Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture:A case report

BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.

Hemorrhagic shock due to submucosal esophageal hematoma along with mallory-weiss syndrome:A case report

BACKGROUND Esophageal submucosal hematoma is a rare condition.Although the exact etiology remains uncertain,vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation;the vessel was ruptured by a sudden increase in pressure due to nausea,and the hematoma was enlarged by antiplatelet or anticoagulant therapy.Serious conditions are rare,with a better prognosis.We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm.The patient received aspirin and clopidogrel before surgery and heparin during surgery,and was well during the surgery.Several hours after returning to the ICU,she complained of chest discomfort,vomited 500 m L of fresh blood,and entered hemorrhagic shock.Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography.In addition to a massive fluid and erythrocyte transfusion,we performed a temporary compression for hemostasis with a Sengstaken-Blakemore(S-B)tube.Afterwards,she became hemodynamically stable.On postoperative day 1,we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding;therefore,we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction.We started oral intake on postoperative day 10.The patient made steady progress,and was discharged on postoperative day 33.CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.

Effect of Hypertonic Versus Isotonic Saline Resuscitation on Heme Oxygenase-1 Expression in Visceral Organs Following Hemorrhagic Shock in Rats

To compare the early effects of hypertonic and isotonic saline resuscitation on heme oxygenase-1 （HO-1） expression in organs of rats with hemorrhagic shock. Rats were randomly divided into hypertonic saline resuscitation （HTS）, normal saline resuscitation （NS） and sham groups. HO-1 mRNA, protein expression and apoptosis were evaluated in organs. In the HTS group, significant difference was noted in HO-1 protein in small intestinal mucosa and liver compared with the NS and sham groups, and in HO-1 mRNA in liver and kidney compared with the sham group. The apoptosis of small intestinal mucosa, liver, heart, and lung was significantly lower in the HTS group than that in the NS group. In this study, small volume resuscitation with HTS can efficiently up-regulate the expression level of HO-1 in small intestinal mucosa and liver, which may be one of the mechanisms alleviating organ damage.

Effects of environmental hypothermia on hemodynamics and oxygen dynamics in a conscious swine model of hemorrhagic shock

BACKGROUND:Hypothermia is associated with poor outcome in trauma patients;however,hemorrhagic shock(HS)model with anesthetized swine was different from that of clinical reality.To identify the effects of environmental hypothermia on HS,we investigated hemodynamics and oxygen dynamics in an unanesthetized swine model of HS under simulating hypothermia environment.METHODS:Totally 16 Bama pigs were randomly divided into ambient temperature group(group A)and low temperature group(group B),8 pigs in each group.Venous blood(30 mL/kg)was continuously withdrawn for more than 15 minutes in conscious swine to establish a hemorrhagic shock model.Pulmonary arterial temperature(Tp),heart rate(HR),mean arterial pressure(MAP),pulmonary arterial pressure(PAP),pulmonary arterial wedge pressure(PAWP),central venous pressure(CVP),cardiac output(CO),hemoglobin(Hb),saturation of mixed venous blood(SvO_2)and blood gas analysis were recorded at the baseline and different hemorrhagic shock time(HST).The whole body oxygen delivery indices,DO_2l and VO_2l,and the O_2 extraction ratio(O_2ER)were calculated.RESULTS:Core body temperature in group A decreased slightly after the hemorrhagic shock model was established,and environmental hypothermia decreased in core body temperature.The mortality rate was significantly higher in group B(50%)than in group A(0%).DO_2l and VO_2l decreased significantly after hemorrhage.No difference was found in hemodynamics,DO_2l and VO_2l between group A and group B,but the difference in pH,lactic acid and O_2ER was significant between the two groups.CONCLUSION:Environmental hypothermia aggravated the disorder of oxygen metabolism after hemorrhagic shock,which was associated with poor prognosis.

