Shock, hemorrhagic

Other forms of shock (hemorrhagic, cardiogenic, septic)... 

Normal saline is an isotonic fluid composed of water, sodium, and chloride. It provides primarily ECF replacement and can be used for virtually any cause of TBW depletion. Common uses of normal saline include perioperative fluid administration volume resuscitation of shock, hemorrhage, or burn patients fluid challenges in hypotensive or oliguric patients and hyponatremia. 

Immediate Care Shock, airway problems, chest injury, crush injury, amputation, open fracture Class I (emergent) Red Critical life threatening—compromised airway, shock, hemorrhage... 

Nephrotoxins or ischemic disorders can initiate acute renal failure. Shock, hemorrhage, septicemia, or vasodilation due to hypertensive medication can precipitate ischemic acute renal failure. Systemic reactions to certain drugs and nephrotoxins such as aminoglycoside antibiotics and heavy metals lead to acute renal failure. The extent of retention of creatinine and urea in blood is directly related to the severity of acute renal failure. This condition is not readily reversible and, as such, should be distinguished from reversible phenomena such as prerenal or postrenal azotemia, in which there is also an increase in levels of plasma urea and creatinine (13). In volume-depleted states, for example, diarrhea, the kidney is hypoprefused. This results in increased back diffusion of urea into the circulation from the tubular fluid because of the reduced urine flow. In addition to an increase in urea levels in circulation, there is also a slow increase in creatinine levels. Plasma urea and creatinine levels can be restored to normal within 24 hours by appropriate fluid and electrolyte replacement in prerenal azotemia. In condi-... 

Most iron salts and compounds may be safely handled following common safe laboratory practices. Some compounds are irritants. A more serious threat is ingestion of massive quantities of iron salts which results in diarrhea, hemorrhage, fiver damage, heart damage, and shock. A lethal dose is 200 250 mg/kg of body weight. The majority of the victims of iron poisoning are children under five years of age. 

World War II ushered ia the modem era of blood fractionation. It was shown that plasma could be adniinistered directiy to humans (23,24). Although cases of semm sickness frequendy occurred five to seven days after the iafusion, the procedure could be life-saving ia cases of hemorrhagic shock (see Fractionation, blood) (25). 

Plasma protein fractions include human plasma protein fraction 5% and normal serum albumin 5% (Albuminar-5, Buminate 5%) and 25% (Albuminar-25, Buminate 25%). Plasma protein fraction 5% is an IV solution containing 5% human plasma proteins. Serum albumin is obtained from donated whole blood and is a protein found in plasma The albumin fraction of human blood acts to maintain plasma colloid osmotic pressure and as a carrier of intermediate metabolites in the transport and exchange of tissue products. It is critical in regulating the volume of circulating blood. When blood is lost from shock, such as in hemorrhage, there is a reduced plasma volume. When blood volume is reduced, albumin quickly restores the volume in most situations. 

The IV solutions of plasma expanders include hetastarch (Hespan), low-molecular-weight dextran (Dextran 40), and high-molecular-weight dextran (Dextran 70, Dextran 75). Plasma expanders are used to expand plasma volume when shock is caused by bums, hemorrhage surgery, and otiier trauma and for prophylaxis of venous thrombosis and diromboembolism. When used in die treatment of shock, plasma expanders are not a substitute for whole blood or plasma, but tiiey are of value as emergency measures until die latter substances can be used. 

Whole blood Blood cell and volume replacement for hemorrhagic shock, surgery... 

Renal Effects. Hemorrhage of the medullary layer of the kidneys was observed in an early report of three fatal cases of acute oral poisoning with endosulfan (Terziev et al. 1974). More recent studies have reported acute renal failure after ingestion of endosulfan as a major contributing cause of death in two individuals in both cases, postmortem examination showed extensive tubular necrosis (Blanco-Coronado et al. 1992 Lo et al. 1995). Neither case discussed the possible mechanism of endosulfan-induced acute renal failure, but in one case, the authors of the report indicate that the renal lesions may relate to sepsis and shock (Blanco-Coronado et al. 1992). Ingested doses were not determined in any of these cases, and it is not totally clear that the effects observed at autopsy were a direct result of endosulfan exposure, although based on results from acute animal studies, it seems likely. 

Preparations of human albumin have been widely used in the treatment of hemorrhagic shock and of burns. Flowever, this treatment is undet teview because some recent smdies have suggested that administration of albumin in these conditions may increase mortality rates. 

Blood products are indicated in adult hypovolemic shock patients who have sustained blood loss from hemorrhage exceeding 1500 mL. 

Decreased hemoglobin/hematocrit (hemorrhagic hypovolemic shock)... 

Generally, the major adverse effects associated with colloids are fluid overload, dilutional coagulopathy, and anaphy-lactoid/anaphylactic reactions.24,32 Although derived from pooled human plasma, there is no risk of disease transmission from commercially available albumin or PPF products since they are heated and sterilized by ultrafiltration prior to distribution.24 Because of direct effects on the coagulation system with the hydroxyethyl starch and dextran products, they should be used cautiously in hemorrhagic shock patients. This is another reason why crystalloids maybe preferred in hemorrhagic shock. Furthermore, hetastarch can result in an increase in amylase not associated with pancreatitis. As such, the adverse-effect profiles of the various fluid types should also be considered when selecting a resuscitation fluid. 

Late The skin becomes violaceous and progressively gangrenous hemorrhagic bullae may be present. Septic shock may ensue. 

Bacterial and viral infections Immunological depression Hemorrhagic and endotoxin shock Altered drug response... 

Intravenous administration of rTNF induces a disease state that closely resembles septic shock accompananied by tissue damage (M28, T12). TNF induces fever, leukocyte aggregation, hypotension, stress hormone release, lung edema, and hemorrhagic necrosis of various organs (T12). 

J. Puyana, B. Soller, S. Zhang, and S. Heard, Continuous measurement of gut pH with near infrared spectroscopy during hemorrhagic shock. J. Trauma 46, 9-15 (1999). 

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