney failure, damage to the lung mucosa or partial atrophy brain. Such consequences can occur even with timely infusion therapy.
After strong shock Stages 2-4 in most cases require long-term rehabilitation with the restoration of the normal functioning of the brain, kidneys, lungs and liver. Working out new blood takes 2-4 days.
With postpartum shock, loss of reproductive function is possible due to removal fallopian tubes or uterus.

Video: what is shock

hemorrhagic shock It is customary to call the totality of responses of the organism of a generalized nature to acute blood loss. Usually, the shock clinic develops when the amount of blood loss is more than 15% of the BCC.

Acute blood loss is a starting factor for the development of a chain of compensatory reactions aimed at maintaining adequate functioning, first of all, of vital systems and organs. Under conditions of a significantly reduced BCC (a state of normocythemic hypovolemia is formed), perfusion of absolutely all tissues of the body becomes impossible, therefore, blood supply to critical organs is ensured to the detriment of peripheral tissues. This phenomenon is called centralization of the blood supply and is provided by the biological effects of catecholamines. Their release from the adrenal glands is perhaps the first response of the body in response to acute blood loss. Possessing a vasoconstrictor effect, catecholamines cause spasm of small-caliber vessels, thereby blocking the blood supply to peripheral tissues. The appearance of arteriovenous shunts bypassing the capillary network contributes to the redistribution of blood into the main vessels, due to which the perfusion of vital organs is maintained at the proper level. The duration of the period of such compensation is directly dependent on the volume of blood loss.

Ischemia of peripheral tissues leads to a gradual accumulation of incompletely oxidized metabolic products in them, and the extent of ischemia increases as the tissue blood supply decompensates. This, in turn, leads to an increase in metabolic acidosis, which, ultimately, with untimely assistance, covers all systems and organs - multiple organ failure is formed, which in itself is a very poor prognostic sign and indicates a severe degree of shock.

Criteria by which one can judge the progression of hemorrhagic shock:

Increasing impairment of consciousness (gradual transition from mild stupor to stupor), decreased mobility, emotionality, etc.;
A gradual decrease in blood pressure (indicates decompensation of the pumping function of the heart, an increase in heart failure, the development vascular collapse);
Progressive increase in pulse, weakening of its strength, first on the peripheral, and then on the central arteries;
Increase in the rhythm of breathing with the appearance of elements abnormal breathing(the latter indicates a severe degree of shock).

For any shock, including hemorrhagic, the traditional division into two successive phases is characteristic:

Erectile (excitation phase). Always shorter than the phase of inhibition, it characterizes the initial manifestations of shock: motor and psycho-emotional arousal, a restless gaze, hyperesthesia, pallor of the skin, tachypnea, tachycardia, increased blood pressure;
Torpid (braking phase). The clinic of excitation is replaced by a clinical picture of inhibition, which indicates a deepening and aggravation of shock changes. A threadlike pulse appears, blood pressure drops to below normal levels, up to collapse, consciousness is disturbed. The victim is inactive or motionless, indifferent to the environment.

The torpid phase of shock is divided into 4 degrees of severity:

I degree: slight stupor, tachycardia up to 100 beats / min, systolic blood pressure of at least 90 mm Hg. Art., urination is not disturbed. Blood loss: 15-25% of the BCC;
II degree: stupor, tachycardia up to 120 beats / min, systolic blood pressure of at least 70 mm Hg. Art., oliguria. Blood loss: 25-30% of the BCC;
III degree: stupor, tachycardia more than 130-140 beats / min, systolic blood pressure not more than 50-60 mm Hg. Art., urination is absent. Blood loss: more than 30% of the BCC;
IV degree: coma, the pulse on the periphery is not determined, the appearance of abnormal breathing, systolic blood pressure less than 40 mm Hg. Art., multiple organ failure, areflexia. Blood loss: more than 30% of the BCC. Should be regarded as a terminal state.

