Hemorrhage and Shock Chapter 4

Hemostatic Agents

• Combat hauze, Hemcon dressing, and Celox are hemostatic agents.

Neurogenic Shock

• Typically occurs after an injury to the spinal cord at the sixth thoracic vertebra or above.
• The SNS is shut down, resulting in no vasoconstriction.
• Clinical presentation:
  • No pale skin, no tachycardia, and no sweating (due to lack of catecholamine release).
  • Normal or slow heart rate, decreased blood pressure, warm, dry, and pink skin.
  • May have accompanying paralysis.
• Patients may look better than their actual condition.

Hypovolemic Shock

• Can be considered as mechanical shock.
• Signs of shock appear after losing 1 L of blood.
• First sign of late shock is hypotension.
• Clinical presentation:
  • Pale skin, thready pulse (weak radial pulse), flat neck vein, tachycardia, and sweating.

Obstructive Shock

• Can be caused by:
  • Tension pneumothorax.
  • Cardiac tamponade.
  • Massive pulmonary embolism.

Tension Pneumothorax

• Clinical presentation:
  • Agitated, cyanosis, decreased level of consciousness.
  • Decreased or absent breath sounds on the affected side.
  • Hyper-resonance to percussion.
  • JVD and tracheal deviation (as a late sign).
  • Possible subcutaneous emphysema.
• Needle decompression is indicated when:
  • Absent radial pulse, cyanosis, and loss of consciousness.

Cardiac Tamponade

• Clinical presentation:
  • Trachea midline, normal breath sound.
  • Hypotension, narrow pulse pressure.
  • Beck's triad: JVD, pulses paradoxus, and muffled heart sound.

TXA

• Should be given as early as possible.