Urological Emergencies in Clinical Practice стр.106

and bladder. Br J Urol 1991;68:510-512. Phipps JH. Torsion of testis following orchidopexy. Br J Urol 1987;59:596. Reynard JM, Barua JM. Reduction of paraphimosis the simple way—the

Dundee technique. Br J Urol Int 1999;83:859-860. Rolnick D, Kawanoue S, Szanto P, et al. Anatomical incidence of testic-

ular appendages. J Urol 1968;100:755. Thurston A, Whitaker R. Torsion of testis after previous testicular

surgery. Br J Surg 1983;70:217. van Ophoven A, deKernion JB. Clinical management of foreign bodies of

the genitourinary tract. J Urol 2000;164:274-287. Wallace DMA, Gunter PA, London GV, et al. Sympathetic orchidopathia,

an experimental and clinical study. Br J Urol 1982;54:765-768.

Chapter 7

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.


Предыдущая Следующая