Diagnosis and treatment of hemorrhagic shock

chief opening event in the diagnosis and treatment of HSH is to determine the localization of bleeding, especially if it continues. In the latter case, the decisive measure is its reliable stop. In conditions first aid it is possible to use only temporary methods to stop bleeding: digital clamping of a bleeding vessel or application of a tourniquet proximal to the injury site (with arterial bleeding) or pressing aseptic dressing(with venous bleeding). signs arterial bleeding : scarlet blood, flows out under pressure up to a gushing jet, signs of hemorrhagic shock increase rapidly. signs venous bleeding : blood is dark cherry color, flows from the wound under slight pressure. Compensation of body functions is maintained for a relatively long period of time.

Another obligatory and urgent measure of help in hemorrhagic shock is the replenishment of the BCC. Almost the entire arsenal of blood-substituting solutions is used: from physiological saline(0.9% saline solution) and ending with low molecular weight dextrans. However, blood preparations have been and remain the most preferred when replenishing BCC: erythrocyte and platelet masses, fresh frozen plasma. Only doctors have the right to transfuse them to the victim, since this requires mandatory control of group affiliation, checking the suitability of the blood product even with the expiration date indicated on the label.

Manifestations of severe blood loss are eliminated exclusively first on the operating table (in the presence of bleeding, which becomes possible to stop only surgically), and then under the conditions intensive care unit. The main efforts, in addition to eliminating bleeding and replenishing BCC, are aimed at combating multiple organ failure, dynamic monitoring of critical indicators: pulse, blood pressure, central venous pressure, hourly diuresis. Be sure to regularly take blood for the study of its gas composition, pH level. Symptomatic treatment is carried out.

Hemorrhagic shock is called severe, requiring emergency assistance a condition in the body that can cause severe blood loss. A critical condition leads to polysystemic and multiple organ failure.

This is pathological disorder blood microcirculation, which interferes with the timely entry of nutrients, energy products and oxygen into the tissues.

It turns out that hemorrhagic shock is a condition in which there is no removal of toxins from the body.

oxygen starvation comes gradually - depending on the intensity of the loss of an important biological fluid. If blood loss is more than 500 milliliters, hemorrhagic shock occurs. This most dangerous condition can also lead to death, since blood circulation is disturbed or completely stopped in the lungs and brain tissue.

On the causes of the onset of a dangerous condition and the mechanism of its progression

The main reason for the onset of hemorrhagic shock is serious injuries leading to blood loss. Vessel injuries can be closed and open. The second reason for the pathological condition is severe bleeding caused by diseases of the uterus, perforation of the gastric ulcer, decay of cancerous tumors in the last stages of the development of the disease.

In gynecological patients, shock from blood loss can be caused by: rupture of the ovary, spontaneous abortion or artificial termination of pregnancy, uterine fibroids and injuries of the genital organs, cystic drift.

The central link in the pathogenesis of hemorrhagic shock is a violation of the systemic circulation. The amount of circulating blood drops very quickly. Naturally, the body's systems cannot quickly respond to this loss.

Through the nerve endings, the receptors transmit “alarm signals”, which lead to an increased heartbeat, spasms of peripheral vessels, increased respiration, followed by centralization of blood circulation, when the biological fluid begins to actively circulate through the vessels of some internal organs. There is a further decrease in pressure, stimulation of baroreceptors.

Gradually, all organs, with the exception of the brain and heart, cease to participate in blood circulation. The amount of oxygen in the pulmonary system decreases as quickly as possible, which leads to the inevitable lethal outcome.

Manifestations and shock signs of blood loss

Medical specialists identify the main signs of hemorrhagic shock that can be observed when it occurs.

These include:

Dry mouth and nausea.
Excessive weakness and severe dizziness.
Darkening in the eyes and even loss of consciousness.
Compensatory redistribution of blood and a decrease in its amount in the muscles leads to blanching of the skin. A gray tint may appear if the person is about to lose consciousness.
Hands and feet become damp and clammy from cold sweat.
Violations of blood microcirculation in the kidneys lead to hypoxia, tubular necrosis and ischemia.
There is severe shortness of breath, impaired respiratory function.
Violation of heart rhythms and excessive excitement.

