Hypovolemic Hemorrhagic Shock Research Articles

Non-Puerperal Uterine Inversion Caused by Embryonal Rhabdomyosarcoma in an Adolescent: A Case Report

Introduction: Non-puerperal uterine inversion is an uncommon gynecologic emergency that can be triggered by either malignant or, more commonly, benign tumors. Uterine sarcoma, including the rare subtype known as embryonal rhabdomyosarcoma, is among the malignant causes. The management of this condition poses a significant challenge for surgeons. Case Report: A 15-year-old nulliparous and virgin female arrived at the emergency department in hemorrhagic hypovolemic shock, experiencing pelvic discomfort and expelling endometrial tissue through the vagina. She underwent a total abdominal hysterectomy with bilateral oophorectomy, a pathological examination revealed that the uterine inversion was caused by embryonal rhabdomyosarcoma. Subsequently, the patient was referred to an oncologist for chemotherapy. Conclusion: Rapid perioperative diagnosis can be achieved through physical examination and magnetic resonance imaging (MRI), with histopathological examination serving as the definitive diagnostic confirmation tool.

Erratum to: Nuclear Factor-κB as a target of cyclosporin in acute hypovolemic hemorrhagic shock.

Erratum to: Nuclear Factor-κB as a target of cyclosporin in acute hypovolemic hemorrhagic shock.

Damage Control in Cervico-Thoracic’s Transition Wound: Case Report

The case addresses a patient who suffered a penetrating wound by a knife in right anterior cervical region (zone I) and left thoracic region that was admitted with signs of hemorrhagic hypovolemic shock (class III). The emergency surgical approach in patients with cervical trauma is indicated in cases of shock that is refractory to volume replacement, murmurs in the cervical region, and intense active bleeding. It is also suggested to avoid approaching non-expandable hematomas due to the risk of rebleeding. In this case, the patient had bleeding in the orifice of the cervical region and signs of shock. First, bleeding control was performed with Foley catheter placed in the wound and a massive transfusion protocol was initiated in the emergency room. Then, the patient was referred to the operating room. The management of penetrating neck injuries is based on anatomical division of the cervical region into zones I, II and III. Zone II is the area where most lesions are observed, followed by zones I and III.

The effect of blood transfusion on sublingual microcirculation in critically ill patients: A scoping review.

To investigate the effects of red blood cell (RBC) transfusion on sublingual microcirculation in critically ill patients. Systematic strategy was conducted to search studies that measured sublingual microcirculation before and after transfusion in critically ill patients. This review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Scoping Review Extension. The literature search yielded 114 articles. A total of 11 studies met the inclusion criteria. Observational evidence showed diffusive capacity of the microcirculation significantly improved in intraoperative and anemic hematologic patients after transfusion, while the convective parameters significantly improved in traumatic patients. RBC transfusion improved both diffusive and convective microcirculatory parameters in hypovolemic hemorrhagic shock patients. Most of the studies enrolled septic patients showed no microcirculatory improvements after transfusion. The positive effects of the leukoreduction were insufficiently supported. The effects of the storage time of the RBCs were not conclusive. The majority of the evidence supported a negative correlation between baseline proportion of perfused vessels (PPV) and changes in PPV. This scoping review has catalogued evidence that RBC transfusion differently improves sublingual microcirculation in different populations. The existing evidence is not sufficient to conclude the effects of the leukoreduction and storage time of RBCs.

