Hemorrhagic shock
Hemorrhagic shock is a type of hypovolemic shock that occurs due to blood loss. Early symptoms may include a fast heart rate and narrowing pulse pressure. With further blood loss anxiety, cool arms and legs, decreased consciousness, and low blood pressure may occur. Complications may include hypothermia, blood clotting problems, and multiple organ dysfunction syndrome.
The cause of blood loss may include trauma, gastrointestinal bleeding, childbirth, ectopic pregnancy, and underlying blood vessel problems. Bleeding may occur within the body or externally. Significant blood loss can occur within the abdomen, chest, and retroperitoneum. The underlying mechanism involves not enough blood flow to body tissues. A shock index of greater than 1 can indicate who is likely to need blood transfusions. Ultrasound, in the emergency department, may be useful in determining the location of the blood loss.
The initial management is based on [Advanced Major trauma|trauma life support|ATLS]. The primary treatment is stopping the source of bleeding. This may include direct pressure or tourniquet use. Other measures may include tranexamic acid, blood products, and temperature management. In those without a head injury, the blood pressure may be permitted to remain relatively low until surgery can be performed. Hemorrhagic shock is relatively common. About half of deaths due to trauma are due to bleeding and bleeding remains the primary preventable cause of trauma related death. The risk of death or poor outcomes is high.