Hemorrhagic (hypovolemic) shock – causes, symptoms, first aid. How to treat this sudden life-threatening condition?

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Haemorrhagic shock is a medical emergency that can lead to the patient’s death. For this reason, it is very important to provide first aid and appropriate treatment. What are the main causes of hemorrhagic shock? What is the treatment of a patient in a life-threatening condition?

Haemorrhagic shock and hypovolemic shock

Hypovolemic shock (oligovolemic shock) is one of the four primary forms of shock that have all clinical forms leading to a life-threatening emergency. It is caused by the sudden loss of fluids that fill the vascular bed. Haemorrhagic shock is the most common form of hypovolemic shock.

Other forms of shock that may be directly life-threatening include:

1. Cardiogenic shock – the direct cause is a decrease in the contractility of the heart caused by acute coronary syndrome, inflammation of the heart or arrhythmias,
2. Obstructive shock – caused by mechanical pressure (e.g. in the case of cardiac tamponade),
3. Distribution shock – associated with loss of vascular tone that directly leads to abnormal blood distribution (e.g. anaphylactic shock).

Hemorrhagic shock – characteristics

Haemorrhagic shock is the primary form of hypovolemic shock and is a haemorrhage, meaning extravasation of blood beyond the vascular bed. Despite the different types of shock, paramedics determine whether the haemorrhage can be controlled. For this reason, it is very important to recognize the symptoms accurately.

1. What symptoms accompany a hemorrhage?

Haemorrhagic shock refers to the loss of more than 1/3 of the blood volume. The body is able to compensate for the loss not exceeding this value by reducing the capacity of the vessels while increasing blood pressure.

Hemorrhagic shock – causes

Haemorrhagic shock occurs most often during surgery, but there are more reasons for the dynamic life-threatening condition. They include:

1. Extensive trauma (of a closed or open nature),
2. Postoperative bleeding,
3. Spontaneous bleeding (most often diagnosed in patients with low clotting or taking anticoagulants),
4. Bleeding from the gastrointestinal tract
5. Rupture of an ectopic pregnancy,
6. Bleeding esophageal varices in liver failure,
7. Third degree burns.

Hemorrhagic shock – first symptoms

For each shock, including hemorrhagic shock, we can distinguish two phases – balanced and uncontrolled.

A characteristic feature of the even phase is an attempt to compensate for blood loss involving the stimulation of the sympathetic system, which is not indifferent to the body. Therefore, the first symptoms of developing hemorrhagic shock are:

1. Weakness,
2. Dizziness,
3. Pale skin,
4. Excessive sweating
5. Increased thirst
6. Reduction of diuresis,
7. Heart rate weakness.

If the first symptoms are recognized as symptoms of hemorrhagic shock, treatment may be effective. If the patient does not recognize the symptoms, the uncontrolled phase occurs, which is associated with a critical weakening of the tissue flow. The respiratory muscles and the heart stop working as they should because the blood cannot transport the right amount of oxygen and nutrients.

In the decompensated phase, there is hypotension, cardiac arrest, loss of consciousness and acidosis. Despite medical care, at this stage, multiple organ failure may occur and the patient may die.

Haemorrhagic shock – symptoms and the volume of blood lost

The severity of hemorrhagic shock may depend on the volume of blood lost, which also translates into the appearance of specific symptoms:

1. <750 ml utraconej krwi (15 proc. Całkowitej krwi) – accelerated heart rate (<100), blood pressure normal, breathing normal, skin normal, consciousness normal,
2. 750-1500 ml of blood lost (15-30% of the total blood volume) – heart rate ~ 100, pulse tension decreased, 20-30 breaths per minute, skin pale after pressure, state of consciousness normal,
3. 1500-2000 ml of blood lost (20-40% of the total blood volume) – heart rate ~ 120, blood pressure <90 mmHg, 30-40 breaths per minute, prolonged pale after compression, the patient is agitated,
4. > 2000 ml of blood lost (> 40% of total blood volume) – heart rate> 40, blood pressure <60 mmHg, pale, cold skin, the patient may become lethargic.

Hemorrhagic shock – first aid

In the case of first aid given to a patient diagnosed with hemorrhagic shock, bleeding is stopped. If isolated bleeding can be secured at the scene, the situation can be managed with fluid therapy.

1. What is the process of hemostasis?

Patients who can only undergo haemostasis in a hospital setting should be transported to hospital by ambulance as soon as possible. The rescuer should protect the respiratory tract of the injured person, because with blood loss, the patient loses erythrocytes, which are oxygen carriers.

Hemorrhagic shock – fluid therapy

If internal haemorrhage cannot be controlled, heavy intravenous infusions cannot be used to control blood pressure. This can lead to a deterioration of the patient’s condition.

In this case, it is important to implement fluid therapy (crystalloids and colloids) as soon as possible, thanks to which it is possible to fill the vascular bed. As a result, the risk of the patient’s death is significantly reduced. In case of stage I hypovolemic shock, the patient should be infused with 1000 ml of isotonic crystalloids. At stage II or higher, 500 ml of liquid are administered. However, it should be remembered that due to hypothermia, crystallides should be warmed before administration.

Hemorrhagic shock – treatment

Treatment of a patient who has hemorrhagic shock primarily consists of:

1. Stopping bleeding,
2. Administering oxygen,
3. Administering fluids,
4. Protection against heat loss,
5. Lifting the patient’s legs up,
6. Ensuring proper ventilation.