Hemorrhagic shock due to ruptured lower limb vascular malformation in a neurofibromatosis type 1 patient:A case report

BACKGROUND Neurofibromatosis type 1(NF-1)is a common autosomal dominant genetic disorder.It is characterized by café-au-lait spots and cutaneous neurofibromas.Although NF-1 typically involves the skin,nerves,bones,and eyes,vascular manifestation in the form of devastating hemorrhage can occur rarely.CASE SUMMARY We present the case of a 47-year-old female with NF-1 who had a ruptured right lower limb arterial malformation.She presented with sudden right lower limb swelling for two hours and symptoms of hemorrhagic shock on admission.The physical examination revealed a right lower limb presenting as elephantiasis and visible dark-brown pigmentation over a large area.Computed tomography angiography showed right lower limb arteriovenous malformation.Therefore,the patient underwent emergency right lower limb digital subtraction angiography(DSA)and vascular embolization after blood transfusions.However,after DSA,vascular embolization,and repeated blood transfusions,the anemia and right lower limb swelling and tenderness did not improve.As a result,the patient underwent right lower extremity above-knee amputation.After amputation,the patient's hemoglobin level improved significantly without blood transfusion,and she was discharged from the hospital after the incision healed.Postoperative pathological examination suggested neurogenic tumors.No other complications had occurred 1-year follow-up.CONCLUSION Vascular malformation and rupture are fatal complications of NF-1.Embolization may not provide complete relief,the patient might need to undergo neurofibroma resection or amputation.

Effects of different infusion volumes on hemo-dynamics of portal hypertension canines after hemorrhagic shock

BACKGROUND: Portal hypertension ( PHT) with upper gastrointestinal hemorrhage as its chief complication is a very common disease with great harm to humans. The effects of infusion volume, speed, and type on hemody- namics in case of cirrhosis, PHT esophageal variceal bleed- ing, and their mechanism should be clarified. This study was designed to assess the effects of different infusion vo- lumes on hemodynamics of PHT canines after hemorrhagic shock (HS). METHODS: PHT canine models were made by chronic embolization via coarctating half of the main portal vein with silk suture. Two weeks later, the models were subjec- ted to hemorrhagic shock by quick femoral artery venesec- tion. The canines were divided into two groups to resusci- tate : one to receive a large volume of infusion (n =6) (large volume infusion group) and the other to receive a small vo- lume of infusion (n =6) (small volume infusion group). Hemodynamic indexes of PHT canines after HS and infu- sion were observed closely. RESULTS: The PHT canines showed a series of hemody- namical changes in hemorrhagic shock stage, which aggra- vated hemodynamical disorder in PHT. After quick infu- sion, mean arterial pressure (MAP), inferior vena cava pressure (IVCP), portal venous pressure ( PVP), portal vein pressure gradient ( PVPG), portal vein blood flow ( PVBF), hepatic artery blood flow ( HABF) and hepatic blood flow (HBF) increased significantly. These indexes in the large volume infusion group were higher than those in the small volume infusion group. Portal vascular resistance (PVR), splanchnic vascular resistance ( SVR), hepatic arte- rial resistance ( HAR) decreased significantly, but PVP, PVPG, PVBF, HABF and HBF showed a rebounding in- crease above the baseline values in the large volume infu- sion group. The changes of PVP, PVPG, PVBF, HABF and HBF were in parallel with those of MAP and inferior vena cava pressure (IVCP), without a rebounding increase in the small volume infusion group. In the large volume in- fusion group PVPG increased earlier and more significantly than did PVP; moreover PVPG exceeded the baseline by 13% , making the possibility of rebleeding great. In the small volume infusion group, PVPG was lower than the baseline by more than 22% , indicating a small possibility of rebleeding. SVR and HAR were lower in the large volume infusion group. PVP, PVPG, PVBF, HABF and HBF were positively correlated with accumulated volume of vein infusion. PVR showed a positive correlation with accumu- lated volume of vein infusion in the small volume infusion group. HAR was negatively correlated with accumulated volume of vein infusion in the large volume infusion group. CONCLUSIONS: PHT canines after HS, resuscitated by vein infusion, may show a rebounding increase of PVP, PVPG, PVBF, HABF and HBF above the baseline values in the large volume infusion group but not in the small vol- ume infusion group. A large volume infusion causes PVP, PVPG, PVBF, HABF and HBF to increase higher than does a small volume infusion.

