ROLE OF TXA IN MANAGEMENT OF TRAUMATIC HEMORRHAGE IN THE FIELD Roy Alson, MD, PhD, FACEP, FAAEM and Sabina Braithwaite, MD, MPH, FACEP INTRODUCTION Hemorrhagic shock remains a serious problem for the multiple trauma patient. Spinal Shock vs. Neurogenic Shock • Spinal shock » Temporary, up to 2-3 days » Like a spinal cord contusion or stunned cord » Loss of motor and sensation » Loss of all spinal cord reflexes, even below level of injury • Neurogenic shock » Hemodynamic phenomenon due to loss of sympathetic innervation • Bradycardia and hypotension • Vasodilation of arteriovenous system Patients with shock following major trauma have sustained significant blood loss until proven otherwise. emergency department bach mai hospital, hanoi. the use of txa michael m. neeki , do,ms, facep. 1,2 Septic shock has a mortality of up to 50%. FLUID MANAGEMENT • Start with large bore venous access: + Can use compressor bag + Ringers lactate is common - Choose NS 0.9% if suspected hyperkalemia - NS 0.9% can be used for the line of blood transfusion. Emergency DepartmentBach Mai Hospital, Hanoi, Objectives • Definition of traumatic shock • Recognition of shock stages and severity • Management of shock according to stages and severity, DEFINITION OF SHOCK • Inadequate organ perfusion and tissue oxygenation. rbc in fibrin mesh. Hemorrhagic shock is an important contributor to postresuscitation organ failure and late mortality. Symptoms and diagnosis • Hemorrhagic shock: • Manifestations: • Obvious blood lost: Hematemesis, black or bloody stools. publisher the goodheart-willcox co., inc. tinley park, illinois. Identify the source of haemorrhage Airway / C-spine 1 Protect airway, secure if unstable. 3) Anaphylactic Shock. It happens when a child experiences symptoms like fear or shock for at least one month post a traumatic event. definition of. 1) Hpyovolemic Shock. It is the most common form of shock seen in … If you continue browsing the site, you agree to the use of cookies on this website. TRAUMATIC SHOCK. Clipping is a handy way to collect important slides you want to go back to later. Respiratory Distress. See our Privacy Policy and User Agreement for details. The article presents literature review on the use of extracorporeal shock-wave therapy in physiotherapeutic practice. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Hypovolemic Shock. Consequently, an anaphylactic shock could be considered a traumatic event that may lead to PTSD. - Ieinfosoft pvt.ltd is an innovative and committed provider of ongoing, Full Service Moving Plano TX - PowerPoint PPT Presentation - Stonebriar moving services is a full service moving company. If you continue browsing the site, you agree to the use of cookies on this website. traumatic shock: Etymology: Gk, trauma, wound; Fr, choc the emotional or psychological state after trauma that may produce abnormal behavior. TRAUMATIC SHOCK We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. goal. Non-traumatic, non-cardiac chest pain. Although there are other possible causes of circulatory collapse in trauma victims, such as tension pneumothorax, central nervous system injury and pericardial tamponade, in the vast majority of these patients shock is due to blood loss. 59 DEFINITION AND PATHOPHISIOLOGY OF SHOCK. The basic mechanisms of shock waves influence on the organism are spotlighted. Symptoms and diagnosis • Hemorrhagic shock: •  Respiratory disorders: tachypnea, cyanosis • Oliguria, anuria • Monitor, assessment of the severity of blood lost: • Orthostatic hypotension: BP  > 20 mmHg, pulse > 20 BPM: 10-20% blood lost • Supine hypotension: >20% blood lost, Symptoms and diagnosis • Non-hemorrhagic shock (Hypovolemia): • Causes: dehydration or electrolyte disturbance • Manifestation: mainly symptoms of dehydration and electrolyte disturbance • ECF dehydration • ICF dehydration • Others: oliguria, cold, Consequences of shock Consequences of shock: • Kidney: acute renal failure • Lungs: ARDS • Heart: hypoxic heart failure, metabolic acidosis, cardiac muscle stress • GE: gastric ulcers or bleeding • Liver: failure • Pancreas: edema, necrosis • Endocrinological glands: pituitary gland is most vulnerable in bleeding  necrosis (Sheehan syndrome). Head Injury.ppt - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online. drain and squeeze ... alternatives directly. ... BOOD PRESSURE REGULATION(ROLE OF NEURO-ENDOCRINE SYSTEM), INITIAL ASSESSMENT AND MANGAGEMENT OF SHOCK. Ambu bag or endotracheal intubation for ARF • Monitoring for heart rate, blood pressure, SpO2, EKG • Basic labs: CBC, hematocrit, platelets, blood group, fibrinogen, prothrombin. 