WÜNDERLICH SYNDROME: A CASE OF HYPOVOLEMIC HEMORRHAGIC SHOCK

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Wünderlich syndrome (WS) is a rare presentation of hypovolemic hemorrhagic shock. It is a fatal disease described as a syndrome of spontaneous non-traumatic subcapsular and retroperitoneal hemorrhage. The etiology of WS is varied, with renal causes including malignancy being the most common, followed by renal vasculature abnormalities, vasculitis, cystic rupture, pyelonephritis, and idiopathic. The appropriate treatment depends on the accuracy of diagnosis and precise determination of its cause. To our knowledge, this is the first case report of WS due to acute pyelonephritis in a patient with congenital solitary kidney and Jehovah's Witness religious beliefs which impacted his care. CASE PRESENTATION: A 77 year old male with a two day history of flank pain accentuated on the right side, fevers, and confusion presented as critically ill and requiring vasopressor support. His medical history comprises prostate cancer in remission and atrial fibrillation on aspirin. He was diagnosed clinically with pyelonephritis, and culture positive urinary tract infection and sepsis with Escherichia coli. The initial hemoglobin was of 10.3 g/dL. Computed tomography (CT) of the abdomen showed nonspecific stranding and a solitary right kidney. He clinically deteriorated prompting repeat CT imaging that showed a large right perirenal hematoma with retroperitoneal blood. He underwent emergent coil angioembolization of a hemorrhagic branch of the inferior pole renal artery. His hemoglobin of 4 g/dL recovered with erythropoietin and intravenous iron. He briefly required hemodialysis for his acute kidney injury. The patient survived and the function of his congenital solitary kidney was preserved. DISCUSSION: The classic signs of WS include Lenk’s triad of flank pain, abdominal mass, and hypovolemic shock. However, in only 20% of cases, all three symptoms present. Acute onset of flank pain is the most common symptom. Although pyelonephritis is a rare cause of WS, in our case we believe that bleeding diathesis and etiology of WS was driven by cytokine induced endothelial damage from pyelonephritis along with aspirin induced platelet dysfunction. CT is preferred for the initial imaging workup. Angioembolization is a minimally invasive treatment modality for acute hemorrhage. Exploratory laparotomy or nephrectomy is typically recommended if malignancy is suspected. CONCLUSIONS: WS requires prompt recognition to prevent death from exsanguination. Shock is relatively common with WS, however, surgical exploration is not absolutely necessary with the advent of angioembolization. The unconventional treatment method with erythropoietin instead of blood may be considered in patients with Jehovah’s Witness religious beliefs. Reference #1: Katabathina VS, Katre R, Prasad SR, Surabhi VR, Shanbhogue AK, Sunnapwar A. Wunderlich syndrome: cross-sectional imaging review. J Comput Assist Tomogr. 2011;35(4):425-33. Reference #2: Chen YC, Lin YC. Wunderlich syndrome. QJM. 2013;106(2):187-8. Reference #3: Chamarthi G, Koratala A. Wunderlich syndrome. Clin Case Rep. 2018;6(9):1901-1902. DISCLOSURES: No relevant relationships by Francois Kaleta, source=Web Response No relevant relationships by Mitra Sahebazamani, source=Web Response No relevant relationships by Pratyaksha Sankhyan, source=Web Response

Hemorrhage Attenuates Neutrophil Recruitment in Response to Secondary Respiratory Infection by Pseudomonas Aeruginosa.

Neutrophil recruitment into the lung airspaces plays an important role in the containment and clearance of bacteria. Hemorrhagic shock, a complication of traumatic injury, induces immune dysfunction that compromises host defense and frequently leads to secondary infection. The objective of the current study was to determine whether prior hemorrhage impacts neutrophil recruitment in response to secondary Pseudomonas aeruginosa. Experiments were performed using a mouse model (C57BL/6) of respiratory infection by P. aeruginosa (strain PA103, 3 × 10 colony-forming units [CFUs]) that is delivered by intratracheal inhalation 24 h after hypovolemic hemorrhagic shock (fixed mean arterial blood pressure at 35 mmHg for 90 min, Ringer's lactate infused as fluid resuscitation). By postmortem flow cytometry analyses of bronchoalveolar lavage fluid, we observe that prior hemorrhage attenuates the entry of neutrophils into the lung airspaces in response to P. aeruginosa. The reduction in neutrophil recruitment occurs in an amplified inflammatory environment, with elevated lung tissue levels of interleukin 6 and C-X-C motif ligand 1 in mice receiving hemorrhage prior to infection. As compared to either insult alone, outcome to sequential hemorrhage and respiratory infection includes enhanced mortality. The effect of prior hemorrhage on clearance of P. aeruginosa, as determined by quantifying bacterial CFUs in lung tissue, was not statistically significant at 24 h postinfection, but our data suggest that further inquiry may be needed to fully understand the potential impact of hemorrhagic shock on this process. These results suggest that changes in neutrophil recruitment may contribute to the immune dysfunction following hemorrhagic shock that renders the host susceptible to severe respiratory infection.

Hypovolemic and hemorrhagic shock

The term "shock" refers to alife-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by areduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with arightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e.g. kidneys, endocrine system and endothelium). For further identification of a state of shock caused by bleeding, vital functions, coagulation tests and hematopoietic procedures are implemented. Every hospital should be in possession of aspecific protocol for massive transfusions. The differentiated systemic treatment of bleeding consists of maintenance of an adequate homeostasis and the administration of blood products and coagulation factors.

