ANESTHESIA MANAGEMENT IN HEMORRAGIC SHOCK DUE TO UTERINE RUPTURE AFTER SPONTANEOUS DELIVERY
Odih Fahruzi, Doddy Tavianto, Iwan Fuadi, Erwin Pradian, Suwarman, Reza Sujud

Departement of Anesthesiology and Intensive Care Faculty of Medicine Padjajaran University

Abstract

Introduction : The American College of Surgeons has identified 4 classes of bleeding, class I is a blood loss of less than 15%, class II is a blood loss of 15-30%, class III is a blood loss of 30-45%, and in class IV there is a blood loss of more than 40%.
Case summary : A 30-year-old woman, with hemorrhagic shock after uterine rupture. On examination in the resusitation room, there were signs of shock, then a large infusion access was installed for fluid resuscitation. After fluid resuscitation and stable hemodynamics was established, the patient was transferred to the operating room with blood supply for prepared. Intraoperative induction was carried out in a rapid sequence induction using ketamine and rocuronium, maintenance of sevoflurane, O2 and air. There was intraoperative bleeding of 8000 cc. We give 3000 cc crystalloid, 3000 coloids, PRC 8 bags, FFP 8 bags, TC 8 bags. The bleeding was still occured, damage control was done by packing. The patient was transferred to ICU.
Discussion : In the above case, the patient was in a hemorrhagic shock. The patient was subjected to damage resusitation from the resuscitation room to the operating room. When the bleeding condition cannot be stopped, damage control is done to stop the bleeding temporarily until the patient^s condition is stable and improves the bleeding condition due to heavy bleeding.
Conclusion : Management of a patient with hemorrhagic shock must be done quickly and simultaneously, from perioperative, intraoperative to postoperative.

Keywords: damage control, damage resuscitation, uterine rupture, hemorrhagic shock

Topic: Update Emergency Assesment and Management