What are the causes of hemorrhagic shock? In hemorrhagic shock .

The most common cause of hemorrhagic shock is the rupture of solid organs in the abdominal cavity due to closed abdominal injury, most commonly liver rupture and spleen rupture. Abdominal injuries, such as mesenteric injuries, and local vascular injuries can also lead to internal bleeding. If the trauma causes damage to the large blood vessels of the heart, it is also easy to cause hemorrhagic shock, such as lung injury caused by multiple rib fractures, damage to the intercostal blood vessels or chest stab wounds, which can easily induce blood loss when the major blood vessels of the heart are punctured.

Patients may also have a significant drop in blood pressure, an increase in heart rate, and even fainting, and clammy and cold all around. Diagnosis can be confirmed by imaging and, if necessary, thoracentesis or paracentesis. Hemorrhagic shock should be expanded in a timely manner, anti-shock**, and surgery should be performed at the same time**.

Microcirculation disorders (ischemia, congestion, disseminated intravascular coagulation) cause insufficient microcirculation arterial blood perfusion, and functional and metabolic disorders of important vital organs due to hypoxia are the common laws of all types of shock. The changes in microcirculation during shock can be roughly divided into three stages, namely microcirculatory ischemic phase, microcirculatory congestion phase and microcirculatory coagulation phase.

a) Microcirculatory ischemic phase (ischemic hypoxic phase).

The microcirculatory changes in this phase are characterized by contraction of arterioles, posterior arterioles and anterior capillary sphincter, a sharp decrease in microcirculatory perfusion and a decrease in pressure; Venules and venules are less sensitive to catecholamines and have less contraction; Arteriovenous anastomosis may have varying degrees of opening, and blood flows directly from the arteriole through the arteriovenous anastomosis into the venule.

The key change that causes microcirculatory ischemia is intense excitation of the sympathetic-adrenoledullary system. Different types of shock can cause sympathetic pathetic mechanisms – in adrenal medullary shock and cardiogenic shock, decreased cardiac output and decreased arterial blood pressure excite the sympathetic-adrenomedullary system through the sinus arch reflex; In most cases of endotoxin shock, endotoxin directly stimulates the sympathetic—adrenal medullary system.

The overall effect of sympathetic excitation and increased catecholamine release on the cardiovascular system is an increase in total peripheral resistance and an increase in cardiac output. However, the response of blood vessels in different organs varies greatly. **, abdominal viscera and kidney blood vessels, due to the abundance of sympathetic constriction vascular fiber innervation.

Moreover, the receptor has a dominant advantage, so when the sympathetic nerve is excited and catecholamines are increased, the arterioles, venules, arterioles and red muscles in the precapillary sphincter of these parts are contracted, among which the sympathetic constriction of the arterioles is the most densely distributed, and the precapillary sphincter is the most responsive to catecholamines, so they contract the most strongly. As a result, the anterior capillary resistance is significantly increased, the microcirculatory perfusion is sharply reduced, the average blood pressure of the capillaries is significantly reduced, and only a small amount of blood flows into the venules and venules through the direct and rapid access and a few true capillaries, resulting in severe ischemic hypoxia in the tissue. The sympathetic constriction of cerebral blood vessels has the least distribution of vascular fibers, and the receptor density is also low, and there is no obvious change in caliber.

Although the coronary arteries also have sympathetic innervation and receptors, sympathetic nerve excitation and catecholamine increase can be strengthened by cardiac activity, and the metabolic level is increased to the increase of vasodilated metabolites, especially adenosine, which causes coronary artery dilation.

Sympathetic excitation and hypovolemia also activate the renin-angiotensin-aldosterone system, which has strong vasoconstrictive effects, including coronary artery contraction.

Hemorrhagic shock () tartardan orange.

a.Decreased circulating blood volume and decreased vascular volume.

b.Circulating blood volume decreases and vascular volume increases.

c.Decreased circulating blood volume and unchanged vascular volume (correct answer) dCirculating blood volume does not originate fission, and vascular volume decreases.

e.The circulating blood volume remains unchanged and the vascular volume increases.

