Treatment of shock

How best to combat shock if U are alone?? Management of Obstet shock ??

Urgent interference is indicated as follow:

Detect the cause and arrest haemorrhage.

Establish an airway and give oxygen by mask or endotracheal tube.

Elevate the legs to encourage return of blood from the limbs to the central circulation.

Two or more intravenous ways are established for blood, fluids and drugs infusion which should be given by IV route in shocked patient. If the veins are difficult to find a venous cut down or intrafemoral canulation is done.

Restoration of blood volume by:

Whole blood: cross-matched from the same group if not available group O-ve may be given as a life -saving.

Crystalloid solutions: as ringer lactate, normal saline or glucose 5%. They have a short half life in the circulation and excess amount may cause pulmonary oedema.

Colloid solutions: as dextran 40 or 70, plasma protein fraction or fresh frozen plasma.

Drug therapy:

Analgesics: 10-15 mg morphine IV if there is pain, tissue damage or irritability.

Corticosteroids: Hydrocortisone 1gm or dexamethasone 20 mg slowly IV. Its mode of action is controversial; it may decrease peripheral resistance and potentiate cardiac response so it improves tissue perfusion.

Sodium bicarbonate: 100 mEq IV if metabolic acidosis is demonstrated.

Vasopressors: to increase the blood pressure so maintain renal perfusion.

Dopamine: 2.5m g/ kg/ minute IV is the drug of choice.

ß -adrenergic stimulant: isoprenaline 1mg in 500 ml 5% glucose slowly IV infusion.

Monitoring:

Central venous pressure (CVP): normal 10-12 cm water.

Pulse rate.              

Blood pressure.

Urine output: normal 60 ml/hour.

pulmonary capillary wedge pressure: Normal 6-18 Torr.

Clinical improvement in the: pallor, cyanosis, air hunger, sweating and consciousness.

Complications

Acute renal failure.

Pituitary necrosis (Sheehan’s syndrome).

Disseminated intravascular coagulation