Compensated Shock In Trauma Patients - Everything You Need To Know - Dr. Nabil Ebraheim

Описание: Dr. Ebraheim’s educational animated video describes the condition of compensated shock in trauma patients.

What is compensated shock? With compensated shock, the patient has vital signs that appear normal, however the vital signs are not a sensitive indicator of shock or resuscitation.
The heart and brain are perfused at the expense of other organs, so you have an occult hypoperfusion that cannot be detected by the vital signs.
You have to get it from the pH, the base deficit, and from the serum lactate level. These are very helpful in monitoring resuscitation!
The patient may have a normal heart rate, blood pressure, adequate urine output, but the serum lactate level may be 3. This serum lactate level of 3 is high! It should be less than 2.5, and some labs have it as less than 2. If the patient has occult hypoperfusion, then you will use damage control first before doing definitive care.
In multiple trauma patients, the only time you will rod the femur is if the lactic acid and base deficit are within normal levels. For resuscitation and normalizing the lactate level, you can do early appropriate care, because if you have adequate resuscitation, the patient will be able to tolerate the nailing. You probably can lose up to 1/3 of the total blood volume before the blood pressure will be affected.
Sometimes it is very hard to determine the extent of resuscitation. Is the patient fully resuscitated? Or does the patient have compensated shock? This could be difficult to determine, which is why you get the base deficit and the serum lactate level. Both are predictive of survival and are used to guide the resuscitation.
If the patient is under resuscitated, what are you going to do? You are going to do damage control orthopaedics. How do you do stabilization? Decrease the trauma by initial stabilization followed by staged definitive management. If the trauma involves the pelvis, you will have a sheet, a bind and traction. Do not leave the sheet or binder in place for more than 24 hours. Once the patient becomes stable, we will get the chest, abdomen and pelvic CT scans. If the patient is unstable, you will do angiography and embolization. Do external fixation for long bone fractures. Do splints for the forearm and for the humerus. There is no significant advantage of the external fixator on the femur more than skeletal traction unless the patient is already in the operating room. The typical scenario is a huge story about the patient, don’t worry about the details first! Check the patient’s serum lactate level and base deficit. If it is high, you are going to do damage control orthopaedics (DCO).
Start looking for the correct answers! Looking for external fixators. For the humerus and forearm, you are going to use splints. You will want to wait at least 5 days before doing definitive treatment, and this has to do with the inflammatory markers (controversial). Definitive treatment can be delayed 7-10 days for pelvic fractures and up to 3 weeks for fractures of the femur to change from external fixator to an IM rod. About 7-10 days is needed for the tibia to change from external fixator to an IM rod.
Remember! In morbid obese polytrauma patients, there will be increased systemic complications with IM nails of the femur with increased ARDS and death. In patients with head injury, intraoperative hypotension increases the mortality rate.

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