LO2

🔴 1. Haemorrhage

• Definition: Acute loss of blood from the vascular system.

• Classification:

  • Class I: <15% blood loss (usually well-compensated)

  • Class II: 15–30% (tachycardia, anxiety)

  • Class III: 30–40% (hypotension, confusion)

  • Class IV: >40% (severe hypotension, unconsciousness)

• Causes: Trauma, surgery, obstetric complications, GI bleed.

• Clinical signs: Tachycardia, hypotension, cool/clammy skin, delayed cap refill, decreased urine output.

🩸 2. Haemostasis

• Phases:

  1. Vasoconstriction – to reduce blood flow.

  2. Primary haemostasis – platelet plug formation.

  3. Secondary haemostasis – clotting cascade activates fibrin.

  4. Fibrinolysis – clot breakdown.

• Disorders: Haemophilia, Von Willebrand disease, thrombocytopenia.

• Pharmacology:

  • Pro-coagulants: Tranexamic acid, fibrinogen.

  • Anti-coagulants: Heparin, warfarin.

💉 3. Rapid Infusion Devices

• Used in emergency scenarios requiring rapid fluid/blood product administration.

• Indications: Hypovolaemia, trauma, obstetric haemorrhage, burns, massive transfusion.

• Types: Belmont Rapid Infuser, Level 1, Fluido system.

• Safety: Temperature control (prevent hypothermia), pressure regulation, monitoring for air embolism.

🚨 4. Massive Haemorrhage Protocols (MHP)

• Trigger: >1 blood volume loss in 24 hrs or >50% in 3 hrs.

• Goals: Restore circulating volume, oxygen delivery, prevent coagulopathy.

• Components:

  • RBCs, plasma, platelets (1:1:1 ratio)

  • TXA within 3 hours

  • Calcium replacement (citrate toxicity)

  • Monitor ABGs, electrolytes, coagulation (TEG)

• Complications: DIC, hypothermia, acidosis, hypocalcaemia.

🧪 5. TEG (Thromboelastography)

• Purpose: Real-time assessment of clot formation and stability.

• Key parameters:

  • R-time: Time until clot starts forming.

  • K-time: Time to reach clot strength.

  • Alpha angle: Speed of clot strengthening.

  • MA (Maximum Amplitude): Clot strength.

  • LY30: % clot breakdown in 30 mins (fibrinolysis).

• Used to guide: Transfusion (FFP, platelets, cryo), antifibrinolytics (TXA).

⚡ 6. Shock and Pathophysiology

• Definition: Inadequate tissue perfusion causing cellular hypoxia.

• Common Pathways:

  • ↓O2 delivery → anaerobic metabolism → lactic acidosis → organ dysfunction.

• Stages:

  1. Initial: ↓ perfusion

  2. Compensatory: ↑ HR, vasoconstriction

  3. Progressive: worsening hypoperfusion

  4. Irreversible: multi-organ failure

💧 7. Hypovolaemic Shock

• Cause: Fluid/blood loss → ↓ preload → ↓ CO → ↓ perfusion.

• Signs: Tachycardia, hypotension, poor cap refill, cold extremities.

• Management: ABCs, control bleeding, IV fluids, blood products, vasopressors if needed.

🐝 8. Anaphylactic Shock

• Cause: IgE-mediated allergic response → histamine release.

• Effects: Bronchospasm, vasodilation, ↑ permeability → oedema.

• Signs: Stridor, urticaria, hypotension, wheezing.

• Treatment:

  • IM Adrenaline (0.5 mg adult)

  • IV fluids

  • Antihistamines

  • Steroids

  • Oxygen, airway support

🦠 9. Septic Shock (From PDF)

• Cause: Infection → systemic inflammation → vasodilation + capillary leak.

• Criteria (Sepsis-3):

  • Infection + organ dysfunction (↑ SOFA)

  • Persistent hypotension requiring vasopressors + lactate >2

• Management:

  • Early broad-spectrum antibiotics

  • Source control

  • Fluids (30 mL/kg)

  • Vasopressors (noradrenaline)

  • Monitor lactate, urine output

🤰 10. Postpartum Haemorrhage (PPH) (From PDF)

• Definition: >500 mL vaginal or >1000 mL C-section blood loss.

• Causes (4 Ts):

  • Tone (uterine atony)

  • Trauma

  • Tissue (retained placenta)

  • Thrombin (coagulopathy)

• Management:

  • Uterotonics (oxytocin, misoprostol)

  • Fundal massage

  • Bakri balloon

  • Blood products

  • MHP activation

🧬 11. Disseminated Intravascular Coagulation (DIC) (From PDF)

• Trigger: Sepsis, trauma, obstetric complications.

• Pathophysiology: Widespread clotting → consumption of clotting factors → bleeding.

• Lab: ↓ platelets, ↑ PT/APTT, ↓ fibrinogen, ↑ D-dimer.

• Treatment:

  • Treat underlying cause

  • Replace blood products (platelets, cryo, FFP)

  • Monitor TEG

🔥 12. Burns and Haemodynamics (From PDF)

• Fluid shifts: Capillary permeability ↑ → plasma loss → oedema.

• Risk: Hypovolaemia, compartment syndrome, renal failure.

• Resuscitation: Parkland formula

  • 4 mL x %TBSA x weight (kg)

  • 50% in first 8 hrs, 50% in next 16 hrs

• Monitoring: Urine output, electrolytes, lactate.

💧 13. TURP Syndrome (From PDF)

• Cause: Absorption of irrigation fluid (e.g. glycine) during prostate surgery.

• Pathophysiology: Fluid overload + hyponatraemia → cerebral oedema.

• Symptoms: Confusion, bradycardia, hypertension, nausea, seizures.

• Management:

  • Stop surgery

  • ABCs

  • Diuretics

  • Correct Na⁺ slowly

🫁 14. Thromboembolic Disease (From PDF)

• Types:

  • DVT

  • PE

• Risk factors: Surgery, immobility, pregnancy, malignancy.

• Signs of PE: SOB, chest pain, tachycardia, hypoxia.

• Prevention:

  • Mechanical: compression stockings, devices

  • Pharmacological: LMWH, heparin

• Treatment:

  • Anticoagulation (e.g. enoxaparin → warfarin/apixaban)

  • Thrombolysis in massive PE

🧩 15. Shock Cascades (From PPT)

• Shared outcomes:

  • ↓ perfusion → cellular hypoxia → lactic acidosis → organ dysfunction → death

• Systemic effects:

  • Cardio: ↓ CO, tachycardia

  • Renal: ↓ urine output

  • Resp: tachypnoea, ARDS

  • Neuro: altered LOC

  • GI: ↓ motility, ischaemia