According to these signs of shock from blood loss, medical specialists can accurately diagnose this condition. Immediate detection of pathology by symptoms is required in order to be able to avoid a fatal outcome.

The main indicators of the state of a suffering person include:

Temperature and color of the epidermis.
Pulse rate (may show hemorrhagic shock only when combined with other symptoms).
Shock index - is considered the most informative indicator of a serious condition. This is the ratio of pulse rate to systolic pressure. In a healthy person, it should not be more than 0.5.
Hourly diuresis. Its gradual decrease will indicate the onset state of shock.
Hematocrit index. This is a test that can reveal the adequacy or inadequacy of the blood circulation in the body.

Intensity of development of hemorrhagic shock

Dangerous manifestations are not the same at different stages of hemorrhagic shock. There is the following generally accepted classification, according to which the symptoms of this disease are gradually detected:

First stage

This is a compensated shock that occurs when sharp decline circulating blood volume by fifteen percent. AT clinical picture minor ejection syndrome is dominated by signs such as moderate and oliguria, a sharp blanching of the skin, its absence or a clear decrease. Central venous pressure does not change.

Compensated shock can last quite a long time if not provided urgent care. As a result, the progression of a dangerous condition occurs.

Second stage

This is a subcompensated hemorrhagic shock, in which the BCC decreases by about 18 - 20 percent. Decreased arterial and central venous pressure, weakness, darkening of the eyes and dizziness, severe tachycardia - all these are signs of the second degree of severity of hemorrhagic shock.

Third stage

Received the name of uncompensated or decompensated reversible shock. Blood loss reaches thirty to forty percent. It is characterized by a significant deepening of circulatory disorders. Significantly decreases blood pressure due to severe vascular spasm.

Additional symptoms are also highlighted:

Severe tachycardia and severe shortness of breath.
, rapid pulse, skin pallor.
Cold sweat and decreased oliguria.
A sharp slowdown in human behavior.
The normal blood supply to the heart, kidneys, liver, lungs and intestines is gradually disrupted, which inevitably leads to tissue hypoxia.

Fourth stage

Decompensated or irreversible shock. This is the most serious condition and is fatal in most cases. The decrease in circulating blood volumes is approaching 45 percent or more. Tachycardia reaches 160 beats per minute, and the pulse is not actually felt, the patient's consciousness is completely confused.

The skin takes on an unnatural marble hue, that is, they turn pale against the background of clearly defined blood vessels. Systolic pressure at this stage decreases to critical levels - up to 60 mm Hg. There is hyporeflexia and anuria.

Further disturbance of microcirculation leads to irreversible loss of plasma, stupor and severe coldness of the extremities. Significantly increased respiratory distress. At the last stage of hemorrhagic shock, urgent hospitalization should be carried out so as not to lose the patient.

Help with shock

Emergency care for hemorrhagic shock should be very prompt, especially if the patient's condition has reached a critical degree of severity. First you need to quickly call the brigade medical professionals and then try:

Stop bleeding if it is not internal. Be sure to use harnesses, whatever you find at hand. Bandage or gently compress the wound until the ambulance arrives.
Eliminate any items that you think may interfere with the person's breathing. Be sure to unbutton the tight collar. In case of an accident, it is advised to first remove from oral cavity any foreign bodies that could get there, including vomit, fragments of teeth, if necessary. Such assistance can be provided by a non-professional physician who happened to be at the scene. Try to prevent the tongue from falling into the nasopharynx. All of these manipulations will help a person not to suffocate and survive until the arrival of professionals.
If possible, non-narcotic painkillers should be given to the victim. Lexir, Tromal and Fortral are best. Please note that these medicines should not affect the work of the respiratory and circulatory system. Also Baralgin and Analgin can help in this situation. These funds are normally combined with antihistamines.

