It consists of basic detail about hemorrhage and shock. In hemorrhage, there is classification of hemorrhage on various basis, it's sign and symptoms and treatment modalities. The treatment consist of methods to control bleeding and substitutes use for restoration of blood. It also explain the hemorrhagic shock. Shock consist of its pathophysiology, classification and description of types of shock. Each type consist of its general feature, pathogenesis and treatment.

1. HEMORRHAGE AND
SHOCK
Name- Chhaya Dev
Roll No- 106
BDS 4th year

2. Hemorrhage (Hemo + rrhage) denotes the
escape of blood from a blood vessel. The
word hemorrhage is synonymous with
bleeding. Any damage to the vasculature
leads to outflow of blood.

3. Hemorrhagecanbeclassifiedinfollowingways:
I. DEPENDING UPON SOURCE OF
BLEEDING
1. External Hemorrhage- When the
bleeding is revealed and seen outside,
e.g. epistaxis, bleeding from scalp
wound, bleeding during surgery.
2. Internal Hemorrhage- When the bleeding
is concealed and not seen outside, e.g.
intracranial hematoma.

4. II. DEPENDING UPON NATURE OF
BLEEDING VESSEL
1. Arterial Hemorrhage- It is bright red in color.
The blood is emitted as a jet with each
heartbeat. The bleeding vessel can be
identified and secured easily.
2. Venous Hemorrhage- It is dark red in color. The
blood flow is steady and non-pulsatile. If a large
vein is injured, e.g. internal jugular vein, there is
tremendous blood loss due to low pressure but
high flow bleeding. The bleeding is difficult to
stop because the vein gets retracted.
3. Capillary Hemorrhage- It is bright red in color.
There is generalized ooze of blood instead of
blood flow from definite sites. It can cause
serious blood loss in disorders like hemophilia.

5. III. DEPENDING UPON TIME
OF HEMORRHAGE
1. Primary Hemorrhage- It occurs at the time of
trauma or surgery.
2. Reactionary Hemorrhage- It occurs within 24
hrs of trauma or operation. In most of the
cases, it occurs within 4-6 hrs. due to
dislodgement of blood clot or slippage of
ligature.
3. Secondary Hemorrhage-It occurs after 7-14
days of trauma or operation).

6. IV. DEPENDING UPON VOLUME OF
BLOOD LOSS
1. Mild Hemorrhage- When blood loss is
less than 500 ml.
2. Moderate Hemorrhage- when blood
loss is 500-1000ml.
3. Severe Hemorrhage- When blood loss
is more than 1L.

7. V. DEPENDING UPON SPEED OF BLOOD
LOSS
1. Acute Hemorrhage- Massive bleeding in
a short span of time
2. Chronic Hemorrhage- It is slow bleeding
that is small in quantity and continues for
longer time e.g.: bleeding piles, bleeding
peptic ulcer

8. SignandSymptomsofhemorrhage:
 Confusion or decreasing alertness
 Clammy skin
 Dizziness or light-headedness after an
injury
 Low blood pressure
 Paleness (pallor)
 Rapid pulse, increase heart rate
 Shortness of breath
 Weakness

9. Symptoms of internal bleeding may also
include:
 Abdominal pain
 Chest pain
External bleeding through a natural opening
 Blood in stool
 Blood in urine
 Blood in vomit
 Vaginal bleeding
Skin color changes may occur after several
days of injury(skin may black, blue, purple,
yellowish green)

10. TREATMENTOFHEMORRHAGE:
1. Control of bleeding
 Pressure and packing (digital pressure using
forefinger and thumb ; tourniquet)
 Position (Trendelenburg position in ruptured
varicose veins in legs ; reverse trendelenburg
in thyroidectomy)
 Rest
 Operative methods (artery forceps)

12. 2. Restoration of blood volume
The blood transfusion is started as soon
as it becomes available. In case, blood is
not available or delayed, various
substitutes can be used:
 Dextran
 Gelatin
 Hydroxyethyl starch
 Fluorocarbons
 Human albumin

13. SHOCK:
It is a clinical syndrome characterized by
severe dysfunction of vital organs due to
inadequate tissue perfusion.

14. CLASSIFICATIONOFSHOCK:
1. Hypovolaemic shock
2. Cardiogenic shock
3. Distributive shock
4. Obstructive shock
5. Hemorrhagic shock

15. HypovolaemicShock
 Loss of blood—hemorrhagic shock
 Loss of plasma—as in burns shock
 Loss of fluid — dehydration as in
gastroenteritis
FEATURES:
 Tachycardia
 Low blood pressure
 Decreased urine output

17. TREATMENT:
 The primary goal is to return the blood
volume, tissue perfusion and oxygenation
to normal as early as possible.
 Blood transfusion may be needed if large
amounts of blood is lost (Hb <8–10 gm%)
or if the patient is anemic.

18. CardiogenicShock
The blood flow is reduced because of an intrinsic
problem in the heart muscle or its valves. Any
damage to the valves, especially acute may also
reduce the forward cardiac output resulting in
cardiogenic shock.
FEATURES:
 Tachycardia
 Low blood pressure
 Decreased urine output
 Peripheries are cold
 Patient may be confused

19. TREATMENT:
 The primary goal is to improve cardiac
muscle function.
 Oxygenation can be improved by
administering oxygen, either by facemask
or by endotracheal intubation and
ventilation as necessary.
 Inotropes: improve cardiac muscle
contractility.
 Vasodilators such as nitroglycerine may
dilate the coronary arteries.

20. DISTRIBUTIVESHOCK
Distributive shock can occur in the
following situations.
1. Septic shock
2. Anaphylactic shock
3. Neurogenic shock
4. Acute adrenal insufficiency shock

21. SEPTICSHOCK
It is due to infection caused by bacteria,
virus, fungi or protozoa. Clinically, there are
two types of septic shock:
1. Early warm shock- Toxins cause cutaneous
vasodilation and skin becomes warm and
pink. The patient has fever with chills. There
is tachycardia and hypotension.
2. Late cold shock- If toxemia persists, it leads
to increased capillary permeability,
hypovolemia, decreased cardiac output,
tachycardia and vasoconstriction. The skin

22. TREATMENT
1. Treatment of infection by:
 Appropriate antibiotics.
 Surgical drainage/debridement of wound
2. Treatment of shock by:
 I/V fluid infusion
 Vasopressor drugs
 Steroids in high doses over a short period are
protective against endotaxemia. Single dose of
methyl prednisolone (15-30 mg/kg) is given and
repeated after 4 hrs. It improves cardiac, renal
and pulmonary functions and does not impair
immune response of the body.

23. ANAPHYLACTICSHOCK
It is due to hypersensitivity to a drug, toxin
or serum leading to acute circulatory
collapse.
FEATURES:
 Skin rashes
 Difficulty in breathing due to
bronchospasm and laryngeal edema
 Sudden hypotension
 Loss of consciousness

24. TREATMENT
 Maintenance of airway
 Injection Hydrocortisone 200-400 mg I/V
 Injection adrenaline 0.5 mg S/C, I/M or I/V
 Vasopressors (dopamine) for hypotension
 Bronchodilators (Injection aminophylline)
for bronchospasm

25. NEUROGENICSHOCK
It is caused by sympathetic failure leading
to vasodilation, peripheral pooling of blood
and hypotension. It leads to reduced
cerebral perfusion, cerebral hypoxia and
unconsciousness.
FEATURES:
 Hypotension without tachycardia
 May deteriorate to produce cardiac arrest

26. TREATMENT:
 Intravenous fluids
 Inotropes
 Vagolytics

27. THANK YOU