Lecture of shock in obstetrics

2021-03-20 12:00 AM

Genital tract infections, amniotic infections cause disturbances in the metabolism of organizational cells, causing a severe decrease in the ability to use cellular oxygen due to damaged cell membranes.

General perception

Dizziness is a medical condition resulting from a lack of tissue oxygen mainly due to a decrease in blood supply to the organ, or an impaired ability to use oxygen by the organ's cells (eg, an infection or intoxication...) - In obstetrics often dizziness caused by trauma decreased blood volume due to bleeding. Shock toxic infection caused by genital infection.

Causes of obstetric shock

Due to the loss of bloody blood because:

Trauma causes bleeding (tearing of the vaginal soft tissue, tearing the cervix, rupture of the uterus, perforation of the uterus, bleeding and often accompanied by pain that causes more shock).

Vegetable forwards.

Young vegetables, unfinished vegetables, combs.

Endometriosis after childbirth, after abortion, especially stillbirth.

Due to infection, intoxication (toxin caused by bacteria):

Genital tract infections, infection of amniotic fluid (in which the gram (-) bacteria disturbs the metabolism of the organizational cells, causing shock and the ability to use oxygen in cells is greatly reduced due to damaged cell membranes.

Suffering from a lot of pain:

Due to difficult labor trauma, surgical intervention is not adequately anesthesia, anesthesia, and supportive resuscitation. There is a psychotic manifestation in an abnormal state.

Favorable factors

When the above causes are accompanied by the following favorable factors, the shock will occur in obstetrics.

Have heart disease.

Pregnancy poisoning.

Prolonged labor, not good health condition before giving birth, so much fatigue.

Fear and poor tolerance.

Symptoms and diagnosis

With shock due to blood loss and ch publications injured

Symptoms and diagnosis are based on the following factors (for all glands):

Screening:

Pale, tired, sweating on lips, forehead, lethargic appearance, cold limbs, sometimes struggling, struggling (due to hypoxic muscle contraction).

Fast, shallow (gasp) breathing.

The pulse is fast, small, skim (sometimes difficult to pulse) or without a spin, if severe blood loss (lOOOml or more).

Low blood pressure, sometimes not measured (if severe blood loss or trauma, or severe mental and mental dizziness ...). These are the clinical signs at any level that can be seen and should have a timely, positive, and technically correct attitude.

Subclinical:

Testing depends on the ability of each route that:

You see a decrease in red blood cells (more or less depending on how the bleeding).

Hematocrit less than 30% (causing severe hypoxia).

Central venous pressure can be measured.

Measure blood pH (would be <7.2, normal is 7.35-7.4).

Electrolytes have: increased blood potassium decreased blood sodium.

Prognostic factors:

It is important to determine the amount of blood lost, whether it is a specific measurement or an approximate calculation, but remember that a blood loss of 30-50% (equivalent to 1,600-2.OOOml) is dizzy and a loss of more than 50% ( equivalent to more than 2,000 ml of blood) often stunned, irreversible, easily fatal without good emergency management and management.

Clinical measurements usually estimate less blood loss than the actual loss. Therefore, for the grassroots health level or higher, if the amount of blood loss from 350-500ml is seen for Vietnamese women, it is necessary to have the right attitude in time (from referral to real treatment for each level). Specifically, at the grassroots level, it is generally a trip to the higher level when these signs appear. care should be taken to the grassroots level to immediately invite the upline to support with severe shock (risk of no recovery) because of dangerous moving.

Dizziness of obstetric infection

Clinical symptoms and diagnosis (in any glands can be seen).

Clinical:

Fatigue, lethargy, cold hands and feet, struggling, sometimes calling out a hot, fever.

High fever, chills (39-40 ° C), sometimes hypothermia.

Small fast circuit.

Low blood pressure, stuck, fluctuated.

Central venous pressure decreased (at measured routes: Province, Central).

Rapid, deep breathing (threat of respiratory failure).

There are purple petechiae in the extremities (fingers, knees).

There may be muscle pain, stiffness of the jaw.

Little urine, liver, kidney, cardiovascular failure (severe).

Subclinical:

At higher levels: provincial obstetric centers, the highest level should have blood and fluid analysis (depending on ability at the level to be able to do) the following tests:

Leukocytes increase> 15,000-20,000, of which 80-90% are neutrophils (acute inflammation).

Blood urea increased, urine urea decreased (poor excretion).

Increased blood sugar due to increased secretion of catecholamine.

Transaminase increased.

Culture of visible germs (+).

Treatment

Management of obstetric shock caused by blood loss

Purpose to achieve:

Make up for the lost volume of blood (or blood replacement fluid).