After hospitalization: actions of specialists

If a patient in a state of hemorrhagic shock was successfully hospitalized, doctors carry out overall rating his condition.

The indicators of respiration, blood pressure are measured, the stability of consciousness is determined. Doctors then proceed to stop the loss of body fluid.

This is main measure to remove a person from a state of shock and prevent death.

Be sure to carry out infusion intensive therapy with constant simultaneous monitoring of hourly diuresis. Similar actions with therapy in two or three veins are relevant if the decrease in circulating blood volume is up to forty percent or more.

You will also need to inhale 100% oxygen through a special mask and injection adrenaline. It can be replaced by dopamine-containing drugs.

Medical professionals after hospitalization should perform the following actions:

Use catheters for oxygen inhalation.
Insert a catheter into the patient's central vein to provide free access to the vessels. With a strong loss of biological fluid, this will not be enough - you will have to use the femoral vein.
Next begins infusion therapy(it was mentioned above in connection with a large blood loss).
Evaluation of the effectiveness of infusions and control of urination of the patient with the help of an installed Foley catheter.
Blood test.
The doctor should prescribe analgesics and sedatives.

In the process of providing first aid and treatment, it is very important to determine the source of blood loss and try to alleviate the patient's condition, stop the loss of biological fluid, as much as possible at the moment.

In a different situation, the victim simply will not have a chance to live until the arrival of qualified doctors. Seventy percent of patients die before the ambulance arrives.

In medicine, hemorrhagic shock is called extensive blood loss, an unexpected release of blood from the vascular bed. This phenomenon usually develops quite rapidly and can lead to grave consequences up to a tragic outcome. What are the signs to diagnose hemorrhagic shock, and what kind of help can those around a person with sudden onset of bleeding be able to provide?

Causes of hemorrhagic shock

The root causes of hemorrhagic shock - various damage, injuries, surgeries, etc.

Note. According to medical statistics Hemorrhagic shock in obstetrics takes the 1st place in the frequency of occurrence.

Abundant acute blood loss occurs in expectant mothers in the case of:

gap fallopian tube- consequences of ectopic pregnancy;
uterine rupture;
some types of uterine bleeding;
so-called acute fatty liver of pregnancy.

The consequences of this condition can be:

the development of oncological diseases of the female genital organs;
sepsis accompanied by tissue necrosis;
ovarian apoplexy.

Hemorrhagic shock is also considered as a result of late or incorrectly selected therapy for such conditions / diseases as:

cholera;
diabetes;
peritonitis;
sepsis;
cancer;
osteomyelitis;
prolonged stay in an environment with elevated temperature air;
pathology that provokes dehydration of the body, etc.

Indirect causes of shock development are:

Incorrect assessment of bleeding features - volume or speed.
The wrong way to replenish lost blood.
Incorrect/late error correction during blood transfusion.
Belated/incorrect choice of medications that can stop blood loss.

What determines the severity of shock

The basis of the disruption of the body's vital functions in hemorrhagic shock is a sharp decrease in blood volumes distributed through the vessels. A decrease in the amount of blood provokes a spasm in these very vessels. The result is the transition of tissue fluid into the channels of the vessels, which contributes to the thinning of the blood, the violation of its microcirculation in the organs.

The lack of timely assistance threatens with global failures of microcirculatory processes and endangers human health and even life.

The intensity of blood loss depends on a number of determining factors:

body endurance;
fortresses of immunity;
states nervous system(it is directly involved in the control of vascular tone);
heart disease, etc.

Hemorrhagic shock is a state of critical imbalance in the body caused by a rapid single loss of blood. As a result of violations, the vessels cannot cope with the volume of blood circulating through them.

The development of hemorrhagic requires emergency care, because its result is critical in organs and tissues, which leads to dangerous manifestations and the consequences. The conditions are recognized as life-threatening, since the stress reaction of the body does not allow in full manage his system.

