Obstetrics and gynecology. Modern technologies for providing emergency infusion and transfusion care for acute massive blood loss (the most important)

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Obstetrics and gynecology. Modern technologies for providing emergency infusion and transfusion care for acute massive blood loss (the most important)

Lecture notes, cheat sheets

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40. Modern technologies for providing emergency infusion-transfusion care for acute massive blood loss

The scheme of infusion-transfusion intensive therapy for acute massive blood loss:

1) ensure an adequate supply of oxygen;

2) assess the most important vital signs (pulse, blood pressure, respiratory rate per minute, patient adequacy) and, based on the combination of these indicators, determine the severity and approximate volume of blood loss. There are four degrees of severity of acute massive blood loss:

a) I-I degree of severity: the volume of blood loss < 750 ml; the volume of blood loss < 15% of the BCC (< 15% of the BCC); pulse < < 100; BP (mm Hg) - norm; pulse pressure (mm Hg) - normal; respiratory rate - 14-20; hourly urine output > 30 ml/h; the state of the central nervous system - mild arousal;

b) II-nd degree of severity: the volume of blood loss - 750-1500 ml; the volume of blood loss is 15-30% of the BCC; pulse > > 100; BP (mm Hg) - norm; pulse pressure (mm Hg) is reduced; respiratory rate - 20-30; hourly diuresis - 20-30 ml / h; the state of the central nervous system - excitation;

c) III-rd degree of severity: volume of blood loss - 2500-2000 ml; the volume of blood loss is 30-40% of the BCC; pulse > 120; BP (mm Hg. Art.) reduced; pulse pressure (mm Hg) is reduced; respiratory rate - 30-40; hourly diuresis - 5-15 ml / h; state of the central nervous system - lethargy;

d) IV-th degree of severity: the volume of blood loss > > 2000 ml; volume of blood loss > 40% of BCC; pulse > > 140; BP (mm Hg. Art.) reduced; pulse pressure (mm Hg) is reduced; respiratory rate > 40; hourly diuresis (ml / h) is absent; state of the central nervous system - precoma;

3) examine blood for group affiliation by erythrocyte antigens. Take blood for a general clinical analysis (Hb, Ht, erythrocytes, platelets), for a biochemical study (creatinine, electrolytes, total protein), for a coagulogram (clotting time, prothrombin, APTT, fibrinogen, clotting time);

4) further carry out therapy in accordance with scheme 1 or, if the hospital has a solution of "Infucol HES" 6- or 10%, with scheme 2.

Sequencing. If indicated, catheterize any available vein and begin infusion of a solution of crystalloids and colloids based on the amount of measured or estimated blood loss. The rate of solution transfusion is 100 ml/min until blood pressure is stabilized at an average level. Calculate the sum of the upper and lower numbers and divide by 3. The result should not be lower than 60. Catheterize the bladder. For blood loss of 1500 ml (30% of blood volume) or more, transfusion of up to 1500 ml of fresh frozen plasma is mandatory. If bleeding continues, the total volume of blood loss is more than 2 liters, instability of hemodynamic parameters, increasing pallor of the conjunctiva and the appearance of congestion, proceed with red blood cell transfusion. If there are no red blood cells of one group, you can use red blood cells 0 (I) Rh neg.

Author: Ivanov A.I.

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