1 Ingredients: 10g angelica, 2 eggs.

Method: Wash the egg shell and boil it with angelica water for 10 minutes, remove the egg after it is cooked, put it in cold water for 30 seconds to remove the shell, then use a toothpick to prick a few small holes on the surface of the egg, continue to put it in angelica water and boil for about 15 minutes, add brown sugar and eat.

Efficacy: Angelica sinensis can nourish blood; Eggs can be rich in protein nutrients. Angelica egg water has a certain tonic effect on patients with hemorrhagic shock caused by trauma.

2 Ingredients: 40g of red peanuts, 500g of lean meat, appropriate amount of stem rice.

Method: Add an appropriate amount of water to the red peanuts and stem rice and cook them into porridge, add them and boil them together for about 2-3 minutes, then you can use them, one bowl in the morning and one bowl in the evening.

Efficacy: Red-coated peanuts can replenish qi and stop bleeding, and red-coated peanut lean porridge can play a role in nourishing blood and stopping bleeding, mainly for people with qi deficiency and bleeding.

3 Ingredients: 30g of cooked ground, 20g of red dates

Method: Wash the cooked ground slightly, simmer with red dates for about 20 minutes, add an appropriate amount of brown sugar and eat, one bowl each morning and evening.

Efficacy: Cooked land can replenish blood and nourish yin, fill in lean marrow; Jujube can nourish blood and calm the nerves, and cooked jujube water is used for patients with hemorrhagic shock due to lack of qi and blood and blood deficiency.

4 Ingredients: a black chicken, a soft-shelled turtle, a pork belly, an appropriate amount of straw mushrooms, an appropriate amount of lion's mane mushroom, 10g of American ginseng, about 15g of wolfberry.

Method: Pass the fresh pork belly with boiling water, then knead it with vinegar for about 20 minutes, try to remove the peculiar smell on the pork belly, and cut it into strips. Simmer the chopped chicken pieces in a casserole with the slaughtered soft-shelled turtle and other ingredients for 1-2 hours, and then add an appropriate amount of seasoning.

Efficacy: soft-shelled turtle can nourish the liver and kidneys, clear heat and cool blood; Black chicken can nourish blood and benefit the shrewd purpose; Pork belly can make up for deficiency, strengthen the spleen and stomach, and replenish the middle and invigorate qi; American ginseng can nourish qi and blood; Goji berries can nourish the liver and kidneys. Citi wolfberry soup has a good effect on nourishing blood gas for patients with hemorrhagic shock who are weak.

Answer] During incomplete :d abortion, part of the embryonic tissue remains in the official cavity, which affects the uterine contraction and the blood sinus cannot be closed, which can cause a large amount of continuous bleeding and even shock, which can be life-threatening if not treated in time. If the embryo dies for a long time, the placental tissue is organized and the uterine adhesion is not easy to peel off, and it is easy to be infected; At the same time, during the autolysis process of the placenta, thromboplastin is released, and the consumption of fiber and egg is empty and the white plain causes coagulation dysfunction and disseminated intravascular coagulation (DIC).

The fight is buried.

Answer]: A1Bed rest traction in the long limb cavity after fracture can affect blood circulation in the compression area of the body, resulting in pressure ulcers.

2.There are many arteriovenous plexuses in the pelvis, which have an abundant blood supply, and fractures can cause extensive hemorrhage, and large hematomas can spread without retroperitoneal space, often accompanied by shock.

3.When the fracture is fixed with intramedullary nails, the bone marrow can be destroyed, and fat droplets can enter the ruptured venous sinus, causing fat embolism.

4.Intra-articular fractures are not accurately reduced, and the articular surface is uneven, causing traumatic arthritis.

Answer]: C analysis: The basic stage of hemorrhagic shock is insufficient blood volume, and ** is infusion and blood transfusion, mainly to supplement blood volume. Master the knowledge points of "function and metabolic changes, and the characteristics of several common shocks".

a.Prerenal renal failure.

b.Nephrogenic renal failure.

c.Postrenal renal function is characterized by infiltration and energy failure.

d.Chronic renal failure.

e.Diabetes insipidus.

Correct answer to the base case: B