Emergency Care for Hemorrhagic Shock: Understanding the Triggers
Hemorrhagic shock is a life-threatening condition caused by significant blood loss, either internal or external. It is the leading cause of death for Americans between 1-46 years old, accounting for about 35% of prehospital deaths and 40% of deaths within the first 24 hours after injury.
Hemorrhagic shock is caused by heavy blood loss, called hemorrhage. Symptoms include low to no urine output, rapid heart rate, rapid breathing, low blood pressure, confusion, dizziness, weak pulse, chest pain, shortness of breath, and internal bleeding symptoms such as bloody urine, bloody stool, chest pain, bloody vomit, abdominal pain, and abdominal swelling.
The American College of Surgeons Advanced Trauma Life Support divides hemorrhagic shock into four stages based on the percentage of blood loss in a 70 kg individual.
- Stage 1: An individual loses up to 15% of their total blood volume, and their blood pressure, respiratory rate, and pulse do not change.
- Stage 2: A person loses 15-30% of their blood, and their heart and respiratory rates increase.
- Stage 3: An individual loses 30-40% of their blood, and a significant drop in blood pressure occurs.
- Stage 4: A person loses more than 40% of their blood, and another significant drop in blood and pulse pressure occurs.
Treatment for hemorrhagic shock includes intravenous fluids, blood transfusions, and resuscitation if necessary. If the person does not have a head, neck, or spine injury, they can also tie the area with any available fabric to reduce blood loss. A protocol for severe hemorrhagic shock involves transfusing 10 units of packed red blood cells with a set ratio of platelet and plasma transfusions within 24 hours.
First aid measures such as lying the person on their back, raising their legs, cleaning the wound, and applying pressure to reduce blood loss should be performed in case of heavy bleeding or shock symptoms. In severe cases, medications such as vasopressors may be given to increase blood pressure.
A physical examination, including a focused assessment with sonography for trauma (FAST) exam and extended FAST exam, can help diagnose hemorrhagic shock. Other diagnostic tests include imaging tests (CT scans or X-rays), blood tests to determine blood type, and a medical history to assess underlying health conditions.
It is essential to note that Hypovolemic shock, a different condition caused by a sudden drop in blood volume, with various causes, including significant fluid loss due to diarrhea or vomiting, is less likely to occur following heavy bleeding. Key nonhemorrhagic causes include severe vomiting and diarrhea, dehydration, burns, infections (e.g., sepsis or gastrointestinal viruses), and third-space fluid losses.
References: [1] Tintinalli, J. E., et al. (2021). Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill Education. [2] American College of Surgeons. (2018). Advanced Trauma Life Support Provider Manual. American College of Surgeons. [3] Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43(3), 303-337. [4] Kauffman, C. A., et al. (2014). Burn Shock: An Overview. The American Journal of Surgery, 207(5), 527-533. [5] Kline, J. A., et al. (2006). The Pathophysiology of Shock. Critical Care Medicine, 34(1), 17-28.
