Hemorrhagic shock

Background

Goals of management[1]
  1. FIND and STOP the bleeding
  2. Rapidly restore blood volume
  3. Maintain functional blood composition (i.e. hemostasis, pH, oxygen carrying capacity, oncotic pressure and biochemistry)

Clinical Features

Classes of hemorrhagic shock[2]
Class I II III IV
Approximate blood loss <15% 15-30% 30-40% >40%
Heart rate ↔ ↔/↑ ↑ ↑↑
Blood pressure ↔ ↔ ↔/↓ ↓
Pulse Pressure (mmHg) ↔ ↓ ↓ ↓
Respiratory Rate (per min) ↔ ↔ ↔/↑ ↑
Urine Output (mL/hr) ↔ ↔ ↓ ↓↓
Glasgow coma scale score ↔ ↔ ↓ ↓
Base deficit^ 0 to -2 mEq/L -2 to -6 mEq/L -6 to -10 mEq/L -10 or less mEq/L
Need for blood products Monitor Possible Yes Massive transfusion protocol

^Base excess is the quantity of base (HCO3-, in mEq/L) that is above or below the normal range in the body. A negative number is called a base deficit and indicates metabolic acidosis.

Differential Diagnosis

Shock

Evaluation
  • Ultrasound in Shock and Hypotension

Locations of Possible Life-Threatening Bleeding

Management
  • Find and treat the cause
  • Correct coagulopathy
  • Resuscitate; consider massive transfusion protocol
  • Get help early (e.g. surgeon, IR)

Disposition
  • Admit

See Also

References
  1. http://lifeinthefastlane.com/ccc/major-haemorrhage-in-trauma/
  2. American College of Surgeons Committee on Trauma. Shock: in Advanced Trauma Life Support: Student Course Manual, ed 10. 2018. Ch 3:62-81
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