HYPOVOLEMIC CONDITIONS: DIAGNOSTICS AND
TACTICS OF
EMERGENCY CARE FOR INFECTIOUS DISEASES
АЛЬ-КХАТТАВИ АБААЛХАСН СААД 692
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
Both infectious agents (bacteria, viruses, protozoa, helminths) and non- •
infectious factors (poisoning by fungi, alcohol, acids) can lead to the
development of dehydration (hypovolemic) shock (HS).
+The classic picture of hypovolemic shock develops with cholera algida. In •
contrast to TSS, in which initially the volume of circulating blood is reduced
due to an increase in vascular capacity (relative hypovolemia), in cholera
there is absolute hypovolemia due to secretory diarrhea
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
With a loss of fluid up to 5% of body weight, the volume of circulating blood decreases by no •
more than 10%, which is completely compensated by the body. There are no clinical
manifestations. When the loss reaches 6-9%, and the BCC decreases by 15-20%,
compensatory mechanisms are activated. Decreased BCC causes a decrease in cardiac output
and blood pressure, which is offset by an increase in heart rate - tachycardia occurs. The
second compensatory mechanism is the transition of fluid from the interstitium into the
bloodstream, resulting in a decrease in skin turgor. The third component of compensation is
spasm of the renal vessels and increased tubular reabsorption, which is manifested by a
decrease in diuresis. And, finally, there is shunting of blood and centralization of blood
circulation. This is clinically manifested by pallor of the skin, acrocyanosis, cold extremities.
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
If fluid loss is not compensated and reaches 9%, and BCC decreases by 30% or •
more, then compensatory mechanisms are depleted. The viscosity of the
blood increases. It becomes "thick", which violates its fluidity in small vessels rheology is disturbed. This leads to the formation of sludges in the MCR
vessels, which causes hypoxia, acidosis, and triggers DIC.
+It should be noted that the loss of fluid at this stage increases the osmolarity •
of the blood, which leads to dehydration of the cells of the internal organs,
causing their deep degeneration
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
Clinic
•
There are 4 degrees of dehydration
+
•
•
•
Fluid loss is 3% of body weight. Clinically, it manifests itself as a slight weakness due to the loss of K +, thirst and hemodynamic lability
(a tendency to tachycardia and hypotension during exercise).
Fluid loss 4-6%. Dryness of the mucous membranes joins, as a result of which the voice becomes hoarse. Muscle weakness becomes •
pronounced. As a result of the loss of magnesium and chlorine ions, cramps appear in the calf muscles. The skin becomes pale,
acrocyanosis appears. Extremities become cold. The skin turgor decreases - the skin fold straightens slowly (up to 2 seconds). There is
tachycardia. BP drops to the lower limit of normal. Oliguria occurs.
Fluid loss 7-9%. The patient is retarded. Facial features are sharpened. Tonic convulsions. Aphonia. diffuse cyanosis. The skin fold •
straightens out very slowly (more than 2 seconds). Dyspnea. Severe tachycardia. BP is reduced to a critical level - 50-60 mm Hg. Art.
Diastolic pressure may not be detected. Oligoanuria.
More than 9% fluid loss. The patient is in sopor. Eyes sunken, dry. Tonic convulsions. total cyanosis. The skin fold does not straighten
out. Hypothermia. Pulse and blood pressure are determined with great difficulty. Marked dyspnea. Anuria.
•
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
Diagnostics •
Diagnosis and severity of hypovolemic shock is based on clinical signs. The •
volume and list of additional studies depends on the underlying pathology.
Urine and blood tests are taken without fail, the blood type is determined. If
fractures are suspected, X-rays of the corresponding segments are performed,
if damage to the abdominal organs is suspected, laparoscopy is prescribed ,
etc. Until the state of shock is recovered, only vital studies are carried out to
identify and eliminate the cause of hypovolemic shock, since shifting,
manipulation, etc. can adversely affect the patient's condition
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
Treatment of hypovolemic shock •
The main task at the initial stage of therapy is to ensure sufficient blood •
supply to vital organs, eliminate respiratory and circulatory hypoxia.
Catheterization of the central vein is performed (with a significant decrease in
BCC, catheterization of two or three veins is performed). A patient with
hypovolemic shock is administered dextrose, crystalloid and polyionic
solutions. The rate of administration should ensure the fastest possible
stabilization of blood pressure and its maintenance at a level not lower than
70 mm Hg. Art. In the absence of the effect of the listed drugs, an infusion of
dextran, gelatin, hydroxyethyl starch and other synthetic plasma substitutes is
carried out.
HYPOVOLEMIC SHOCK IN INFECTIOUS PATHOLOGY
If hemodynamic parameters do not stabilize, intravenous administration of •
sympathomimetics (norepinephrine, phenylephrine, dopamine) is performed.
At the same time, inhalations with an air-oxygen mixture are performed.
According to indications, IVL is performed . After determining the cause of the
decrease in BCC, surgical hemostasis and other measures are performed to
prevent a further decrease in blood volume. Hemic hypoxia is corrected by
infusion of blood components and natural colloidal solutions (protein,
albumin)
LITERATURE
1. Diagnosis and treatment of emergency conditions / Suvorov A.V., •
Sveshnikov K.A., Yakushev D.B. - 2014
2. Irreversible changes in shock and blood loss / Petrov I. R; Vasadze G. Sh. - •
1972
3. Shock conditions. Scientific and informational material / Russian State •
Medical University of the Federal Agency for Health and Social Development 2010