HEMORRHAGIC SHOCK

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HEMORRHAGIC SHOCK
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HEMORRHAGIC SHOCK

• When much blood is lost, the pulse becomes
  feeble, the skin extremely pale, the body covered
  with a malodorous sweat, the extremities frigid,
  and death occurs speedily
• Aulus Conelius Celsus,
• First Century Roman Savant

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TYPES OF SHOCK

• HEMORRHAGIC
• NONHEMORRHAGIC
• Cardiogenic
• Tension Pneumothorax
• Neurogenic
• Septic

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TYPES OF SHOCK

• Note that regardless of the classification, the
  underlying defect is always
• Inadequate Organ Perfusion and Tissue
  Oxygenation !

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HEMORRHAGIC SHOCK

• Hemorrhage acute loss of circulating blood
• Most common cause of shock after injury
• Virtually all patients with multiple injuries
  have an element of hypovolemia

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HEMORRHAGIC SHOCKCombat Mortality

• 40-55 of all combat deaths were directly
  attributable to uncontrolled hemorrhage.
• 10-25 of those could have been saved with
  appropriate control of bleeding.

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HEMORRHAGIC SHOCKPathophysiology

• First, in response to hemorrhagic hypotension
  (acute blood loss), the skin, skeletal muscles,
  and kidneys undergo intense vasoconstriction
• Systemic blood flow is shunted away from
  non-vital organs to assist in maintaining blood
  flow to vital organs

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HEMORRHAGIC SHOCKPathophysiology

• The body sacrifices less vital organ tissue to
  maintain oxygen and nutrient flow to the brain
  and heart
• In the brain and heart, blood flow and oxygen
  delivery remain constant over a wide range of
  arterial pressures

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HEMORRHAGIC SHOCKPathophysiology

• During severe hypotension, oxygen delivery is
  markedly reduced, and tissue oxygen extraction is
  increased to meet demand, thus,
• the Physiology of Hypotension

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Pathophysiology
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Shock
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ASSESSMENT

• Evaluation of the patient in shock must be
  directed at assessing oxygenation and perfusion
  of the various body organs

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ASSESSMENT

• Airway
• Breathing
• Circulation
• Radial pulse 80 mm Hg systolic
• Femoral pulse 70 mm Hg systolic
• Carotid pulse 60 mm Hg systolic
• Disability
• Altered mental status
• Expose/Environment

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ASSESSMENTSigns and Symptoms

• Breathing
• Increased respirations
• Circulation
• Increased pulse rate
• Cool and clammy skin
• Thirst
• Nausea
• Disability
• Agitation

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Shock Management

• Recognize presence
• Identify probable cause
• Initiate appropriate treatment
• Observe response

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Shock Management

• Airway
• Establish airway
• Breathing
• Ventilate
• Circulation and Hemorrhage Control
• Emergency trauma dressing/kerlex
• Tourniquet
• Rapid volume replacement if bleeding is controlled

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Shock Management

• Disability
• Monitor mental status
• Expose/Environment
• Expose only as needed
• Prevent hypothermia!!!

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Summary

• Management
• control bleeding give fluids
• monitor patients response

Goal restoration of organ perfusion
Goal restoration of organ perfusion
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QUESTIONS?