The principle of fluid replacement should be followed in shock treatment

Shock is a relatively common symptom and is quite harmful to humans. When shock occurs, emergency treatment should be adopted and fluid replacement should be carried out in time, which mainly refers to the rapid replenishment of blood volume and the increase of blood pressure through the first injection of normal saline. In addition, if there is bleeding, it should be stopped in time. Let us learn about this aspect below.

The principle of fluid replacement should be followed in shock treatment

1. Rapidly replenish blood volume: First, quickly infuse 1000-2000ml of normal saline or balanced salt solution. If the blood pressure rises and can be maintained, it means that the amount of bleeding is small and the bleeding has stopped; if the hematocrit is above 30%, no blood transfusion is needed, otherwise an appropriate amount of blood should be transfused, preferably fresh whole blood, to maintain the hematocrit at 30%. If blood pressure remains low during fluid replacement and central venous pressure is also low, fluid replacement should be continued. If the central venous pressure increases, it indicates excessive fluid replacement or cardiac failure. 0.2-0.4 mg of digoxin should be injected intravenously to reduce the cardiac venous pressure to normal. If the central venous pressure drops significantly after the use of digoxin and is lower than normal, it means that the fluid volume is insufficient and fluid replacement should continue.

2. Stop bleeding: While replenishing blood volume, bleeding should be stopped as quickly as possible. In general, fundamental hemostasis should be performed after shock is basically corrected. However, for bleeding that is difficult to control with general measures, surgical hemostasis should be performed while replenishing blood volume.

3. Replenishing blood volume, treating the underlying disease and stopping bleeding are the central links in treating hemorrhagic shock, but other general treatment measures should not be ignored.

General emergency treatment

The patient is usually in a supine position. If necessary, the head and trunk are elevated by 20° to 30° and the lower limbs are elevated by 15° to 20° to facilitate breathing and venous return of the lower limbs, while ensuring cerebral perfusion pressure. The airway is kept open and oxygen can be inhaled by nasal cannula or mask. If necessary, an artificial airway is established and ventilator-assisted ventilation is used. A relatively normal body temperature is maintained. When the body temperature is low, attention should be paid to keeping warm. When the body temperature is high, the temperature should be lowered as much as possible. Intravenous access is established as soon as possible, and blood pressure is maintained with medication. Try to keep the patient quiet and avoid moving him/her. Small doses of analgesics and sedatives may be used, but respiratory and circulatory depression must be avoided.