2) Cardiogenic Shock. Pathophysiology of Traumatic Shock Richard P. Dutton S HOCK, a condition of decreased total body oxygen delivery, can be brought on by a num- ber of mechanisms. introduction to elevations. do ngoc son md., phd. objectives. Explain Contraindications And Make PPT. Post-traumatic stress disorder (PTSD), also called as shell shock, battle fatigue, accident neurosis and post rape syndrome, 1. Traumatic shock is most commonly associated with haemorrhage, although non-haemorrhagic shock can be found in trauma in the form of cardiogenic or neurogenic shock. thaitraumanurse@gmail.com. Shock As Resulting From “a Significant Fall In The Blood Volume PPT Presentation Summary : shock as resulting from “a significant fall in the blood volume due to hemorrhage or a loss of body fluids” and . PPT Presentation - Robert d. ballard fulfilled his dream of a lifetime in locating the remains of the titanic. z. Tissue acidosis is eliminated. for component therapy in traumatic hemorrhage shock and recent data specifically addressing hemostatic concerns of cold-stored whole blood, it appears cold-stored whole blood may be a suitable blood product for trauma resuscitation in hemorrhagic shock, in … Create Presentation Download Presentation. Scribd is the world's largest social reading and publishing site. Emergency Department Bach Mai Hospital, Hanoi. Do you have PowerPoint slides to share? (aka: psychological shock) -Results from physical/mental stress, fear, or pain in accordance with/from PTSD, usually subsides within a few hours or even days -symptoms include: initial state of "daze", inability to comprehend imformation, low attention, & agitation. Rapid and effective control of This study aimed to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized adult patients and its association with shock at a Level I trauma … CONTENTS Definition Diagnosis Causes of shock Evaluating the cause of shock Stabilization Checklist Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) Shock is a state of systemic hypoperfusion, with inadequate blood supply to the tissues. z. Objectives. Emergency treatment Emergency treatment • Position: head down, open the airway • Breathing: O2 4-8 LPM. Hypovolemic shock is a life-threatening condition that results when you lose more than 20 percent of your body's blood or fluid supply, preventing the heart from pumping sufficient blood to … Management of the Trauma Patient Hieu Ton-That, MD, FACS Loyola University Medical Center Division of Burns, Trauma and Surgical Critical Care talk-ppt - PowerPoint Presentation - Make your work visible in popular websites, wikipedia, youtube, facebook, myspace, PowerPoint Presentation. Unfortunately, this may occur in different ways. See our User Agreement and Privacy Policy. Definition of traumatic shock Recognition of shock stages and severity Management of shock according to stages and severity. For every unit of red blood cells, a unit of platelets and a unit of fresh plasma is given: • 1 unit blood cell : 1 unit plasma : 1 unit platelets • Consider auto transfusion, Emergency treatment • Urinary catheter placement • If fluid infusion and blood transfusion is adequate, CVP >7 but still hypotension: • Dopamine: 5- 20 g/kg/min • If failed: add Dobutamine • If failed: add Norepinephrine, Emergency treatment • Ventilatory support if respiratory failure is detected • Identify and treat the causes • Trauma  operate, FLUID MANAGEMENT • Large venous access> 18 F if possible • 2 lines in case of stage 3-4 of shock • Vasopressors are not indicated if circulatory volume is not adequate. Hemorrhage is the most important contributing factor of acute-phase mortality in trauma patients. In order to be diagnosed with PTSD, a person needs to experience an event that meets the following criteria: The experience or witnessing of an event where there is a threat of death or serious injury. ¾. Resuscitation is complete when: z. It is the leading cause of preventable trauma deaths after loss of airway. Emergency treatment • Large venous access: • 500-1000ml Ringer lactate (NaCl 0.9%)/15-20 min. shock as “resulting from a Temp. Chest Injury. Studies proving high efficacy of the method in treatment of wide variety of inflammatory diseases and traumatic genesis are presented. The PowerPoint PPT presentation: "TRAUMATIC SHOCK" is the property of its rightful owner. CHAIR PERSON: Prof. Dr. M.A.Balakrishna SHOCK Introduction and Historical background Classification of shock Patho-physiology of shock Neuro endocrine response in Shock Stages/Severity of shock Hypovolemic shock Traumatic shock Septic shock Cardiogenic shock Obstructive shock Neurogenic shock End points in Resuscitation INTRODUCTION • Shock is defined … Explain contraindications and make sure the reasons why those are contraindications are Create stunning presentation online in just 3 steps. TRAUMATIC SHOCK - PowerPoint PPT Presentation. TRAUMATIC SHOCK Do Ngoc Son MD., PhD. It is a medical condition where an individual perform