Hemorrhagic Shock



  • Loss of effective circulating blood volume resulting in inadequate perfusion
  • Blood loss exceeds ability to compensate and tissue and organ perfusion decrease. At the tissue level, hypoperfusion leads to inadequate oxygenation, anaerobic metabolism, cell death
  • Hemorrhagic shock is the most common cause of shock from injury
  • Compensated shock:
    • Patient's physiologic reserve prevents significant alteration in vital signs
  • Decompensated shock:
    • Loss of circulating volume overcomes patient's physiologic reserve, resulting in significant alteration in vital signs
  • Blood loss estimate:
    • Total blood volume ∼7% of ideal body weight (4,900 mL in 70-kg adult) or 70 mL/kg
    • Multiply 70 mL/kg × body weight (kg) × percentage loss as determined by class of hemorrhage


  • Trauma – penetrating and blunt:
    • Abdominal:
      • Splenic injury
      • Liver injury
    • Chest:
      • Hemothorax
      • Aorta or great vessel injury
    • Pelvis:
      • Pelvic fracture with vascular injury
  • Vascular malformations:
    • May lead to thoracic, intraperitoneal, or retroperitoneal bleeding
    • Aneurysms:
      • Abdominal aortic aneurysm most common
      • Mycotic aneurysm secondary to endocarditis
    • Aortogastric fistula
    • Arteriovenous malformations
  • Abortion: Complete, partial, or inevitable
  • Ectopic pregnancy
  • Epistaxis
  • Fractures (especially pelvis and long bones)
  • GI bleeding
  • Hemoptysis
  • Malignancies
  • Placenta previa or abruption
  • Postpartum hemorrhage
  • Retroperitoneal bleeds
  • Splenic rupture
  • Vascular injuries

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