Mechanisms for the development of pathology

It should be noted right away that the rate of blood loss affects the development of hemorrhagic shock. That is, even significant blood loss will not cause a pathological condition if it proceeds slowly. This fact is explained by the compensation mechanisms that “turn on” to work at the signal of the body, because it has enough time to make up for the missing amount of blood balance. Whereas with the suddenness of the onset of bleeding, even half a liter of lost blood will lead to acute oxygen starvation of tissues.

The severity of hemorrhagic shock depends on five factors:

The ability of a particular organism to nervous regulation vascular tones;
The level of blood clotting;
State of cardio-vascular system and its capabilities when working in conditions of acute hypoxia;
The presence or absence of additional oxygen supply to tissues;
The state of the immune system.

Note!

In a patient with chronic pathologies internal organs, the chances of surviving hemorrhagic shock are extremely small.

The average filling of arteries and veins with blood is about 5 liters. 75% of this volume is received by veins or, as they are also called, the venous main flow. Therefore, the rate of recovery of the body depends on the state of the venous system, the possibilities of its adaptation. Sharp blood loss 1/10 of total blood does not allow you to immediately replenish the missing amount from the depot. Venous pressure drops rapidly, so the body directs the remaining blood centrally: it “saves” the tissues of the heart, lungs and brain. Muscle and skin tissue, the intestines begin to play a secondary role and are soon completely excluded from the blood supply.

The lack of blood also affects the loss of ejected volume during the period of systolic contraction. A small amount of this blood output is only enough to provide blood coronary arteries, and tissues and internal organs it is not received at all. In an emergency, endocrine protection begins, manifested in increased production of hormones. It helps stop fluid loss by blocking the urinary capacity of the kidneys.

In parallel with the loss of potassium, the concentration of sodium and chlorides increases. Due to excessive synthesis of catecholamines, vasospasms begin, which causes vascular resistance. Oxygen starvation of tissues provokes increased concentration slags, which quickly destroy the vascular walls.

Numerous blood clots begin to form, which, in the form of accumulated cellular elements, settle in the vessels. In such cases, there is a risk of developing irreversible blood coagulation processes in the vessels.

The heart works in an enhanced mode, increasing the number of contractions, but these emergency measures not enough: due to the rapid loss of potassium, the ability of the myocardium to contract decreases, therefore, heart failure develops rapidly, and blood pressure indicators are rapidly falling.

Causes and manifestations

Violation of blood microcirculation, which causes hemorrhagic shock, is caused by an open or closed type. The causes and signs of pathology are always associated with a sharp loss of at least 1 liter of blood. These include the following factors:

Postoperative period;
The collapse of malignant tumors at the final stage of oncology;
Perforation of a gastric ulcer;
Ectopic pregnancy;
Premature placental abruption;
Abundant postpartum blood loss;
Frozen pregnancy;
Injury to the birth canal during delivery.

The main signs of shock are the following manifestations of the clinical picture:

The heart and lungs work in an accelerated mode: the heartbeat and breathing become more frequent;
Psycho-emotional arousal;
Paleness of the skin, their moisture;
Nausea;
Feeling of dry mouth;
Weakness and dizziness;
Desolation of the veins under the skin on the hands;
The appearance of dark circles before the eyes;
accompanied by extremely .

Symptoms differ significantly at different stages of the development of pathology.

The severity of hemorrhagic shock and the specifics of its manifestations are presented in the table.

Note!

Blood loss of more than 40% is potentially life-threatening for the patient! In this case, his condition requires urgent resuscitation.

You should be aware that blood loss in children is evaluated by other indicators. For a fatal outcome, a newborn baby needs to lose up to 50 ml of blood. In addition, such a condition in children is much more complicated: in their bodies, compensation processes have not yet been fully formed.

