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Assessment of VCB deficit by shock index (according to V.I. Kulakov, 1998)

A quantity of blood density and hematocrit may also be used (Table 19).

Table 19 Dependence of blood loss volume on blood density and Ht (according to V.I. Kulakov, 1998)

It is necessary to remember that changes of blood density and Ht do not advance just after a blood loss, but in proportion to its dilution with extracellular fluid.

Determination of blood loss volume by blood density:

In test tubes with copper sulfate of different density (from 1.057 to 1.041) a patient's blood, stabilized with Na citrate, is poured in drop-by-drop. Blood density corresponds to the density of solution in that test-tube where a drop of blood hangs for 5-6 sec. In Table 20 we find the volume of blood loss corresponding to this density.

Table 20 Dependence of blood loss volume on blood density

Blood loss determination according to Moore:

Where Ht_due — hematocrit that is to be due, for males — equal to 0.45 and for females — 0.42.

Htfact. — factual hematocrit is determined in laboratory.

In this formula instead of Ht we may put Hbdue data (hemoglobin that is due) equal to 150 g/1;

— VCBdue = 75 ml x weight for males;

— 60 ml x weight for females;

— 75 ml x weight for pregnant women.

Other methods of determination of blood loss volume:

1. Libov's method: blood loss volume is equal to 57% of mass of gauze serviettes and balls used during operation.

2. Blood loss volume in fractures of thighbones is, approximately, equal to 1 1., shin — 750 ml, humerus — 500, hip bones — up to 3 1.

3. In injury of soft tissues or skin through the whole its thickness for the area of 1% of body surface a blood loss makes up 10% of VCB.

4. By a degree of hemorrhagic shock severity: 1 degree = 500 ml; 2 degree = 1000 ml; 3 degree = 2000 ml blood loss.

5. By massiveness of hemothorax in X-ray examination of the chest a blood

loss is from 500 ml (a level of liquid is visible) up to 1000-2000 ml (a shadowing of the greater portion of lung field).

6. In the abdominal cavity a symptom of ballottement starts to be determined when a content of liquid is 1 1.

A severity of the hemorrhagic shock course is in the direct dependence on the amount and rate of blood loss. Therefore, a determination of the blood loss amount is important for a further tactics of hemorrhagic shock treatment.

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