an abnormal behavior. about your project. PowerPoint Presentation - . Emergency DepartmentBach Mai Hospital, Hanoi. Currently, pharmacological treatments are limited by high rates of relapse, and novel treatment approaches are needed. T.C. The most common types are hypovolemic shock from blood loss and neurogenic shock caused by a disruption of the integrity of the spinal cord. do ngoc son md., phd. • Thirsty, dizziness, vertigo, agitation, LOC. DEFINITION AND PATHOPHISIOLOGY OF SHOCK. traumatic . DEFINITION OF SHOCK. Traumatic Injuries, Bleeding & Shock - . ภาวะช็อกจากการบาดเจ็บ Severe hemorrhage after injury carries a mortality rate of 30% to 40% and is responsible for almost 50% of deaths occurring within 24 hours of injury. 6) Traumatic Shock. ... PITFALLS • Not all traumatic shock patients go through all 4 stages • In healthy young adults, the heart rate may be normal even patients are on stage 2 or 3. the hypotensive resuscitation versus standard resuscitation study, PPT (PowerPoint Presentation) Combat Pest Control - Combat pest control provides pest control services across manitoba, 1800 Drivers PPT - PowerPoint PPT Presentation - 1800drivers is the leading truck drivers recruitment and driver hire, IEinfosoft.Pvt.Ltd Powerpoint PPT Presentation. PPT PRESENTATION - Why isn’t turkey successful in pisa research?. > 38 C or < 36 C 2. Post-traumatic stress disorder (PTSD) is a common consequence of exposure to a life-threatening event. ผศ.ดร.กรองได อุ ณ ห สู ต ¾. Hemorrhage is the most common cause of shock in the injured patient. DISTRIBUTIVE SHOCK • As in hypovolemic shock, there is an insufficient intravascular volume of blood • This form of "relative" hypovolemia is the result of dilation of blood vessels which diminishes systemic vascular resistance • Examples of this form of shock : Septic shock Anaphylactic shock Neurogenic shock 51 52. 58 Traumatic Asphyxia. The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients. on…..powerpoint presentations!!. definition of, PowerPoint Presentation - . Traumatic Asphyxia Management Ensure airway Oxygen 15 lpm if available Initiate large bore IV and treat for shock Treat other injuries Transport to nearest medical facility. Oxygen debt is repaid. Respiratory Distress. - Using the contract services of, PowerPoint presentation - Summary of preparation and cooking of soy foods. COMPENSATED SHOCK • Progresses until causes of shock are treated or continues to next stage • Difficult to diagnose due to obscure symptoms • Tachycardia • Signs of reduced skin perfusion • Altered mental status • Some medication (B- blockers) could undermine the symptoms by preventing the tachycardia. emergency department bach mai hospital, hanoi. This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. area. Perform Secondary Survey SIGNS OF SHOCK? HR > 90 bpm 3. PowerPoint Presentation - . Traumatic Brain Injury. • Circulatory … Shock is defined as the failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Objectives • Definition of traumatic shock • Recognition of shock stages and severity • Management of shock according to stages and severity. RR > 20 bpm 4. Now customize the name of a clipboard to store your clips. Circulatory shock has a high mortality. Circulation 1 Secure venous access x 2 large bore cannula. Trauma leads to traumatic shock. Hemorrhagic Shock. . Do Ngoc Son MD., PhD. Combat Trauma Treatment. objectives. TYPE OF SHOCK. ¾. Resuscitation requires: z. Previously, traumatologists and investigators identified iatrogenic and resuscitation-associated causes of coagulopathic bleeding after traumatic injury, including hypothermia, metabolic acidosis, and dilutional coagulopathy that were recognized as primary drivers of bleeding after trauma. UNCOMPENSATED SHOCK • Physiological responses • Pre-capillary sphincter opens • Hypotension • Reduced cardiac output • Blood accumulate in capillary bed • Aggregation of the erythrocytes, UNCOMPENSATED SHOCK • Easier to diagnose than compensated shock: • Longer capillary refill time • Marked increased heart rate • Increased and thready pulses • Agitated, disorientated and confused • Hypotension, IRIVERSIBLE SHOCK • Failed compensated mechanism • Sometimes difficult to distinguish • Resuscitatable but high mortality (ARDS, ARF, hepatic failure, sepsis) • Prolonged organ ischemia, cellular death, MODS: brain, lung, heart and kidney • Coagulation disorders (DIC), Cellular O2 deficiency A. Lactic production Cellular energy starvation Anaerobic metabolism Metabolic disorders Metabolic acidosis CELL DEATH CELULAR O2 DIFFICENCY, INITIAL ASSESSMENT AND MANGAGEMENT OF SHOCK • Initial clinical manifestation may be poor • Identification of the causes is not so as important as prompt treatment for shock • Aim of treatment is recover the circulatory volume and shock management • It is important to exam shock patient regularly to assess their response, ETIOLOGIES • Blood lost • Trauma • Fracture of long bone or opened fracture • Plasma lost due to burn, ETIOLOGIES • Fluid lost to third compartment • Causes: • Peritonitis • Burn, INTERNAL HEMORRHAGE • Hematemesis, black or bloody stools • Hemoptysis • Pleural effusion of blood (Hemothorax) • Peritoneal effusion of blood (Hemoperitoneum) 22, STAGES OF HEMORRHAGIC SHOCK • Stage 1: blood lost < 15% total blood volume • Stage 2: 15-30% total blood volume • Stage 3: 30-40% total blood volume • Stage 4: > 40% total blood volume, STAGE 1 • Blood lost < 750 mL • Total blood volume (%): 0-15% • Central nervous manifestation: slightly anxious • Systolic BP: normal • Diastolic BP: normal • Respiratory rate: 14 - 20 BPM • Pulse < 100 • Urine output: > 30 ml/h • Treatment : Crystalloid infusion (ratio 3/1), STAGE 2 • Blood lost : 750 – 1500 mL • Total blood volume (% ): 15 – 30% • Central nervous manifestation: mild anxious • Systolic BP: normal • Diastolic BP: increased • Respiratory rate: 20 - 30 BPM • Pulse > 100 • Urine output: 20 - 30 ml/h • Treatment: Crystalloid or blood transfusion, STAGE 3 • Blood lost: 1500 - 2000 mL • Total blood volume (%): 30 – 40% • Central nervous manifestation: Anxious and confused • Systolic BP: decreased • Diastolic BP: decreased • Respiratory rate: 30 – 40 BPM • Pulse > 120 • Urine output: 5 - 15 ml/h • Treatment: Crystalloid or blood transfusion, STAGE 4 • Blood lost > 2000 mL • Total blood volume (%) > 40% • Central nervous manifestation: Confused Lethargic • Systolic BP: decreased • Diastolic BP: decreased • Respiratory rate > 40 BPM • Pulse > 140 • Urine output: Negligible • Treatment: colloid, blood and surgery, PITFALLS • Not all traumatic shock patients go through all 4 stages • In healthy young adults, the heart rate may be normal even patients are on stage 2 or 3, SEQUENCES OF EXAMINATION Order of ABC • A = Airway • B = Breathing: + O2 supply + Assisted ventilation, SEQUENCES OF EXAMINATION Order of ABC • C = Circulation: + Hemostasis by local bandage + Blood volume replacement by fluid infusion + Identification of obstructive shock: - Tension pneumothorax: prompt thoracocentesis - Cardiac tamponade: prompt Pericardiocentesis. pressure >90mmHg for those with a traumatic brain injury. You can change your ad preferences anytime. 4) Neurogenic Shock – Vasovagal or Psychogenic Shock. Hypovolemic shock results due to loss of blood and neurogenic shock due to destruction of spinal cord integrity are the common types of traumatic shock. If so, share your PPT presentation slides online with PowerShow.com. The term “shock” may refer to a psychologic or a physiologic type of shock. SIRS: 1. No public clipboards found for this slide, student at M.Gorky National Medical University, Donetsk, M.Gorky National Medical University, Donetsk. ... Clinical signs of life-threatening cardiac tamponade (cardiac shock with hypotension, tachycardia and diminished heart sounds), congestive heart failure due to acute aortic valve regurgitation or acute haemorrhagic shock may be present. 1 Control of c-spine. POSITION OF INFUSION • Upper extremity peripheral vein: preferred  precaution in case of upper extremity fracture • Central veins: sub-clavian and internal jugular vein: best choice even at stage 4  risk of pneumothorax (chest X ray is needed after procedure), © 2021 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. Hemostasis In Traumatic Hemorrhagic Shock - . • Circulatory system failed to meet the metabolic demand of the body, Preload Stroke volume Cardiac output Blood pressure ARTERIAL BLOOD PRESSURE Cardiac contractility Afterload Heart rate Systemic vascular resistance, BOOD PRESSURE REGULATION(ROLE OF NEURO-ENDOCRINE SYSTEM) • Pressure receptors located at the aortic arch and carotids • Sympathoadrenal axis  regulate the release of catecholamine • Renin-angiotensin-aldosteron system  blood vessel tone and urine secretion, PHYSIOLOGICAL RESPONSES DURING SHOCK • In normal condition, the body can compensate for the reduction of tissue perfusion • When the compensated capabilities are overloaded  SHOCK  irreversible shock if undetected and untreated, PHYSIOLOGICAL RESPONSES DURING SHOCK • Systemic vascular constriction • Increased blood flow primarily to important organs (brain, heart) • Increased cardiac output • Increased respiratory rate and tidal volume • Decreased urine output • Decreased gastroenterological activity, COMPENSATED SHOCK • Defense mechanism try to maintain the blood perfusion to main organs by: • Constrict the pre-capillary sphincter, blood bypasses capillary through shunt • Increased heart rate and cardiac muscle contractility • Increased respiratory activity, bronchial dilation. 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