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Hemorrhagic Shock

Hemorrhagic Shock is a topic covered in the 5-Minute Emergency Consult.

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  • 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 signification 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
  • Mallory–Weiss tear
  • Placenta previa
  • Postpartum hemorrhage
  • Retroperitoneal bleeds
  • Splenic rupture
  • Vascular injuries

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Rosen, Peter, et al., editors. "Hemorrhagic Shock." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307461/all/Hemorrhagic_Shock.
Hemorrhagic Shock. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307461/all/Hemorrhagic_Shock. Accessed April 20, 2019.
Hemorrhagic Shock. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307461/all/Hemorrhagic_Shock
Hemorrhagic Shock [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307461/all/Hemorrhagic_Shock.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemorrhagic Shock ID - 307461 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307461/all/Hemorrhagic_Shock PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -