Shock is a condition of circulation breakdown due to various causes, which reduces or stops the blood supply, oxygen to nourish the muscles especially important agencies such as the heart, lungs, brain. This is a dangerous situation that requires medical staff to have a timely and positive attitude to be able to save the lives of patients.
1. General overview
The common obstetric shock is shock of blood loss in obstetrics (post-calving blood bandages, miscarriage of blood bandages, rupture of the uterus …) or bacterial infections (post-production infections, infective abortions …).
Common types of shock in obstetrics and gynecology
1.1 Shock caused by blood loss
- Rupture of the uterus
- Genital and biological layer tearing
- Missed each other
- Uterine phlegm
- Vegetable Striker
- Young peeled vegetables
1.2 Septic shock
In obstetrics and gynecology, septic shock is usually caused by:
- Common in unsafe abortions.
- Missed vegetables after calving.
- There is inflammation in the proboscis and ovulation ducts, or pre-20s genitals.
- Rupture of the uterus comes late.
1.3 Amniotic embolism shock
Amniotic embolism is rare, may be encountered during normal calving or fooc-tearing intervention, or cesarean section. Clinically usually stands out three syndromes: Shortness of breath, cardiovascular collapse, coaculation disorders.
Small rapid circuits (vessels usually > 110 times per minute), sometimes unevenly, peripheral circuits do not catch.
- Hypotension < 90/60 mmHg.
- Blue skin (around the lips, eyelids and palms).
- Cold limbs due to peripheral contractions.
- Shallow rapid breathing (breathing is usually over 30 times per minute).
- Neglect, wrestling or coma.
- Oliguria or anuria.
- Depending on the cause of shock, there are different clinical manifestations.
In the face of a case of shock, active initial treatment is very important to save the person through the critical illness.
- Call on everyone to come and help and provide first aid to the sick.
- Check for signs of survival: Blood pressure, breathing rate, temperature.
- Ensure ventilation of the airways by lying on the head low (or returning to one side if the person vomits).
- Suck sputum if the patient secretes a lot of sputum and ngƣời oxygen breathing through the nose at a rate of 6-8 liters / min. In the commune if there is no oxygen tank that can allow the person to breathe oxygen through an oxygen bag, it is best to pass oxygen through a water tank to ensure sufficient moisture.
- Compensate for retest volume with rapid intravenous infusion of isthat solution (Ringer lactat), sugar solution should not be used to re-compensate for the retress volume. In case of emergency, it is necessary to make multiple lines at once. The rate of infusion can be up to 1 liter of infusion in 15-20 minutes, in the first hour 2 liters of infusion must be transmitted. Try to compensate fluids at a rapid rate in case of shock due to bleeding, the volume of fluid compensated needs to be 2-3 times the volume of blood lost.
- In the case of blood bandages must by all means stop the bleeding immediately and consider blood transfusions to the patient. Whether or not to decide on blood transfusions is based primarily on clinical and hemoglobin testing < 50g/lít.
- Check for signs of survival every 15 minutes.
- Blood formula test, renal liver function, blood clot factors …
- In case of septic shock, blood culture, epidemic implantation finds the cause of the disease and then immediately takes broad-spectrum antibiotics and combines antibiotics, when antibiotics are available, they should be used according to antibiotics.
Handling according to the cause of shock
After the initial treatment of the patient has stabilized, the cause of shock will be determined.
Shock caused by blood loss
- Determine the cause of bleeding and handle he stop bleeding immediately: Bleeding may be possible due to miscarriage, miscarriage of eggs or due to rupture of the intra-uterus pregnancy. It is also possible to bleed in the last months of pregnancy or in labor nhƣ of forward vegetables, young peeling vegetables, rupture of the uterus, to post-calving genital trauma or uterine phlegm causing blood ice. In these cases it is necessary to quickly either with medication or by procedure or surgery to prevent bleeding.
- Blood transfusions as soon as possible compensate for the lost circulation volume.
- Cardiovascular aid: Intravenous dopamine
- Fight blood clot disorders with the use of fibrine anti-pepper drugs and blood products.
Shock caused by bacterial infections and intoxication
- Intramuscular injection of high-dose combination antibiotics (can ampicilin 1g and gentamycin 160 mg), initial active resuscitation and upline transfer.
- Oxygen breathing, infusion.
- Cardiac support.
- High-dose antibiotics coordinate and follow antibiotics.
- Treatment of the cause of infection: Purulent conduction, removal of the bacterial drive (shearing of the uterus).
- It is necessary to make the maternity feel secure, less anxious in the days near birth and during labor.
- It is not recommended to let the maternity work until the date of calving.
- It is recommended to apply pain relief methods during calving such as painless calving, local anesthesia, horsetail anesthesia, oxygen relief for women after long labor, difficult calving.
- If an emergency cesarean section is required, in-administration anesthesia with an oxygen rate of at least 60%.
- Pay attention to the maternity position, if you lie on your back and your blood pressure drops, you must immediately shift your lying on your side. Watch out for reflux for new women who eat full.
- Early detection and active treatment of cases of gestational intoxication or heart valve diseases must be detected.
- Iron must be given during pregnancy, if the maternity is severely anemic (red blood cells less than 3 million, blood cells less than 10g / 100ml).
- Here do not rely on hematocrit, because it is incorrect. Blood transfusions are required, but preparations must be made in advance.
- You have to choose blood to take and when you get a blood giver to starve, there is no viral hepatitis, use blood of the same group (cross-try 2 times).
- Diings (lasix x 20mg) must be given to the dilfare maternity, pre-urinating a volume of water of at least 500ml before starting a blood transfusion. For every 500ml of urine, it is passed into 250ml of blood. To avoid the risk of excessive transmission, do not transmit a large volume at once. In circumstances of urgency should also only transmit no more than 500ml of blood (if the patient does not bleed) and it is best to separately transmit red blood cells (leaving plasma behind).
- Vaginal pregnancy examinations should not be too much when not needed. Each examination must wash your hands, wear ermic gloves.
- Early and timely detection of all manifestations of bacterial infections.
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