Title : Assessment & management of hemorrhagic shock and exsanguinations: Approach, tactics, strategies, titrated-to-response anesthesia
Abstract:
The “revised physiological classification” is the only classification that optimizes timely intervention of source control of hemorrhagic shock, and suits tactics such as titrated hypotensive resuscitation and iatrogenic vasoconstriction, and strategies such as titrated-to-response anesthesia and damage control surgery, all actions mandatory for survival to be timely applied when indicated. In any case, any hypotensive progressing or critical shock with imminent or impending cardiac arrest, direct source control via laparotomy/thoracotomy, with concomitant or soon following venous and diastolic refilling, are the two essential initial life-saving steps. This is accomplishable rapidly and efficiently only by a direct ingress for source control, which is a crush laparotomy if the bleeding is coming from an abdominal +/lower limb site, and rapid sternotomy/anterolateral thoracotomy if the bleeding is coming from a chest +/upper limbs site. When cardiac arrest by exsanguination has occurred, the core of the physiological issue remains the rapid restoration of a sufficient venous return, allowing the heart to pump it back into systemic circulation either by open massage via sternotomy or anterolateral thoracotomy, or spontaneously after aortic clamping in the chest or in the abdomen. Extracorporeal resuscitation and induced hypothermia are used as the last ditch under sternotomy for direct vision and final war plan. Without first stopping the bleeding and refilling the heart, any resuscitation of advanced progressive HS is an exercise doomed to failure.
Audience Take Away Notes:
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Assessment & Management of Hemorrhagic Shock. Tactics and Strategies. Titrated-to-Response Anestesia. Perspectives on cardiac arrest by exsanguination outcome
