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Postoperative Emergencies After Urological Surgery
Hashim Hashim and John Reynard
SHOCK DUE TO BLOOD LOSS
Shock is defined as inadequate organ perfusion and tissue oxygenation. The causes are hypovolaemia, cardiogenic, septic, anaphylactic, and neurogenic. The commonest cause of hypovolaemic shock is haemorrhage. Haemorrhage is an acute loss of circulating blood volume.
Following surgery, it is important to recognise the presence of shock early, identify the cause, and treat it promptly. Haem-orrhagic shock may be categorised into four classes:
■ Class I: up to 750 mL of blood loss (15% of blood volume); normal pulse rate (PR), respiratory rate (RR), blood pressure, urine output, and mental status.
■ Class II: 750 to 1500mL (15-30% of blood volume), PR >100; decreased pulse pressure due to increased diastolic pressure; RR 20 to 30; urinary output 20 to 30mL/h; mildly anxious.
■ Class III: 1500 to 2000 mL (30-40% of blood volume); PR >120; decreased blood pressure and pulse pressure due to decreased systolic pressure; RR 30 to 40; urine output 5 to 15 mL/h; anxious and confused.
■ Class IV: >2000mL (>40% of blood volume); PR >140; decreased pulse pressure and blood pressure; RR >35; urine output <5mL/h; lethargic. The skin will feel cold and clammy.