Helping prometheus: liver protection in acute hemorrhagic shock.

Acute hemorrhagic hypovolemic shock is caused by a significant high blood loss and leads to hemodynamic instability. The decrease in intravascular volume results in cellular hypoxia and finally in damage to organs such as the liver and the kidney. The liver plays a decisive role in the development or prevention of multiple organ failure after hemorrhagic shock. Despite the large number of experimental studies, the knowledge of pathophysiological mechanisms in the liver after hemorrhagic shock is incomplete. The aim of this mini review was to provide an overview of the pathophysiological changes in liver function after acute hemorrhagic shock and to address treatment options to improve liver perfusion.

Experimental Study on the Efficacy of Site-Specific PEGylated Human Serum Albumins in Resuscitation From Hemorrhagic Shock

To evaluate the resuscitative efficacy and the effect on reperfusion injury of two site-specific PEGylated human serum albumins modified with linear or branched PEG20kDa, compared with saline, 8% human serum albumin and 25% human serum albumin, in a hemorrhagic shock model. Laboratory. Male Wistar rats. Prospective study. Rats were bled to hemorrhagic hypovolemic shock and resuscitated with different resuscitation fluids. The mean arterial pressure and blood gas variables were measured. Hemorheology analysis was performed to evaluate the influence of resuscitation on RBCs and blood viscosity. The microvascular state was indirectly characterized in terms of monocyte chemotactic protein-1 and endothelial nitric oxide synthase that related to shear stress and vasodilation, respectively. The levels of inflammation-related factors and apoptosis-related proteins were used to evaluate the reperfusion injury in lungs. The results showed that PEGylated human serum albumin could improve the level of mean arterial pressure and blood gas variables more effectively at the end of resuscitation. poly(ethylene glycol) modification was able to increase the viscosity of human serum albumin to the level of effectively enhancing the expression of monocyte chemotactic protein-1 and endothelial nitric oxide synthase, which could promote microvascular perfusion. The hyperosmotic resuscitative agents including both 25% human serum albumin and PEGylated human serum albumins could greatly attenuate lung injury. No significant therapeutic advantages but some disadvantages were found for Y shaped poly(ethylene glycol) modification over linear poly(ethylene glycol) modification, such as causing the decrease of erythrocyte deformability. Linear high molecular weight site-specific PEGylated human serum albumin is recommended to be used as a hyperosmotic resuscitative agent.

Testing nursing students' clinical judgment in a patient deterioration simulation scenario: Development of a situation awareness instrument

Situation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios. To develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT). Instrument development and validation. A faculty of nursing of a French-Canadian university. 15 critical care experts and 234 bachelor-level nursing students from a critical care course. The queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey. The instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation. This instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios.

Median preoptic nucleus mediates the cardiovascular recovery induced by hypertonic saline in hemorrhagic shock.

Changes in plasma osmolarity, through central and peripheral osmoreceptors, activate the median preoptic nucleus (MnPO) that modulates autonomic and neuroendocrine adjustments. The present study sought to determine the participation of MnPO in the cardiovascular recovery induced by hypertonic saline infusion (HSI) in rats submitted to hemorrhagic shock. The recordings of mean arterial pressure (MAP) and renal vascular conductance (RVC) were carried out on male Wistar rats (250–300 g). Hemorrhagic shock was induced by blood withdrawal over 20 min until the MAP values of approximately 60 mmHg were attained. The nanoinjection (100 nL) of GABAA agonist (Muscimol 4 mM; experimental group (EXP)) or isotonic saline (NaCl 150 mM; control (CONT)) into MnPO was performed 2 min prior to intravenous overload of sodium through HSI (3 M NaCl, 1.8 mL/kg, b.wt.). Hemorrhagic shock reduced the MAP in control (62 ± 1.1 mmHg) and EXP (61 ± 0.4 mmHg) equipotently. The inhibition of MnPO impaired MAP (CONT: 104 ± 4.2 versus EXP: 60 ± 6.2 mmHg) and RVC (CONT: 6.4 ± 11.4 versus EXP: -53.5 ± 10.0) recovery 10 min after HSI. The overall results in this study demonstrated, for the first time, that the MnPO plays an essential role in the HSI induced resuscitation during hypovolemic hemorrhagic shock.