Effects of GLP on Intestinal Mucosal Injury and the Change of TNF-α Content in Hemorrhagic Shock Rabbits

Objective To observe the intestinal mucosal injury and the change of TNF-αcontent in rabbits with hemorrhagic shock/reperfusion(HS-R)and the effects of ganoderma Lcidum polysaccharide(GLP)on them.Methods 30rabbits were made into hemorrhagic shock,then reperfused with different liquids.These rabbits were divided by random number table into three groups:sham operation group(Sham group),reperfusion with normal saline group(NS group),reperfusion with 1%GLP group(LS group).Bacterial translocation of blood and TNF-αcontent in serum were respectively observed at the time before shock,40 min after shock,40 min and 90 min after.TNF-αcontent in intestinal mucosa and the degree of intestinal mucosal injury were examined at 90 min post-resuscitation.Results 1 With the extension of reperfusion time,the positive rate of blood bacteria increased gradually in NS group,which was significantly higher than that of Sham group and LS group(P<0.05),meanwhile the degree of intestinal mucosal injury in NS group was more severe than that of Sham group and LS group too(P<0.05).2TNF-αcontent in serum of NS group and LS group were increased obviously compared with that before shock and in Sham group(P<0.05).TNF-αcontent in serum was further increased after reperfusion with NS,which was distinctly higher than that in LS group.TNF-αcontent in intestinal mucosa of NS group was significantly higher than that in LS group and Sham group too(P<0.05).Conclusion GLP can protect intestinal mucosa against HS-R injury,and its effects may relate with the change of TNF-αin hemorrhagic shock rabbits.

Esketamine use for anesthesia induction in an ectopic pregnancy patient with hemorrhagic shock:a case report

Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Therefore,it may be more suitable for patients with hypovolemic shock.Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours.Menstruation of the patient was regular,her self-reported urine pregnancy test was positive half a month earlier,and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test.Gynecological ultrasonography demonstrated no pregnancy sac in utero,confirming ectopic pregnancy.Emergency laparoscopy for ectopic pregnancy should be performed immediately.We administered esketamine for induction.Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.

Effects of glycine and methylprednisolone on hemorrhagic shock in rats

Background Methylprednisolone (MP), a synthetic glucocorticosteroid, has been broadly studied in experiments on endotoxin-induced shock and septic shock. This study was designed to ascertain whether glycine and MP can protect against organ injury and death caused by hemorrhagic shock, and to elucidate the underlying mechanisms of these protective effects in rats.Method To establish a shock model, Wistar rats were bled to maintain mean arterial pressure at 30-50 mmHg for 1 hour and subsequently resuscitated with the shed blood and normal saline. Just prior to resuscitation, the rats were randomly assigned to four groups: sham group (operation performed without inducing shock), shock group, shock+glycine group (glycine injected at the beginning of resuscitation) and shock+MP group (MP injected at the beginning of resuscitation).Results ① Seventy-two hours after resuscitation, the survival rate of rats from the shock group had decreased to 20%, while the survival rates of rats from the shock+glycine and shock+MP groups were 77.8% and 80%, respectively. The difference was significant (P<0.05). ② Eighteen hours after resuscitation, pathological alterations in the organs of the rats were apparent. In rats from the shock group, edema, interstitial leukocyte infiltration, and cellular degeneration occurred in the liver, lungs, kidneys, and heart. Glycine and MP reduced these pathological changes significantly. ③ Eighteen hours after resuscitation, the levels of creatine phosphokinase, transaminases, and creatine were elevated significantly in rats from the shock group, indicating injury to the heart, liver, and kidneys, while these levels were elevated only slightly in the shock+glycine and shock+MP groups. The differences were significant (P<0.01). ④ There were significant increases in intracellular calcium and production of tumor necrosis factor (TNF-α) by isolated Kupffer cells stimulated by endotoxin after hemorrhagic shock. These changes were completely prevented by glycine and MP (P<0.01). Conclusion Glycine and MP reduce organ injury and mortality caused by hemorrhagic shock by preventing increase of intracellular calcium levels in Kupffer cell, suppressing Kupffer cell activation, decreasing the production of TNF-α by Kupffer cells, and blocking systemic inflammatory responses.