Diagnostic measures

Diagnostic measures for hemorrhagic shock are aimed at determining the amount of blood lost. Appearance the patient cannot give objective data. Therefore, to clarify the stage of shock, 2 methods are used:

indirect ways. The determination of blood loss is carried out using a visual examination of the patient and an assessment of the work of the main organs and systems: the presence of pulsation, blood pressure, skin color and breathing patterns.
direct methods. The essence of the methods is to determine the weight of the patient himself or the materials with which the blood was stopped.

Indirect methods of assessing the patient's condition can help calculate the shock index. To do this, you need to determine the vital signs of the victim and compare them with approximate indicators of the degree of blood loss. The definition of the shock index, as a rule, is done at the stage before hospitalization. In a hospital setting, diagnostic data are refined using laboratory tests.

Urgent measures

Emergency care for hemorrhagic shock is based on 2 main tasks:

Stop blood loss;
Prevent dehydration.

Considering that its immediate stop, the algorithm of urgent actions will be as follows:

Use or special bandages to stop bleeding;
Lay the victim down, because in the presence of the first stage of shock, the patient is in a state of euphoria and may make attempts to move independently;
Let the person drink as much as possible pure water without gases;
Warm it up with any means at hand: blankets, clothes, heating pads.

Regardless of the patient's condition, if hemorrhagic shock is suspected, you should immediately call medical workers. His life depends on how quickly professionals begin to provide emergency assistance to the victim.

Actions of professionals

To rule out an attack severe complication, medical assistance begins to be provided on the way to medical institution. At the same time, therapeutic measures are carried out, which consist in performing three actions:

To replenish the necessary balance in the blood system and stabilize cell membranes, catheters are installed on peripheral veins;
To maintain the exchange of gases and the necessary patency in the respiratory organs, a special probe is installed. In case of emergency, use the device for artificial ventilation lungs;
Install catheters in the area of the bladder.

After the victim is taken to a medical facility, diagnostic measures to determine the severity of shock, and then proceed to intensive care. Actions medical staff are carried out according to an urgent algorithm:

The necessary laboratory tests are being carried out;
On an emergency basis, preventive measures are started to prevent the development of Wernicke's encephalopathy;
In case of emergency, narrow profile antidotes are used;
Eliminate puffiness meninges and reduce intracranial pressure;
Use symptomatic therapy aimed at eliminating and;
During the period of stabilization of the patient's condition in without fail monitor pressure, pulse, cardiac activity, the amount of urine excreted.

It should be noted that the actual therapy is carried out only after stabilization of the patient's condition. The standard set of drugs that improve the replenishment of the bloodstream is as follows:

Vitamin C and medicines containing it;
Ganglioblockers for relief of the effects of vein spasms;
In order to improve cardiac metabolism use riboxin, carvetin and cytochrome;
Developing may require the inclusion of prednisolone and hydrocortisone to improve the contractility of the heart muscles;
Kontrykal is used to normalize blood clotting.

Therapy emergency hemorrhagic shock has been tested for many years and recognized as successful with strict adherence to medical prescriptions and dosage medications. For fixing therapeutic actions rehabilitation after treatment is important, which includes gentle exercise therapy.

Replenishment of the bloodstream

In case of significant blood loss, to prevent irreversible consequences, the victim is urgently given a blood transfusion. The procedure is performed according to certain rules:

Blood loss within 25% is compensated by its substitutes;
For babies under the age of three, the missing volume is compensated by blood with the addition of red blood cells in proportions of 1 to 1;
With blood loss up to 35% of the BCC, the compensated solution should consist of blood, its substitutes and erythrocyte mass;
The volume of fluids artificially introduced into the body must exceed the blood loss by 20%;
In the case of a decrease in the volume of BCC by half, the liquid is administered more than 2 times, while the number of erythrocytes should also exceed blood substitutes by 2 times.

Emergency measures are stopped when the patient's condition stabilizes, which manifests itself in the normalization of blood pressure, cardiac activity and diuresis.