Muerte súbita por rúptura esplénica en un ternero. Descripción patológica

El objetivo de este estudio es reportar un caso de muerte súbita en un ternero de 7 días por ruptura esplénica en el departamento de Córdoba (Colombia). Fueron analizados: la historia clínica, los hallazgos de necropsia y el estudio histopatológico con tinción de Hematoxilina-Eosina. El animal fue dejado en la tarde del día anterior en condiciones de aparente normalidad y al día siguiente en horas de la mañana el operario reportó decaimiento y muerte unos minutos después. En la necropsia, al examen del cadáver se determinó mucosas pálidas y marcado signo de deshidratación, debido a la depresión ocular y a la resequedad de los tejidos, en la cavidad abdominal se encontró marcada colección de líquido sanguinolento libre acompañado de aumento focalizado del bazo debido a un hematoma subcapsular, posiblemente de origen traumático con ruptura del borde mayor, causando un shock hipovolémico de tipo hemorrágico.

Effects of alpha1-acid glycoprotein in combination with catecholamines on hemorrhagic hypovolemic shock in rats.

To determine whether the beneficial effects of catecholamines on the variables of hemorrhagic hypovolemic shock are augmented by coadministration of alpha1-acid glycoprotein during resuscitation, alpha1-acid glycoprotein (200 mg/kg), a placebo formulation or Ringer's solution was infused in a rat model of hemorrhagic hypovolemic shock for 1 h concomitantly with either norepinephrine (CAS 51-40-1; 0.1, 0.3, 1 microg x kg(-1) x min(-1)) or dopamine (CAS 62-31-7; 5, 10, 15 microg x kg(-1) x min(-1)). Resuscitation with norepinephrine or dopamine alone was continued for a further 4 h. Mean arterial blood pressure, cardiac output, stroke volume, heart rate and total peripheral vascular resistance were measured during the entire 5-h period. The combination of dopamine or norepinephrine with alpha1-acid glycoprotein more effectively restored mean arterial blood pressure and cardiac output than analogous combinations with placebo formulation or Ringer's solution. So co-administration with alpha1-acid glycoprotein considerably augments the beneficial effects of catecholamines on the main variables of hemorrhagic hypovolemic shock.

Cardiopulmonary effects of a new inspiratory impedance threshold device in acute hemorrhagic shock in dogs

To compare cardiovascular and respiratory effects of an inspiratory impedance threshold device (ITD) in dogs before and after induction of acute hemorrhagic shock. Prospective experimental randomized study. Eight healthy adult dogs. Dogs were anesthetized and maintained on spontaneous ventilation. Tidal volume (V(T)), systolic, mean and diastolic arterial blood pressure (SAP, MAP, DAP), central venous pressure (CVP), gastric P(CO2) (GBF) as an indicator of gastric perfusion, cardiac index (CI), systemic vascular resistance (SVR), oxygen delivery (DO(2)), and plasma lactate were monitored. To monitor respiratory compliance (RC) and respiratory resistance (ResR), animals were briefly placed on mechanical ventilation. Dogs were studied under 4 different conditions: (1) baseline (euvolemic state) (MAP > 60 mm Hg) with and without the ITD and (2) acute hemorrhagic shock (hypovolemic state) (target MAP of 40 mm Hg) with and without ITD. These 4 conditions were performed during one anesthetic period, allowing time for stabilization of parameters for each condition. Data were analyzed by ANOVA for repeated measure mixed models. No cardiovascular changes were detected between groups with and without use of ITD during euvolemic states. During acute hemorrhagic hypovolemic state, CI and DO(2) were higher with the ITD (2.9 ± 0.6 L/min/m(2)) and (326.5 ± 86.8 mL/min) compared with no ITD (1.8 ± 0.6 L/min/m(2)) and (191.3 ± 58.1 mL/min), respectively. The use of ITD during hypovolemia also increased SAP and MAP. There was an increase in ResR and decreased RC with the ITD in both euvolemic and hypovolemic states. The use of an ITD in dogs during acute hemorrhagic hypovolemic shock improved cardiovascular parameters but had negative effects on RC and ResR.

Pulmonary arterial thermodilution, femoral arterial thermodilution and bioreactance cardiac output monitoring in a pediatric hemorrhagic hypovolemic shock model

AimBioreactance is a new non-invasive method for cardiac output measurement (NICOM). There are no studies that have analysed the utility of this technique in a pediatric animal model of hemorrhagic shock. MethodsA prospective study was performed using 9 immature Maryland pigs weighing 9 to 12kg was performed. A Swan-Ganz catheter, a PiCCO catheter and 4 dual surface electrodes were placed at the four corners of the anterior thoracic body surface. Shock was induced by withdrawing a blood volume of 30mL/kg, and then after, 30mL/kg of Normal saline was administered. Seven simultaneous measurements of cardiac index (CI) were made by pulmonary artery thermodilution (PATD), Femoral artery thermodilution (FATD), and NICOM before, during, and after hypovolaemia and during and after volume expansion. ResultsThe mean difference (bias) of differences (limits of agreement) between PATD and FATD was 0.84 (−1.87–3.51)L/min/1.77m2, between PATD and NICOM was 1.95 (−1.79–5.69)L/min/1.77m2, and between FATD and NICOM was 1.06 (−1.40–3.52)L/min/1.77m2. A moderate correlation was found between PATD and FATD (r=0.43; P=0.01), but no correlation was found between bioreactance and either PATD or FATD. Hypovolemia and volume expansion produced important significant differences in CI as measured by PATD and FATD, while the changes with bioreactance were small and non significant. ConclusionsPATD and FATD measurements showed similar responses to hypovolemic shock and volume expansion. Bioreactance persistently underestimates the CI and is not significantly altered by either inducing hemorrhagic shock, or later, through volume expansion. Bioreactance is not a suitable method for monitoring the CI in pediatric hemorrhagic shock.

24 Comparison of Normal Saline, Hypertonic Saline and Hypertonic Colloid Resuscitation Fluids in An Infant Animal Model of Hemorrhagic Hypovolemic Shock

Background: Few studies have analyzed the effect of resuscitation fluid composition in infant animal models of hemorrhagic-hypovolemic shock. Our hypothesis was that hypertonic and hyperoncotic fluid will achieve goal-directed hemodynamic endpoints with less volume infusion than normal saline. Methods: Prospective, randomized study in 34 two month-old piglets (9.9±2kg). Following anaesthesia, paralysis and mechanical ventilation, hypovolemia was induced by controlled 30 ml/kg bleed. After 30 min, pigs were randomized to receive: Normal Saline (S0.9%) 30 ml/kg, n=11, Hypertonic 3% Saline (S3%) 15 ml/kg n=12, or Albumin 5% plus Hypertonic 3% Saline (A5%-S3%) 15 ml/kg, n=11. Hemodynamic (heart rate (HR), mean arterial pressure (MAP), cardiac index (CI)), brain tissue oxygenation by near infrared spectroscopy (bStO2) and tissue perfusion (arterial lactate and gastric pHi) parameters were compared by ANOVA. Results: 30 min. after bleeding, high baseline HR: 192±37, and low MAP 72±19 mmHg, CI 2.8±1L/min/m2, bStO2: 44±8%, gastric pHi 7.1±0.2 and lactate 3.4 ±2.3 mmol/L were recorded with non significant differences between groups. 30 min after infusion there were non significant differences between groups for HR (S0.9%: 188±14, S3%: 184±14, A5%-S3%: 151±14 bpm); MAP (S0.9%: 80±7, S3%: 86±7, A5%-S3%: 87±7 mmHg); CI (S0.9%: 4.9±0.5, S3%: 5.1±0.4, A5%-S3%: 5.3±0.4 ml/min/m2); lactate (S0.9%: 2.8±0.7, S3%: 2.3±0.6, A5%-S3%: 2.5±0.6mmol/l); bStO2 (S0.9%: 43.9±2.2, S3%: 40.1±2.5, A5%-S3%: 45.7±2.3 %); and pHi (S0.9%: 7.07±0.6, S3%: 7.25±0.5, A5%-S3%: 7.23±0.5). Conclusion: In this model of pediatric hypovolemic shock, both hypertonic (S3%) and hyperoncotic (A5%- S3%) fluids achieved similar hemodynamic endpoints, requiring half of the volume compared to normal saline.

