外科急诊创伤(英文)-休克及出血PPT.ppt

Hemorrhage Shock;Sections ;Hemorrhage Abnormal internal or external loss of blood Homeostasis Tendency of the body to maintain a steady and normal internal environment Shock INADEQUATE TISSUE PERFUSION Transition between homeostasis and death;SHOCK;“But a more careful examination soon serves to show that deep mischief is lurking in the system; that the machinery of life has been rudely unhinged, and the whole system profoundly shocked; in a word, that the nervous fluid has been exhausted” ( A System of Surgery, 1859);Represents a generalized failure of the body to deliver sufficient amounts of O2 to its tissues S/S represent compensation measures utilized by the body to maintain delivery of O2 to vital organs Delay of appropriate therapy, cascade of events results in damage to organs;Treatment Goals;Hemorrhage;Cardiovascular System;Components;Circulatory System;Cardiac Output;Blood Pressure;Stroke Volume;Inotropy;Fick Principle;O2 Delivery;Cellular Metabolism;Glycolysis;No O2 present, hypoperfusion, pyruvic acid converted to lactic acid Liver converts some lactic acid Generalized shock Amount of lactic acid exceeds the liver’s ability to convert it Muscle and skin can function in aerobic conditions for short period Brain most sensitive to hypoxia;Kreb’s Cycle;Electron Transport;Cellular Metabolism;Circulatory System;Blood Vessels;Hydrostatic and Oncotic Pressure;Proximal capillary Hydrostatic pressure prevails Allows intravascular fluid and nutrients to diffuse out of capillary Distal capillary Oncotic pressure is dominant Draws fluid from interstitial fluid and waste of metabolism into capillaries;Blood;Function;Acidosis;Alkolosis;Hemorrhage Classification;Clotting;Clotting;Factors Affecting Clotting;Hemorrhage Control;Tourniquets are ONLY used as a last resort!;Hemorrhage Control;Early S/S Internal Hemorrhage;Late S/S Internal Hemorrhage;Hemorrhage Control;Stages of Hemorrhage;15% loss of CBV 70 kg pt = 500-750 mL Compensation Vasoconstriction Normal BP, Puls