This document discusses shock and blood transfusion. It defines shock as inadequate cellular perfusion resulting in impaired metabolism. It describes the different types of shock including hypovolemic, cardiogenic, obstructive, endocrine, and distributive shock. Septic shock is discussed in detail as the most lethal type. The document also defines blood transfusion and describes blood products, collection and storage of blood, complications of transfusion including immunological reactions and infections, and complications of massive transfusion.

1. Shock and
Blood
Transfusion
(2020)
surgical club Red Sea University SC(RSU)

2. Prepared by:
Dr: Aisha Omer Hamid 18
Dr: Khlood Mohamed Osman 18
Dr: Shahid Babeker 17
Dr: Alla Abd Elsamee3 19
 Presented by:
 Dr: Amar Yahia
Registrar of General Surgery
Surgical club Red Sea University SC(RSU)29/6/2020

3. Definition
 It is inadequate cellular perfusion , result in
impairment of cellular metabolism
surgical club Red Sea University SC(RSU)

4. Pathophysiologic
 Low tissue perfusion- hypoxia – anaerobic
metabolism – lactic acidosis – cell wall
damage- Na+ and Ca+ enter the cell- K+
leek out of the cell - intracellular
lysosomes breakdown releasing enzyme –
stick cell syndrome – activation of
platelet forming small clot –DIC-MOD-
DEATH
surgical club Red Sea University SC(RSU)

5. shock
Hypovolemic Cardiogenic Endocrine
Distributive
Obstructive
surgical club Red Sea University SC(RSU)

6. surgical club Red Sea University SC(RSU)

7. Hypovolemic shock
Due decrees blood volume secondary to loss of
blood (internal or external hemorrhage ), plasma as
burn and acute pancreatitis), and Na+ contained
fluid as sever vomiting or diarrhea .
Treatment
 Arresting the volume loss
 Give oxygen at high concentration
 Fluid resuscitation (Ringer lactate , blood in sever
hemorrhage and crystalloid solution in burn and
intestinal obstruction )
surgical club Red Sea University SC(RSU)

8. Monitoring( BP, Pulse, ECG ,Temperature
Urine out put, central Venus pressure
(CVP), blood gas (o2 & Co2)pulmonary
artery wedge pressure (PAWP)
Positioning (elevating both legs )
Pain relief
Inotropic agents are used when fails to
improve despite adequate volume
replacement
surgical club Red Sea University SC(RSU)

9. surgical club Red See Univirsity SC(RSU)

10. Cardiogenic
Inadequate blood flow to vital organ due
to inadequate cardiac out put
Causes
Acute MI- Sever arrhythmia – Pulmonary
embolism
surgical club Red Sea University SC(RSU)

11. Obstructive shock
It is due reduce filing of right side of the
heart , occurs in patient with
 Tension pneumothorax
 Cardiac tamponade
 Massive pulmonary embolism
surgical club Red Sea University SC(RSU)

12. Endocrine shock
The development of shock initiates a
cascade of responses in a effort to
reestablish homeostasis .
three of most important hormonal
 Catecholamine
 Glucocorticoid
 Vasopressin
surgical club Red Sea University SC(RSU)

13. Distributive shock
It is caused by excessive vasodilation and
impaired distribution of blood flow
Classified to
 Neurogenic shock
 Anaphylactic shock
 Septic shock
surgical club Red Sea University SC(RSU)

14. Neurogenic shock
Paralysis vasomotor fiber leading to peripheral
pooling of the blood and inadequate venous
return
Causes
Vasovagal attack – Spinal fracture
Treatment
❖ Patient lie flat-by elevation of the legs
❖ IV crystalloid solution as Ringers lactate
❖ Vasopressors
surgical club Red Sea University SC(RSU)

15. Anaphylactic shock
Follow administration of penicillin or any
irritating substances
TREATMENT
❖ IV crystalloid infusion
❖ IV hydrocortisone
❖ Epinephrine 0.3 - 0.5mg IM
❖ Antihistamine
❖ Endotracheal intubation
surgical club Red Sea University SC(RSU)