Hidroxietilalmidón (Hextend®) en solución electrolítica balanceada en el choque hipovolémico hemorrágico

Use of hetastarch in a balanced electrolyte solution -Hextend®- in the resuscitation of the patient in hypovolemic hemorrhagic shock: Review of the international literature

Exogenous nitric oxide induces protection during hemorrhagic shock

Introduction This study analyzed the systemic and microvascular hemodynamic changes related to increased nitric oxide (NO) availability during the early phase of hemorrhagic shock. Hemodynamic responses to hemorrhagic shock were studied in the hamster window chamber. Materials and Methods Exogenous NO was administered in the form of nitrosothiols (nitrosylated glutathione, GSNO) and was given prior the onset of hemorrhage. Moderate hemorrhage was induced by arterial controlled bleeding of 50% of the blood volume, and the hypovolemic shock was followed over 90 min. Results Animals pre-treated with GSNO maintained systemic and microvascular conditions during hypovolemic hemorrhagic shock, when compared to animal treated with glutathione (GSH) or the Sham group. Low concentrations of NO released during the early phase of hypovolemic shock from GSNO mitigated arteriolar vasoconstriction, increased capillary perfusion and venous return, and improved cardiac function (recovered of blood pressure and stabilized heart rate). GSNO's effect on resistance vessels influenced intravascular pressure redistribution and blood flow, preventing tissue ischemia. Discussion Increases in NO availability during the early phase of hypovolemic shock could preserve cardiac function and microvascular perfusion, sustaining organ function. Direct translation into a clinical scenario may be limited, although the pathophysiological importance of NO in the early phase of hypovolemia is clearly highlighted here.

Shenfu injection in the pre-expansion perioperative treatment of acute hemorrhagic shock effect of observation

Objective To observe the Senate anesthesia injection in the pre-expansion treatment of acute hemorrhagic shock patients and evaluate the results, explore the Shenfu injection in the pre-expansion used in the treatment of acute hemorrhagic shock perioperative treatment of the feasibility of And clinical significance.Methods Acute hemorrhagic shock patients were randomly divided into 50 cases of the observation group (I group, n = 25) and the control group (cn group, n = 25). Two groups of patients with general anesthesia endotra-cheal intubation later. Group I after the Narcotic give Shenfu injection 100ml in 5% glucose injection 500ml intravenous fluid therapy and pre-expansion (colloidal refers to the liquid molecular.weight hydroxyethyl starch 6% HES or Timor million); II group 5% Glucose and sodium chloride injection 500ml intravenous drip. Other blood transfusion, such as vasodilative anti-shock treatment 2, the same group. Monitoring 30,60,120 min after the injection of all time blood pressure, heart rate, cardiac output (CO) and volume changes in Group ￠n of the record amount of bleeding and blood transfusion volume. Compare the two groups were observed after injection of changes in arterial blood gases. Results ① I results of the Group Participation intravenous injection and pre-expansion treatment of liquid after 30, 60 min, blood pressure picked up, cardiac output (CO rebound), heart rate decreased significantly with the early II group (P < 0.05); in the urine 1 h And 2 h with the group II a very significant difference (P<0.05 orP<0.01).② Injection after 90 min ⒌￠n group of blood gas analysis and indicators increased II group were significantly different (P < 0.05 orP < 0.01 ). Conclusion Conclusions of the Senate anesthesia injection in the pre-expansion in the treatment of acute hemorrhagic shock, and rapid restoration of hemodynamic stability, improve microcirculation and metabolism of the organization to promote the recovery of shock, Perioperative to increase security in areas such as better Effect. Key words: Peri-operationai period; Shenfu injection; Hemorrhagic hypovolemic shock; Pre-expan-sion treatment

Fatal Renal Hemorrhage After Extracorporeal Shock Wave Lithotripsy

Renal hematoma is one of the most severe complications of extracorporeal shock wave lithotripsy (ESWL). ESWL is used in the noninvasive treatment of urinary calculosis. The shock waves can lead to capillary damage, renal parenchymal or subcapsular hemorrhage. We present a case with fatal complication and the result of the medico-legal evaluation. A 71-year-old woman was treated by ESWL, renal hematoma was detected during the clinical observation, and the patient died. The death occurred despite close clinical observation as a consequence of a rare complication of ESWL. The mechanism of death was hemorrhagic hypovolemic shock due to renal hemorrhage complications due to ESWL for treatment of renal calculi. This therapeutic complication is a known complication of appropriate treatment.