Vitamin C Attenuates Hemorrhagic Shock-induced Dendritic Cell-specific Intercellular Adhesion Molecule 3-grabbing Nonintegrin Expression in Tubular Epithelial Cells and Renal Injury in Rats

Background： The expression of dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin （DC-SIGN） in renal tubular epithelial cells has been thought to be highly correlated with the occurrence of several kidney diseases, but whether it takes place in renal tissues during hemorrhagic shock （HS） is unknown. The present study airned to investigate this phenomenon and the inhibitory effect of Vitamin C （VitC）. Methods： A Sprague Dawley rat HS model was established in vivo in this study. The expression level and location of DC-SIGN were observed in kidneys. Also, the degree of histological damage, the concentrations of tumor necrosis factor-or and interleukin-6 in the renal tissues, and the serum concentration of blood urea nitrogen and creatinine at different times （2-24 h） alter HS （six rats in each group）, with or without VitC treatment belbre resuscitation, were evaluated. Results： HS induced DC-SIGN expression in rat tubular epithelial cells. The proinflarnmatory cytokine concentration, histological damage scores, and functional injury of kidneys had increased. All these phenornena induced by HS were relieved when the rats were treated with VitC before resuscitation. Conclusions： The results of the present study illustrated that HS could induce tubular epithelial cells expressing DC-SIGN, and the levels of proinflarnmatory cytokines in the kidney tissues improved correspondingly. The results also indicated that VitC could suppress the DC-SIGN expression in the tubular epithelial cells induced by HS and alleviate the inflammation and functional injury in the kidney.

CB 1 cannabinoid receptor participates in the vascular hyporeactivity resulting from hemorrhagic shock in rats

Background Vascular hyporeactivity, which occurs in the terminal stage of hemorrhagic shock, is believed to be critical for treating hemorrhagic shock. The present study was designed to examine whether the CB1 cannabinoid receptor （CB1 R） was involved in the development of vascular hyporeactivity in rats suffering from hemorrhagic shock. Methods Sixteen animals were randomly divided into two groups （n=8 in each group）： sham-operated （Sham） and hemorrhagic shock （HS） groups. Hemorrhagic shock was induced by bleeding. The mean arterial pressure （MAP） was reduced to and stabilized at （25±5） mmHg for 2 hours. The vascular reactivity was determined by the response of MAP to norepinephrine （NE）. In later experiments another twelve animals were used in which the changes of CB1R mRNA and protein in aorta and superior mesenteric artery （SMA） were analyzed by RT-PCR and Western blotting. In addition, we investigated the effects of a CB1R antagonist on the vascular hyporeactivity and survival rates in rats with hemorrhagic shock. Survival rates were analyzed by the Fisher＇s exact probability test. The MAP response was analyzed by one-way analysis of variance （ANOVA）. Results Vascular hyporeactivity developed in all animals suffering from hemorrhagic shock. The expression of CBIR mRNA and protein in aorta and 2-3 branches of the SMA were significantly increased in the HS group after the development of vascular hyporeactivity when compared to those in Sham group. When SR141716A or AM251 was administered, the MAP response to NE was （41.75±4.08） mmHg or （44.78±1.80） mmHg respectively, which was higher than that in saline groups with （4.31±0.36） mmHg （P 〈0.01）. We also showed an increased 4-hour survival rate in the SR141716A or AM251-treated group with 20% or 30%, but with a statistically significant difference present between the AM251-treated and saline groups （P 〈0.05）. Conclusions CBIR is involved in vascular hyporeactivity resulting from hemorrhagic shock in rats, and CB1R antagonist may be useful in treating patients with traumatic, hemorrhagic shock who need field-rescue or initial treatment.

