Typical case sharing of sudden extensive blood seepage in patients with shock in the period of epitherism

If a patient with circamcising shock is bleeding widely, both the surgeon and the anesthesiologist will be very nervousThis means that without the timely termination of this condition, it is difficult for the patient to survive and even to ensure his or her lifeWidespread continuous blood seepage can cause large hematoma, blurred surgical vision, increased surgical difficulty or risk, further lead to loss of a large amount of blood capacity, induce splies intravascular clotting and multi-organ failureSuch cases can be described as "unwanted"To increase awareness of this perinatal event, we share two cases:cases 1.
The patient, a 60-year-old woman, was admitted to hospital with mid-esophageal cancer and had his stomach ulcer removed in 1986Checked: white blood cells 3.73X 10 x 9/L, hemoglobin 90.8g/L, platelets 223X 10?9/L, PT11.5 seconds, APTT 28.3 seconds, hepatitis B five indicators all negative, liver and kidney function is normalhere, there doesn't seem to be anything unusualrehydration fluid, blood transfusion, albumin support and preoperative preparation, total esophagus removal, colon esophagus neck matchfirst caesarean section free colon, the wound surface blood seepage less; after opening the chest due to the separation of a wide range of chest cavity adhesion, wound surface blood seepage more, visible blood clots; After the creation of surface compression to stop blood, rapid blood transfusion, boost and other comprehensive treatment, completed surgery, intraoperative rehydration fluid 11000 ml, blood transfusion plasma 200 ml and library blood 4800 ml, blood loss of about 6000 mlis it reasonablethe component blood transfusion here? For example, should plasma be lost earlier, more than some?checkPT 32.2 seconds, APTT 71.0 seconds, 3P negativeAfter anti-inflammatory, hormone therapy, continue blood transfusion, at the same time with phenol sulphate ethyreamine, ammonia toluene acid, barperase, new blood plasma 1500m1, cold precipitation 8U, fibrin, calcium and fresh whole blood 600 ml hemorrhage treatment the bleeding stopped on the second day after surgery Review PT 13.5 seconds, PTT 29.0 seconds against this case, what do you think is the biggest cause of widespread bleeding? cases 2.
The patient is 26 years old and 27 weeks pregnant Due to the suspension of more than 6 months, painless vagina a small amount of bleeding 3 days admitted to the hospital Married at the age of 23, five pregnancies in the three years after marriage were performed by natural abortion in the third and third months of pregnancy and performed a clean-up procedure The pregnancy in the 3 plus months of pregnancy again appeared vaginal bleeding a small amount, self-treatment in a private clinic after the bleeding stopped During pregnancy, there is no delivery test Admission: Body temperature 36.5C, pulse 84 times/min, breath 12 times/min, blood pressure 14/9kPa 1KPa is 7.5mmHg, so blood pressure is 105/67mmHg Generally good, heart and lung normal Palace height 21cm, abdominal circumference 82cm, front right, fetal heart 148 times / minute Blood routine hemoglobin 113g/L, white blood cell 10.4X10?9/L, red blood cell 3.45X 10?12/L, neutrophil 88%, lymphocyte 12% BT 2 minutes, CT 3 minutes B overdisplay: central front placenta, single-hip first exposure, fetal heart rate and amniotic fluid are normal Clinical diagnosis: central front alta, precious children Here, we found that, in addition to the medical history of multiple bleeding, abortion history, the pre-front placenta is the biggest problem! consider the patient vaginal bleeding less, the fetus is not yet mature, at the same time should be the patient himself and his family's strong request, in close supervision of the downward expectation of therapy, to give the contraction inhibitor and hemorrhoids and other treatment what's the biggest problem here, you should be able to see Can the doctor's opinion be the main party in medical decision-making? On the second day of admission, a large amount of vaginal bleeding suddenly appeared, the amount of about 1000 ml In the anti-shock at the same time emergency caesarean section, the operation found that the placenta attached to the front wall of the uterus, the lower part of the uterus front wall and the entire cervix, incision and placenta bleeding more than, uterine injection of barley-angle neonicotinoid0.2mg and oxytocin 10U immediately after hand take the placenta When stripped, the placenta implants were found in the lower part of the uterus and in the intrauterine placenta Can full pre-frontal placenta and placenta implantation be diagnosed before surgery? What is the cause of the diagnosis? bleeding widely and rapidly, stitching to stop the bleeding and ligation of two-sided uterine artery upward branch effect is not good, the whole cut of the uterus, extensive blood seepage, seindes not coagulation, the patient quickly presents a deep coma, rapid dispersal intravascular clotting laboratory to check the blood clotting dysfunction Despite active rescue searlying, he died six hours after the operation Pathological examination: partial placental implantation, partial penetration of the muscle layer up to the pulp membrane Source: