Excessive bleeding

Introduction It is common in bleeding caused by trauma, bleeding from peptic ulcer, rupture of esophageal varices, and bleeding caused by obstetrics and gynecology. Whether or not shock occurs after blood loss depends not only on the amount of blood loss, but also on the rate of blood loss. Shock is often caused by rapid, large (more than 30 to 35% of total blood) blood loss without timely replenishment.

Cause

A large amount of bleeding usually caused by traumatic or surgical failure leading to hemostasis. Contraction of small arteries such as skin and abdominal organs can increase peripheral resistance to maintain blood pressure, and reduce blood flow in these tissues and organs to ensure blood supply to important organs such as the heart and brain; increased precapillary resistance and capillary fluid statics The pressure is reduced, which causes the tissue fluid to enter the blood vessel to increase the plasma volume. In addition, the arteriovenous anastomosis is open, and the venous contraction reduces the venous volume (normally about 70% of the blood is in the vein), which can accelerate and increase the amount of blood returning, and is also beneficial to The maintenance of blood pressure and the blood supply to the heart and brain. However, most of the tissues and organs are hypoxic due to insufficient perfusion of microcirculation arterial blood.

an examination

Related inspection

Blood routine dynamic blood pressure monitoring (ABPM)

There is bleeding and pale, fainting, lower blood pressure, cold sweat, cold hands and feet, weakness, shortness of breath, rapid pulse and weak symptoms can be diagnosed. When the blood loss is large, causing severe low-volume shock, and it is difficult to grasp the actual and regular changes in the clinical, especially if the rehydration therapy is difficult to show positive effects, it should be considered that the central venous catheter or pulmonary artery can be placed. Catheter for invasive hemodynamic monitoring. Central venous pressure (CVP) and pulmonary wedge pressure (PCWP) were reduced by central manometry, cardiac output was reduced, venous oxygen saturation (SVO2) was reduced, and systemic vascular resistance was increased.

Differential diagnosis

Care should be taken to identify bleeding from the visceral system.

There is bleeding and pale, fainting, lower blood pressure, cold sweat, cold hands and feet, weakness, shortness of breath, rapid pulse and weak symptoms can be diagnosed.

The shock index is used to estimate the amount of blood loss, shock index = pulse rate / systolic blood pressure *. The normal value is 0.58, indicating normal blood volume, index = 1, about 800 to 1200 ml of blood loss (20% to 30% of total blood volume), index > 1, blood loss 1200 to 2000 ml (30% to 50% of total blood volume) .

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