Introduction
For anesthetic technicians (ATs) and/or operating department practitioners (ODPs) the process of monitoring patients and delivering care during perioperative stages is one of the direct responsibilities. Abnormalities in blood pressure can be seen as one of the monitored indicators and which can be attributed to hypovolaemic shock. Hypovolaemic shock can occur in preoperative patients as well. The failure to recognize hypovolaemic shock early is one of the most common errors in its management. Accordingly, such error might be caused by the reliance on blood pressure as an indicator of patients’ possible hemorrhage (Ciammaichella, 2010). In that regard, the present paper will attempt to provide an overview of the identification and management of hypovolaemic shock during surgery.
Identification of Hypovolaemic Shock
A shock can be defined as “[a] serious condition that occurs when the cardio-vascular system is unable to supply enough blood flow to the body, causing inadequate tissue perfusion” (Ambulance Technician Study, 2006). The term hypovolaemic indicates the cause of the shock, which in this case is associated with inadequate loss of fluid volume, leading to a reduction in blood circulation. Such reduction leads to that oxygen-rich blood cells reach cells in a lesser volume, resulting in cell damage, tissue death and organ failure. There are three-stage of shock which indicate the response of the body to its compensatory mechanisms. These stages are applicable for hypovolaemic shock as well and are as follows:
- Compensated – at this stage the decrease in volume loss can be compensated and adequate blood pressure can be maintained.
- Uncompensated – the start of the failure in body’s compensating mechanisms, where blood pressure begins to decrease along with worsening of the patient’s conditions.
- Irreversible – usually a diagnosis of such state is post-mortem state, where the organ becomes damaged due to cell and tissue ischemia.
The aforementioned stages can be linked to four classes of classification system, based on the volume of blood loss, which is stage1 – 15% (750mls), stage 2 – 15%-30% (750-1500mls), stage 3 – 30%-40% (1500-200mls), and stage 4 – greater than 40%(>200mls) (Ambulance Technician Study, 2006). In that regard, the compensated stage is both stage represent stage 1 and two, i.e. a stage at which the body is able to maintain blood pressure. Accordingly, the uncompensated stage might be seen representing stage 3 and 4.
Each of the aforementioned stages can be linked to particular symptoms in intra-operative patient which will facilitate the identification of the stages and accordingly recognize hypovolaemic shock at the earliest stage possible. At the stage of compensated loss, the symptoms usually revolve around slight anxiety, confusion and pallor of the skin at lower blood loss volumes, while at higher blood loss volumes, i.e. stage 2, tachycardia can be witnessed along with sweating from sympathetic stimulation (Ambulance Technician Study, 2006; Ciammaichella, 2010).
At the uncompensated stage, the symptoms start with marked tachycardia which at greater blood losses turns into extreme. The pressure might arise when the body attempts to compensate with vasoconstriction, dropping significantly after. Patients might show cold and pale skin, while preoperative patients might verbalize their feeling of cold and shivery, at lower blood losses pronounced tachypnoea can be observed.
Monitoring and Intra-Operative Tests
Intra-operative tests and procedures that anesthetists might request revolve around monitoring and reading patients’ vital indicators. In addition to blood pressure, which as stated earlier, should be used in conjunction with other parameters. The reliance on blood pressure only can delay diagnosis. Other tests might include temperature, wherein case the temperature becomes low it will interfere with platelet function and coagulation, and bleeding would be difficult to control. It is important to monitor for hypothermia and hyperthermia during the anesthetic phase as well (Hamlin, Richardson-Tench, & Davies, 2008, p. 220).
Hyperthermia is one of the complications of general anesthesia. Accordingly, an emphasis should be paid to body parts in which a life haemorrhage can occur, which are chest (myocrdium, great vessels, lung lacerations), abdomen, and pelvis and thighs (Ambulance Technician Study, 2006; Kolecki & Menckhoff, 2010).
Another important indicator of the status of intra-operative patient is breathing. As previously mentioned, the chest is one of the areas in which a life-threatening haemorrhage can occur. Decreased breath sounds, in that regard, can be used to identify hemorrhage caused by myocardial, vessel or lung laceration. Breathing can be used to identify interfering factors as maximizing the delivery of Oxygen is vital in such a case, where one of the guidelines can be seen in targeting the delivery of O2 to vital organs.
Generally, for the treatment of hypovolaemic shock, the main monitoring indicators used should include “[m]onitor mental status, skin color, blood gases, hemoglobin, urine output, electrolytes and Lactic Acid levels” (Hudson, 2005).All of the aforementioned indicators can be monitored and assessed through using ATs/ODPs during surgery. Additionally, the usage of PA catheter can be seen as a mean to provide a more detailed view of patient condition (Hudson, 2005) as well as CVP monitoring as a substitute. Other monitoring means might include PiCCO catheter, a catheter that provides information on hemodynamic stability through measuring heart and lung volumes, and usually placed in the femoral artery (Hudson, 2005). Accordingly, all of the aforementioned can be used as precautionary measures for early identification of shocks as well as a mean for optimal management of the patient.
The Roles and the Responsibilities of ATs/ODPs
The Role of Anaesthetic Technicians (ATs) and Operating Department Practitioners (ODPs) during the surgery can be seen in the emergency situations which might occur and which require group efforts. Haemorrhage can be seen as one of such situations, along with cardiac arrests, major allergic reactions, and failures to ventilate patients. The latter is specifically related to ATs, and in such situations it is largely a team effort (New Zealand’s Ministry of Health, 2006).
Assessing the cause of the haemorrhage along with the volume of blood lost is one of the most important tasks ATs might have ion such case. In terms of ODPs, their role is more general during the surgery, acting as the link between the surgical team and parts of the surgery room and the hospital. Measuring the temperature, blood pressure, managing intra-operational medication, fluids replacement, and positioning the patient are a few of the responsibilities of ODPs in the case of patient’s haemorrhages.
Conclusion
The present essay provided an overview of hypovolaemic shock, in term so identification and management. It can be concluded that such condition is important to monitor and assess, and accordingly, the roles and the responsibilities of Anaesthetic Technicians and Operating Department Practitioners cannot be overestimated. The failure to recognize and identify hypovolaemic shock can be seen as one of the common pitfalls in medicine, which specifically outlines the significance of ATs/ODPs in managing and treating such conditions.
References
Ambulance Technician Study. (2006). Shock. Ambulance Technician Study. Web.
Ciammaichella, M. M. (2010). HYPOVOLEMIC SHOCK. Emergency Medicine Journal. Web.
Hamlin, L., Richardson-Tench, M., & Davies, M. (2008). Perioperative Nursing: An Introductory Text: Elsevier Australia.
Hudson, K. (2005). HYPOVOLEMIC SHOCK. Dynamic Nursing Educaiton. Web.
Kolecki, P., & Menckhoff, C. R. (2010). Hypovolemic Shock. eMedicine. Web.
New Zealand’s Ministry of Health. (2006). Regulation of the profession of Anaesthetic Technicians under the Health Practitioners Competence Assurance Act 2003. Ministry of Health -New Zealand. Web.