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Shock

Shock. Critical Concepts - Surgery. SHOCK. “Rude unhinging of the machinery of life” -Gross. “A momentary pause in the act of death” -Dr. Cowley. SHOCK. Inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function. Types of Shock. Hypovolemic

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Shock

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  1. Shock Critical Concepts - Surgery

  2. SHOCK “Rude unhinging of the machinery of life” -Gross “A momentary pause in the act of death” -Dr. Cowley

  3. SHOCK Inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function.

  4. Types of Shock • Hypovolemic • Cardiogenic • Neurogenic (distributive) • Septic (distributive) • Obstructive

  5. Types of Shock

  6. Types of Shock • Hypovolemic • Cardiogenic • Neurogenic (distributive) • Septic (distributive) • Obstructive

  7. How to Resuscitate • ABC’s • Choice of line? • What to use? • Rate of administration? • How much? • When to stop?

  8. ABCDE’s • Airway • Breathing • Tension ptx? • Circulation • Tamponade? • Disability • Neurogenic shock? • Exposure • Signs of hemorrhage/trauma?

  9. Intravenous Access

  10. Intravenous Access Hagen-Poiseuile Law

  11. Which fluid? • Crystalloid • Lactated ringers • Normal Saline • Colloid • Synthetic • Albumin • Blood • plasma

  12. Rate?

  13. How much?

  14. How much? • Bolus • 1 liter • Blood • 1:1 • Massive Transfusion • >10 PRBCs in 24 hrs

  15. When to stop? • Vital signs • UOP • Base deficit • Lactate

  16. HEMOSTASIS METHODS

  17. Objectives • Review general concepts about achieving hemostasis in a bleeding subject • Discuss non-surgical compression and tourniquet methods • Discuss surgical methods using sutures, ligatures, and other devices • Understand the application and use of pelvic binders for pelvic fractures

  18. GENERAL CONCEPTS • Direct control • Be as specific (pinpoint) as possible • Avoid collateral damage • Injury to tissue around point of control • Distal ischemia • Temporary versus permanent

  19. Types of Control • Non-Surgical • Compression • Tourniquets • Pro-coagulant products • Surgical • Ligation • Suturing/Stapling • Cautery

  20. Non-Surgical Control- Compression Applying direct pressure to the source o bleeding Usually the best first step Usually done wrong

  21. Keys to Success 1- Pinpoint Source of Bleeding a- Use minimal surface area - Concentrate pressure to exact source of bleeding b- Use minimal gauze -Gauze is for ABSORPTION - Fold minimal amount of gauze into minimal size of square

  22. Keys to Success 2- Apply consistent pressure A- Get into a comfortable position B- Apply bandage/device whenever possible Pressure Dressing

  23. Non-Surgical Control- Tourniquet • Circumferential compression cutting of blood flow to distal limb/appendage • Generally frowned upon • Only when direct pressure cannot be applied due to the nature of the injury • Amputations • Near-amputations • a

  24. Keys to Success • Complete cessation of arterial blood flow • Non-elastic bandage • Tight enough to cause pain • Dress the open wound

  25. Surgical Hemostasis • Bleeding Skin/Tissue Edges • Suture • Staple • Dressing/Adhesive • Severed vessel • Suture • Ligation • Clip • a

  26. Bleeding Skin/Tissue Edges • Wash out wound whenever possible • Suture • Simple interrupted • Simple running • Locking running • Horizontal mattress • Staple • Faster but less available • Dressing/Adhesive • Only if able to temporarily staunch the blood low

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