Protective Effect of Shenfu Injection on Vascular Endothelial Damage in a Porcine Model of Hemorrhagic Shock

Objective:To investigate the effects of Shenfu Injection(SFI)on endothelial damage in a porcine model of hemorrhagic shock(HS).Methods:After being bled to a mean arterial pressure of40±3 mm Hg and held for 60 min,32 pigs were treated with a venous injection of either shed blood(transfusion group),shed blood and saline(saline group),shed blood and SFI(SEI group)or without resuscitation(sham group).Venous blood samples were collected and analyzed at baseline and 0,1,2,4,and 6 h after HS.Tumor necrosis factor-α(TNF-α),serum interleuking(IL)-6,and IL-10 levels were measured by enzymelinked immunosorbent assay(ELISA);expressions of vascular cell adhesion molecule-1(VCAM-1),intercellular adhesion molecule 1(ICAM-1),von Willebrand factor(vWF),plasminogen activator inhibitor-1(PAI-1)and Bcl-2,Bax,and caspase-3 proteins were determined by Western blot.Results:The serum level of TNF-αin the SFI group was significantly lower than in the other groups at 0,1,and 2 h after HS,while the level of IL-6 was lower at 4 and 6 h compared with the saline group(P<0.01 or P<0.05).The concentration of serum IL-10 was significantly higher in the SFI group than in the other groups at 0,1,4,and 6 h after HS(P<0.01).Western blot and immunohistochemistry of vascular tissue showed that the expression of caspase-3 was downregulated,and that of Bcl-2 and Bax was upregulated in the SFI group compared to other groups(P<0.05).Conclusion:SFI attenuated endothelial injury in the porcine model of HS by inhibiting cell apoptosis,suppressing the formation of proinflammatory cytokines,and reducing endothelial activation.

EFFECTS OF CYPROHEPTADINE ON PLASMA SUPEROXIDE DISMUTASE ACTIVITY AND MALONDIALDEHYDE CONTENT IN RABBITS WITH HEMORRHAGIC SHOCK

Profound hemorrhagic shock was produced in thirty rabbits by exsanguination via the carotid artery until blood pressure (BP) reached 5.3 kPa (40 mmHg) and was sustained for a period of 90 minutes. The rabbits were equally divided into cyproheptadine (Cyp) treated group and control group. Blood samples 30 minutes after liquid and blood infusion and administration of Cyp (10 mg / kg) were collected from the carotid artery, and the plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA) content measured. The results showed that Cyp remarkebly enhanced the plasma SOD activity (2462 338 vs 1955- 596, P<0.01) and reduced MDA content (2.68- 0.24 vs 3.20-0.49, P<0.01). We believe that the in crease of O2 production plays an important role in the develop-ment of shock, the single blood and liquid infusion can not significantly improve the shock conditions. Scavenging oxygen free radicals and alleviating cellular damage and multiple or gan failure are the possible mechanisms of cyproheptadine anti-shock effect.

Beneficial effect of arginine vasopressin on hemorrhagic shock through improving the vascular reactivity

