| Hemorrhagic_shock | |
|---|---|
| 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, underlyingblood vessel problems[2][3] |
| Diagnostic method | Based onexamination andmedical imaging[2] |
| Differential diagnosis | Other types ofcirculatory shock[1] |
| Treatment | Direct pressure,tourniquet use,tranexamic acid,blood products, temperature management, surgery[1][2] |
| Prognosis | Variable[2] |
| Frequency | Relatively common[3] |
Hemorrhagic shock is a type ofhypovolemic shock that occurs due toblood loss.[2] Early symptoms may include afast heart rate andnarrowing pulse pressure.[4][5] With further blood lossanxiety, cool arms and legs, decreased consciousness, andlow blood pressure may occur.[4] Complications may includehypothermia,blood clotting problems, andmultiple organ dysfunction syndrome.[6]
The cause of blood loss may includetrauma,gastrointestinal bleeding,childbirth,ectopic pregnancy, and underlyingblood vessel problems.[2][7] Bleeding may occur within the body or externally.[2] Significant blood loss can occur within theabdomen,chest, andretroperitoneum.[2] The underlying mechanism involves not enough blood flow tobody tissues.[4] Ashock index (heart rate/systolic blood pressure) of greater than 1 can indicate who is likely to needblood transfusions.[8]Ultrasound, in the emergency department, may be useful in determining the location of the blood loss.[2]
The initial management is based onATLS.[4] The primary treatment is stopping the source of bleeding.[2] This may include direct pressure ortourniquet use.[1] Other measures may includetranexamic acid,blood products, and temperature management.[1] In those without ahead injury, theblood pressure may be permitted to remain relatively low until surgery can be performed.[2] Hemorrhagic shock is relatively common.[7] 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]