16. Septic shock
Most lethal type of shock and is recognized
as one of the major killer in surgical practice
Causative organism
Gram negative bacilli – staph aurous –
candida
Common sources of bacteria
 Peritonitis causes by perforated viscous ,
gangrenous bowel or leaking anastomosis
 Cholangitis
 Infected central Venus catheter used for
monitoring
surgical club Red Sea University SC(RSU)

17. Risk Factors of septic shock
 Old age
 DM
 Corticosteroid
 Chemotherapy
 Malignance
 HIV
surgical club Red Sea University SC(RSU)

18. Clinical future of septic shock
➢ hyperdynamic (warm septic shock)
Early stage
 Restless and confusion
 Fever above 38C and chills
 Mild reduction in blood pressure
 Tachycardia and tachypnea
 Patient is flushed &warm dry extremities
 Oliguria
 COP is elevated
surgical club Red Sea University SC(RSU)

19. Clinical future of septic shock
➢ Hypodynamic (cold septic shock)
If previous stage not treated efficiently
the patient will develop
Systolic BP < 90 mmHg
Tachycardia &tachypnea
Cold clammy skin
Oliguria
➢ Multiple organs failure start at this stage
surgical club Red Sea University SC(RSU)

20. Diagnosis of septic shock
 CBC(polymorphonuclear leukocytosis )
 High lactate level in blood
 Blood culture
surgical club Red Sea University SC(RSU)

21. TREATMENT OF SEPTIC SHOCK
Cardiovascular support by
1-fluid and
2- use atropine and vasopressor if the
patient remain hypovolemic
3-steroid if no response to iv fluid ))
Respiratory support by(100% Oxygen )
Renal support by(adequate volume
replacement, dopamine and
hemodialysis )
surgical club Red Sea University SC(RSU)

22. Treatment of septic shock
Antibiotic e.g. cephalosporin
aminoglycoside metronidazole
Control blood sugar
Prophylaxis against DVT and stress
ulcer
Monitoring
surgical club Red Sea University SC(RSU)

23. Blood
Transfusion
SC(RSU)
surgical club Red Sea University
SC(RSU)

24. DIFINITION
Transfusion of blood and it is
components
surgical club Red Sea University SC(RSU)

25. Collection and storage of blood
It collected into a citrate anticoagulant
solution and dextrose “kept at 2-6 C “ during
storage.
One blood bag:
70 - 100 ml anticoagulant (citrate).
400 - 450 ml of blood.
The frozen blood doesn't have coagulation
factors, platelets or white cells
surgical club Red Sea University SC(RSU)

26. Blood product
1-packed red cell.
2- Fresh plasma.
3-Fresh-frozen plasma (FFP).
4- platelets.
5-cryoprecipitate.
surgical club Red Sea University SC(RSU)

27. Complications of blood transfusion
1/ immunological complication :-
1) acute hemolytic reaction : ( incompatible red cell )
Management : stop transfusion / repeat typing and
matching /correct shock /check urine output .
2) pyrogenic reaction :( incompatible WBC )
Management : stop transfusion / IV aspirin or
paracetamol.
3) post transfusion purpura: ( incompatible
4) Allergic reaction : (Reaction to protein in plasma )
Management : if sever stope transfusion .platelets)
surgical club Red Sea University SC(RSU)

28. 2/ congestive heart failure .
3/transmission of infection :( hepatitis (B or C)
/AIDS,HIV/syphilis / malaria )
4/hyperkalemia.
5/citrate intoxication .
6/ air embolism.
7/transfusion related acute lung injury
This is the result of incompatibility between
donor antibodies and recipient granulocytes.
surgical club Red Sea University SC(RSU)

29. Complication of massive blood
transfusion :
1/ hypothermia .
2/ hyperkalemia .
3/ hypokalemia.
4/ coagulation failure .
5/ diminished oxygen carrying
capacity .
surgical club Red Sea University SC(RSU)

30. References
 Kasralainy
 BRS General Surgery 1st edition
 BRS General Surgery 1st edition
surgical club Red See Univirsity SC(RSU)