The vascular reactivity and calcium sensitivity were decreased following hemorrhagic shock.Arginine vasopressin(AVP)was beneficial to endotoxic,infec-tious/septic and hemorrhagic shock.Our previous studies found that Rho kinase played an important role in the occurrence of calcium desensitization following shock.It was reported that AVP was with stimulation effect of Rho kinase.So we hypothesized that AVP might have bene-ficial effect on shock via activation of Rho kinase to regu-late the calcium sensitivity and vascular reactivity.Hemorrhagic shock(40 mmHg for 2 h)Wistar rats in vivo were adopted to observe the effects of small dose of AVP on hemodynamics,24-h survival rate,the pressor effect of norepinephrine(NE)and the contractility of superior mesenteric artery(SMA).Isolated SMAs from hemorrha-gic shock rats were adopted to observe the effects of AVP on vascular reactivity and calcium sensitivity and its rela-tionship to Rho kinase with an isolated organ perfusion system.The results show that AVP at the concentration of 0.1 U/kg and 0.4 U/kg significantly improved the hemo-dynamic parameters and the 24-h survival rate of hemor-rhagic shock rats.Meanwhile,these dosages of AVP significantly increased the pressor effect of NE and the contractile response of SMA to NE.Y-27632(3 mg/kg),a Rho kinase specific inhibitor,abolished the beneficial effects of AVP.In vitro,the calcium sensitivity and vas-cular reactivity of SMA to calcium and NE were signifi-cantly decreased following hemorrhagic shock.AVP at the concentration of 0.5 nmol/L and 5 nmol/L signifi-cantly increased the calcium sensitivity and vascular react-ivity.These effects of AVP were abolished by Y-27632(10 mmol/L).Taken together,the results suggest that AVP at 0.1 U/kg and 0.4 U/kg is beneficial to hemorrha-gic shock by improving the vascular reactivity,which involves activation of Rho kinase.

Hemorrhagic shock caused by rupture of cystic artery pseudoaneurysm secondary to calculous cholecystitis

Cholecystitis is a common disease in East Asia. Some of the patients developed cystic artery pseudoaneurysm,a rare complication of cholecystitis. Over the past decades, there have been Tess than 20 reports of patients with cystic artery pseudoaneurysm in the literature. Among them, three of the patients had gallbladder perforation which led to hemorrhagic shock,la We report a case of an 88-year-old woman with a cystic artery pseudoaneurysm following an episode of acute cholecystitis.

Experimental Study on Therapeutic Effect of Combined Administration of Radix Salviae Miltiorrhizae. Ligustrazine and Radix Sanchi on Late Hemorrhagic Shock of Rabbits

Objective: To explore the therapeutic mechanism of the combined use of Radix Salviae Miltiorrhizae, ligustrazine and Radix Sanchi in treating late hemorrhagic shock in rabbit. Methods: Rabbit hemorrhagic shock models were set up according to Wiggers' method and treated with the combined therapy. Levels of RBC superoxide dismutase (SOD) activity, plasma malondialdehyde (MDA), blood lactate (BL) and magnesium (Mg++ ) were continuously monitored before shock, 120 minutes after shock, 60 and 120 minutes after reinfusion. Results: (1) Levels of SOD decreased and MDA, AL, Mg++ increased markedly 120 minutes after shock, indicating that there existed cell membrane damage caused by oxygen free radicals in hemorrhagic shock.(2) The combination therapy could alleviate lipid peroxidation injury to tissue, enhance the activity of SOD and lower the concentration of MDA significantly, P < 0. 01 or 0. 05, as compared with the control group. Conclusion: The combined use of the three drugs could gain the same effect with half dosage as that gained from the whole dosage of one single drug. It could also reduce the negative effect of treatment, such as hypotension and slowing down of heart rate

Therapeutic effect of taurine with hypertonic saline on rat hemorrhagic shock complicated with hypernatremia

Abstract Objective To investigate the therapeutic effect of hypertonic saline (HS) and hypertonic saline with taurine (HST) hemorrhagic shock and hemorrhagic shock with hypernatremia rats. Methods Hypernatremic dehydration and hemorrhagic shock models were produced by Trachtma's and Krausz's methods in Sprague Dawley rats. Hemorrhagic changes of mean arterial blood pressure (MABP), left ventricular end diastolic pressure (LVEDP), ±dp/dtmax and heart rate (HR) were registered on polygraph. Plasma Na +, urea lactate and taurine content were assayed. Results After treatment with HS, the hemodynamic changes of hemorrhagic shock rats were significantly alleviated, and tissue fluid redistributed. When the hemorrhagic shock animals were treated with HS containing taurine (HST), in comparison with HS treatment, the hemodynamic improvement and hemodilution were more obvious. When the hemorrhagic animals complicated with hypernatremia were treated with HS, the symptoms of dehydration and shock further deteriorated, when the hemorrhage with hypernatremia animals were treated with an infusion of HST, the symptoms of dehydration and shock were significantly ameliorated. Conclusion The therapeutic effect of HS with taurine is obviously better than HS alone. So when hemorrhagic shock was complicated with hypernatremia, HS with taurine is recommended in stead of HS alone.

A Review of Nurses’ Perceptions of Traumatic Haemorrhagic Shock Management in Emergency Nursing

Haemorrhagic shock (HS) is a subset of hypovolaemic shock in which there is minimal to massive loss of blood either internally or externally in trauma or injured patients. Data from the World Health Organization (WHO) affirm that injuries account for over 5 million fatalities globally every year, and by 2030, injury mortality is predicted to rise severely. Public health research typically uses the KAP models, which may be divided into three parts: acquiring accurate knowledge, forming an attitude, and adopting behavior, to analyze people’s health behaviors and explain changes in them. This review is about the nurses’ perspectives of the concept of Knowledge, Attitude, and Practice (KAP) Model of hemorrhagic shock in trauma patients and assesses clinical practice tools used by nurses to keep an eye on patients who have the condition. Nurses’ knowledge of indications of shock is either high or very high. The knowledge of nurses was related to their training before working in accident and emergency units. The nurses’ attitude is considered significant, commendable, appropriate, and pertinent to the provision of care for a patient experiencing hemorrhagic shock. And the nurse’s practice of early patient identification, prompt and continuous monitoring, control of the bleeding source, maintenance of hemostasis, and the correction of significant blood loss that can occur quickly to cause death, are the strengths of management. .

Effect of Astragalus membranaceus injection on the activity of the intestinal mucosal mast cells after hemorrhagic shock-reperfusion in rats

Background The mechanism of mucosal damage induced by ischemia-reperfusion （IR） after hemorrhagic shock is complex; mast cells （MC） degranulation is associated with the mucosal damage. Astragalus membranaceus can protect intestinal mucosa against intestinal oxidative damage after hemorrhagic shock, and some antioxidant agents could prevent MC against degranulation. This study aimed to observe the effects of astragalus membranaceus injection on the activity of intestinal mucosal mast cells （IMMC） after hemorrhage shock-reperfusion in rats Methods Thirty-two Wistar rats were randomly divided into the normal group, model group, low dosage group, （treated with Astragalus membranacaus injection, 10 g crude medication/kg） and high dosage group （treated with Astragalus membranacaus injection, 20 g crude medication/kg）. The rat model of hemorrhagic shock-reperfusion was induced by hemorrhage for 60 minutes followed by 90 minutes of reperfusion. The animals were administrated with 3 ml of the test drug solution before reperfusion. At the end of study, intestinal pathology, ultrastructure of IMMC, and expression of tryptase were assayed. The levels of malondisldehyde （MDA）, TNF-α, histamine, and superoxide dismutase （SOD） activity in intestine were detected, and the number of IMMC was counted. Results The Chiu＇s score of the rats in the model group was higher than in other groups （P〈0.01）. The Chiu＇s score in the high dosage group was higher than that in the low dosage group （P〈0.05）. Hemorrhage-reperfusion induced IMMC degranulation： Astragalus membranaceus injection attenuated this degranulation. Expression of tryptase and the number of IMMC in the model group increased compared with the other groups （P〈0.01） and was significantly reduced by the treatments of Astragalus membranaceus injection at both doses. There was no significant difference between the two treatment groups （P〉0.05）. MDA content and concentration of TNF-α in the model group were higher than that in the other three groups （P〈0.05）, and the concentration of TNF-α in the low dosage group was higher than that in the high dosage group （P〈0.05）. SOD activity and the concentration of histamine in the model group were lower than the other three groups （P〈0.05）. There was a negative correlation between the Chiu＇s score and the concentration of histamine and a positive correlation between the Chiu＇s score and the concentration of TNF-α and between the SOD activity and the concentration of histamine in the four groups （P〈0.05）. Conclusion Astragalus membranaceus injection may reduce the damage to small intestine mucosa by inhibiting the activated IMMC after hemorrhagic shock.