Hemorrhagic shock

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Hemorrhagic shock
Video explanation of shock
SpecialtyEmergency medicine
SymptomsFast heart rate, narrowing pulse pressure, anxiety, cool arms and legs, decreased consciousness, low blood pressure[1][2]
CausesTrauma, gastrointestinal bleeding, childbirth, ectopic pregnancy, underlying blood vessel problems[2][3]
Diagnostic methodBased on examination and medical imaging[2]
Differential diagnosisOther types of circulatory shock[1]
TreatmentDirect pressure, tourniquet use, tranexamic acid, blood products, temperature management, surgery[1][2]
PrognosisVariable[2]
FrequencyRelatively common[3]

Hemorrhagic shock is a type of hypovolemic shock that occurs due to blood loss.[2] Early symptoms may include a fast heart rate and narrowing pulse pressure.[1][2] With further blood loss anxiety, cool arms and legs, decreased consciousness, and low blood pressure may occur.[1] Complications may include hypothermia, blood clotting problems, and multiple organ dysfunction syndrome.[4]

The cause of blood loss may include trauma, gastrointestinal bleeding, childbirth, ectopic pregnancy, and underlying blood vessel problems.[2][3] Bleeding may occur within the body or externally.[2] Significant blood loss can occur within the abdomen, chest, and retroperitoneum.[2] The underlying mechanism involves not enough blood flow to body tissues.[1] A shock index (heart rate/systolic blood pressure) of greater than 1 can indicate who is likely to need blood transfusions.[1] Ultrasound, in the emergency department, may be useful in determining the location of the blood loss.[2]

The initial management is based on ATLS.[1] The primary treatment is stopping the source of bleeding.[2] This may include direct pressure or tourniquet use.[1] Other measures may include tranexamic acid, blood products, and temperature management.[1] In those without a head injury, the blood pressure may be permitted to remain relatively low until surgery can be performed.[2] Hemorrhagic shock is relatively common.[3] About half of deaths due to trauma are due to bleeding and bleeding remains the primary preventable cause of trauma related death.[2][1] The risk of death or poor outcomes is high.[1]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Pitotti, C; David, J (November 2020). "An evidence-based approach to nonoperative management of traumatic hemorrhagic shock in the emergency department". Emergency medicine practice. 22 (11): 1–24. PMID 33105073.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Hooper, N; Armstrong, TJ (January 2020). "Hemorrhagic Shock". PMID 29262047. Cite journal requires |journal= (help)
  3. 3.0 3.1 3.2 3.3 Taghavi, S; Askari, R (January 2020). "Hypovolemic Shock". PMID 30020669. Cite journal requires |journal= (help)
  4. "Hemorrhagic Shock". fpnotebook.com. Retrieved 4 January 2021.