Supply the cells with oxygen.

Eliminate (limit me with multiple bleeding causes, if the lower glands before going to a specialist).

Treatment needed:

Oxygen through the nose or supportive respiration.

Fresh blood transfusion of the same group or blood replacement solution:

With a fast infusion rate by multiple lines to be able to reach 500ml / 5 minutes or 1000ml in the first 10 minutes (then the equivalent of flowing close to the flow) to bring the maximum blood pressure to 70 or 80 mmHg just reduce the infusion rate to 100 to 120 drops/min until the blood pressure reaches 100-120mmHg.

Trying at the gland to have supplementary blood transfusion with 2/3 of the lost amount.

Ringer lactate is 1/4 of the calculated compensation.

Dextrose is 5% -10% of the calculated compensation.

Blood replacement fluids (polymers such as gelafundin, fresh plasma, etc., if any, should not exceed 1,000ml / 24 hours).

Cardiovascular support:

Cardiovascular support with dopamine 5-10mcg / kg / min (200mg tube mixed with 500ml 5% glucose infusion 20-25 drops / min).

Diuretics:

Furosemide, lasic diuretics depending on which type are available. If the urine is large (over 700ml- 1000ml), it should not be used during the day.

At higher levels, it is necessary to do some tests on fibrinolytic acid, balance acidosis (to keep pH from 7.35-7.4, an alkaline reserve of 20-26mEq), and if acid metabolism is required. :

Anti-acidosis:

Natribicarbonat 1,4% x 500ml.

Ringer lactat X 500ml.

Anti-coagulation disorder: depending on the case, using:

Transamin 250-500mg intravenously.

Bibrinogene l-4g intravenously.

Treatment of the cause of bleeding: hysterectomy if it is due to uterine sputum or ruptured uterus

metastatic nuclear rupture of the uterus. Before that, it is necessary to carefully examine the soft tear area from the vulva, vagina to the cervix to handle bleeding effectively.

Follow

Is there still bleeding? (tachycardia, blood pressure drop ...?).

If the pulse slows down, the blood pressure decreases gradually, which is a severe prognosis, which is easy to be an irreversible shock, so a transition to a higher level is necessary and needs to be taken quickly to have higher interventions and more active due to the much higher equipment and qualifications - antibiotics to prevent superinfection.

Treatment of obstetric toxic infections

Target

Improving hemodynamic disorders by infusion of solutions to restore blood volume (including blood if there is severe anemia through the number of erythrocytes, haemoglobin...).

Sufficient supply of oxygen to the cells.

Improving functional disorders of the heart, liver, kidneys, respiratory system.

Eliminate pathogens of bacteria.

Specific work

Oxygen (blood oxygen pressure> 80mmHg).

Natribicarbonate alkaline infusion 1,4% x 500ml.

Ringer lactate 1,500-2000ml with an infusion rate of 20ml / min, if the central venous pressure is less than 5cm water, then infusion must be done until this pressure reaches 12cm of water.

Cardiac support, increased circulation: dopamine 200mg for infusion 5-10mcg / kg / min in 5% glucose solution x 500ml.

Fights inflammation and infection with:

Prednisolon 80mg / 6 hours.

Antibiotics according to antibiotic (if there is no antibiotic, then use lactamin, aminozit that works with gram (+) bacteria or ciproílonxalin if thinking of coccidiosis.

Treat the cause of the infection.

Drainage of pus.

Withdraw the bladder sonde.

Get rid of that infection.

Follow up

Functions:

Respiration (breathing rate and breathing pattern).

Circulation (blood pressure, pulse).

Urology (urine: quantity, test).

Theoretically

To prevent disease (need to emphasize to prevent the dizziness from occurring)

In obstetrics, pregnant women must be closely monitored to detect: bleeding during labor, postpartum, risk of infection for early management, early referral before dizziness occurs at grassroots levels (commune, district).

Reduce favorable factors for obstetric stunning:

Detect related diseases in pregnancy.

The surgical procedures must be strictly indicated, gentle with emotion, and pain relief before the procedure.

The aseptic and sterilization regime and rules must ensure good medical examination and delivery as well as treatment.

Prevent obstetric complications

Acute renal failure (due to excessive blood loss, increased secretion of catecholamine causes renal vasoconstriction -> decreased blood flow to the renal cortex - »causes kidney necrosis).

Respiratory failure: due to pulmonary stasis, bronchitis - lung.

Acute heart failure (due to inhibition, impaired cardiac circulation, myocardial floss).

Gastrointestinal bleeding: is a serious complication of irreversible dizziness.