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Hemorrhagic Shock

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Essentials of Shock Management

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Abstract

Hemorrhagic shock induces tissue hypoxia, organ dysfunction, and death. Cardiovascular, neuroendocrine, immunologic, and inflammatory reactions are responsible for the pathophysiology of hemorrhagic shock, and the lethal triad of acidosis, hypothermia, and coagulopathy is related with high mortality in patients with severe hemorrhagic shock. Multidisciplinary approaches including prompt assessment, diagnosis, initial resuscitation, transfusion, administration of pharmacologic agents, and bleeding control are crucial for the treatment of hemorrhagic shock. For the initial assessment, focused ultrasonography and multi-detector CT have been widely used, and the viscoelastic methods for coagulopathy are increasingly used. Damage control resuscitation, represented by permissive hypotension, avoidance of aggressive intravenous fluid, and early high ratio transfusion, has recently been emphasized for initial resuscitation. Massive transfusion protocol should be prepared for the severe hemorrhagic shock, and tranexamic acid is also recommended in traumatic shock patients. Operative management and nonoperative management including angioembolization and endovascular occlusion should be performed early for bleeding control.

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Authors and Affiliations

  1. Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea

    You Hwan Jo

  2. Institute for Trauma Research, Korea University, Seoul, South Korea

    Sung-Hyuk Choi

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Correspondence to You Hwan Jo .

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  1. Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea (Republic of)

    Gil Joon Suh

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Jo, Y.H., Choi, SH. (2018). Hemorrhagic Shock. In: Suh, G. (eds) Essentials of Shock Management . Springer, Singapore. https://doi.org/10.1007/978-981-10-5406-8_2

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