Medicine:Hemorrhagic shock
| Hemorrhagic_shock | |
|---|---|
| File:Shock video.webm | |
| Video explanation of shock | |
| Specialty | Emergency medicine |
| Symptoms | Fast heart rate, narrowing pulse pressure, anxiety, cool arms and legs, decreased consciousness, low blood pressure[1][2] |
| Causes | Trauma, gastrointestinal bleeding, childbirth, ectopic pregnancy, underlying blood vessel problems[2][3] |
| Diagnostic method | Based on examination and medical imaging[2] |
| Differential diagnosis | Other types of circulatory shock[1] |
| Treatment | Direct pressure, tourniquet use, tranexamic acid, blood products, temperature management, surgery[1][2] |
| Prognosis | Variable[2] |
Hemorrhagic shock is a type of hypovolemic shock that occurs due to blood loss.[2] The underlying mechanism that results in shock involves not enough blood flow to body tissues.[4] In this case, inadequate blood flow is caused by insufficient blood volume remaining within the cardiovascular system. Complications may include hypothermia, blood clotting problems, and multiple organ dysfunction syndrome.[5]
Causes
The cause of blood loss may include trauma (often blunt or penetrating), gastrointestinal bleeding, childbirth, ectopic pregnancy, and underlying blood vessel problems.[2][6] Bleeding can occur internally or externally.[2] Significant blood loss can occur within the abdomen, chest, and retroperitoneum.[2] Ultrasound, in the emergency department, may be useful in determining the location of the blood loss.[2]
Symptoms
As blood loss occurs, the body attempts to compensate for the lack of volume within the cardiovascular system by increasing heart rate and vasoconstriction.[2] If the source of bleeding is not stopped, this can cause blood to be lost more quickly as blood is pumped faster.
Early symptoms may include a fast heart rate, narrowing pulse pressure, shallow and rapid breathing, and agitation.[2][4] As blood loss progresses, cool arms and legs, decreased consciousness, cyanosis, increasingly labored breathing, and low blood pressure may occur.[4] Falling blood pressure may be the last sign of shock before it becomes irreversible.
Treatment
Rapid, coordinated treatment is essential for patients presenting with hemorrhagic shock.[4] The initial management is based on ATLS (Advanced Trauma Life Support).[4] The primary treatment is stopping the source of bleeding.[2] This may include direct pressure, pressure dressings, or tourniquet use.[1] Other measures may include tranexamic acid, blood products, oxygen administration, 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] A shock index (heart rate/systolic blood pressure) of greater than 1 can indicate who is likely to need blood transfusions.[4] 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
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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.
- ↑ 2.00 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 2.14 Hooper, N; Armstrong, TJ (January 2020). "Hemorrhagic Shock". StatPearls. PMID 29262047.
- ↑ Taghavi, S; Askari, R (January 2020). "Hypovolemic Shock". StatPearls. PMID 30020669.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 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.
- ↑ "Hemorrhagic Shock". https://fpnotebook.com/er/cv/hmrhgcshck.htm.
- ↑ Taghavi, S; Askari, R (January 2020). "Hypovolemic Shock". StatPearls. PMID 30020669.
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