Skip to main content

Abstract

Hemorrhagic shock is caused by the loss of a significant amount of blood that results in inadequate cellular oxygen delivery and can eventually be a cause of sudden death. Hemorrhage can be caused by a number of factors, including trauma, gastrointestinal hemorrhage, post-operative hemorrhage, rupture of an aneurysm, and maternal hemorrhage (Mannucci PM, N Engl J Med 2007;356:2301) and represents a worldwide issue. Moreover, people who survive the initial hemorrhagic shock risk having poor functional outcomes and long-term mortality.

Hemorrhage causes an inadequate cellular oxygen delivery that results in a shift from aerobic to anaerobic metabolism (Barbee RW, Shock 2010;33:113–122), with an accumulation of lactic acid and oxygen radicals that lead to an inflammatory state, also maintained by damaged-associated molecular patterns. For these reasons cellular homeostasis fails and cell death by membrane rupture, apoptosis, or necroptosis soon follows. At the tissue level, hypovolemia and vasoconstriction cause hypoperfusion resulting in multiple organ failure (MOF), malignant arrhythmias, and brain anoxia. At the site of hemorrhage, a plug gets formed by the clotting cascade and the activation of platelets, at distance, instead, fibrinolytic activity increases to prevent microvascular thrombosis and an excess plasmin activity and autoheparinization can result in pathologic hyperfibrinolysis and diffuse coagulopathy.

Three additional iatrogenic factors can be responsible for a worsening of coagulopathy, and these are:

  • an exaggerated amount of crystalloid used for resuscitation dilutes the clotting factor concentrations.

  • infusion of cold fluids that decreases the body heat ending in a decreased enzymal function for the formation of platelets plug.

  • The use of a great deal of acidic crystalloid solutions increases the acidosis caused by hypoperfusion and decreases the function of clotting factors, thus resulting in an increase of coagulopathy, that together with hypothermia and acidosis contributes to cause the triad of death especially in trauma patients (Biswadev M, Emerg Med J. 2012;29(8):622–5).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Davis JP, et al. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and me-ta-analysis. CJEM. 2019;21(6):727–38.

    Article  Google Scholar 

  2. Chiara O, Cimbanassi S. Protocolli per la gestione intraospedaliera del trauma maggiore. Paris: Elsevier-Masson; 2008.

    Google Scholar 

  3. Sihler KC, et al. Complications of massive transfusion. Chest. 2010;137:209–20.

    Article  Google Scholar 

  4. MacKay EJ, et al. Abnormal calcium levels during trauma resuscitation are associated with increased mortality, increased blood product use, and greater hospital resource consumption: a pilot investigation. Anesth Analg. 2017;125:895–901.

    Article  CAS  Google Scholar 

  5. Spinella PC, et al. Whole blood: back to the future. Curr Opin Hematol. 2016;23:536–42.

    Article  Google Scholar 

  6. Etchill EW, et al. Should all massively transfused patients be treated equally? An analysis of massive transfusion ratios in the nontrauma setting. Crit Care Med. 2017;45:1311–6.

    Article  Google Scholar 

  7. Shafi S, et al. Bundles of care for resuscitation from hemorrhagic shock and severe brain injury in trauma patients — translating knowledge into practice. J Trauma Acute Care Surg. 2016;81:780–94.

    Article  Google Scholar 

  8. Lewis SR, et al. Colloids or crystalloids fluid replacement in critically people. Cochrane. 2018;8(8):CD000567.

    Google Scholar 

  9. Schöchl H, et al. Trauma bleeding management: the concept of goal-directed primary care. Anesth Analg. 2014;119:1064–73.

    Article  Google Scholar 

  10. Brenner M, et al. Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Trauma Surg Acute Care Open. 2018;3:1–3.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Colombo, S., Bissacco, D. (2022). Hemorrhagic Patient. In: Bissacco, D., Settembrini, A.M., Mazzari, A. (eds) Primary Management in General, Vascular and Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-12563-8_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-12563-8_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-12562-1

  • Online ISBN: 978-3-031-12563-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics