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By Garrioch, Magnus

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23 i. How would you categorise this patient’s shock? ii. Describe each category of shock and outline how you would treat each one. iii. What six life-threatening thoracic injuries could this man have, which must be picked up in the primary survey prior to anaesthesia? indd 31 15/10/14 11:37 AM Answer 23 23i. He is stabbed in the chest and is correctly receiving high-flow oxygen through a trauma mask. He is conscious (implying a systolic BP >50 mmHg). He is in class 3 haemorrhagic shock as defined by the American College of Surgeons ATLS guidelines, which categorise shock into 4 classes depending on the percentage of blood volume lost by an adult patient.

The patient must be observed for further evidence of haemorrhage, as he may only transiently respond to fluids. • Class 3 (30–40% 1,500–2,000 ml blood loss). Systolic BP drops and tachycardia is marked. Air hunger with a raised respiratory rate is expected. Immediate administration of up to 2,000 ml of warmed Hartmann’s given in 250 ml boluses is warranted to attempt restoration of systolic BP to approximately 90 mmHg until surgical control of bleeding is achieved. This should be followed by O-negative blood if BP remains unstable.

CH3)3 N CH2 CH2 O C CH2 CH2 C O CH2 CH2 26a N (CH3)3 O N+ O O N+ – 2Cl O i. What is the drug? ii. How does this drug work? iii. Why is it short acting? Explain why, rarely, in some individuals it can last for a long time. iv. Can this drug be used within 24 hours of a 30% body surface area burn? v. What risks are associated with this drug in the burned patient? vi. After a burn, is the patient more or less sensitive to non-depolarising muscle relaxants? Why? indd 37 15/10/14 11:37 AM Answer 26 26i.

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