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
Blood Loss (mL) <750 750-1000 1500-2000 >2000
Blood Loss (%) <15 15-30 30-40 >40
Pulse rate (per min) <100 100-120 120-140 >140
Blood Pressure Normal Normal Decreased Decreased
Pulse Pressure (mmHg) Normal or Increased Decreased Decreased Decreased
Respiratory Rate (per min) 14-20 20-30 30-40 >35
Urine Output (mL/hr) >30 20-30 Negligible
Mental Status Slightly Anxious Mildly Anxious Anxious, Confused Confused, Lethargic
Fluids Crystalloid Crystalloid Crystalloid and blood Crystalloid and blood

Differential Diagnosis

Shock

Evaluation

Locations of Possible Life-Threatening Bleeding

Management

  • Find and treat the cause
  • Correct coagulopathy
  • Get help early (e.g. surgeon, IR)

Disposition

See Also

External Links

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 9. 2012. Ch 3:62-81