MANAGEMENT OF OBSTETRICS SHOCK

HAEMORRHAGIC SHOCK

• Infusion and transfusionBloodCrystalloid- Normal saline Colloids- haemaccel, human albumin solution

4.5%

• Maintenance of cardiac efficiency 6 liter of crystalloid for loss of 1 liter plasma

volume Haemodynamic monitoring – BP, CVP

• Administer oxygen to avoid metabolic acidosis: by mask 6-8 liter/ minIt should be continued to maintain O2

saturation greater than 92%, PaO2 80 – 100 mmhg, PaCO2 30 – 35mmhg and Ph – 7.35

• Pharmacological agent :

Vasoactive drugs, inotropes, corticosteroids

Monitoring • Skin temperature• Urine output greater then 30ml/hr• Arterial blood pressure • CVP• Pulse oximeter and ABG

Endotoxic shock Antibiotics

Inj. Ampicillin 6 hourlyGentamicin 2mg/kg IV loading dose followed

by 1.5mg/kg 8 hourlyMetranedazole 500mg 8 hourly

Alternative regimen

Ceftrazidine

Clindamycine 600mg iv IV fluids and electrolytes Correction of acidosis

• Maintain blood pressure • Vasodilator therapy

- sodium nitroprusside

- nitoglycerine• Diuretic therapy• Corticosteroids

50 mg of hydrocortisone/kg • Treatment of diffuse intravascular

coagulation

- heparine 500IU sc, iv

• Treatment of myocarditis • Elimination source of infection • H2 blockers • Nutritional support

Neurogenic shock

• Fluid replacement• Vasoactive drug and corticosteroids• Correction of acidosis and ventilation• Elimination and correction of source of

neurogenic stimulation