What are the symptoms and treatment of hemorrhagic shock?

From the Guidelines

Hemorrhagic shock should be treated with a restricted volume replacement strategy, targeting a systolic blood pressure of 80-90 mmHg, and employing vasopressors and inotropic agents as needed, according to the most recent European guideline on management of major bleeding and coagulopathy following trauma 1. The primary symptoms of hemorrhagic shock include severe blood loss, hypotension, tachycardia, and decreased urine output. Key steps in managing hemorrhagic shock include:

• Control bleeding: Apply direct pressure, use tourniquets if appropriate, or perform surgical intervention as needed, such as damage-control surgery 1.
• Establish IV access: Place two large-bore IVs (16-gauge or larger) and initiate fluid resuscitation with crystalloids, such as 0.9% NaCl or balanced crystalloid solution, avoiding hypotonic solutions like Ringer's lactate in patients with severe head trauma 1.
• Fluid resuscitation: Begin with a bolus of 1-2 L and reassess as needed, targeting a mean arterial pressure of 50-60 mmHg 1.
• Blood product administration: Initiate massive transfusion protocol if available, aiming for a target Hb of 70-90 g/L, and consider the use of erythrocytes, fibrinogen concentrate, or cryoprecipitate 1.
• Maintain warmth: Prevent hypothermia with warm fluids and blankets to achieve and maintain normothermia 1.
• Monitor closely: Check vital signs, urine output, and mental status frequently.
• Treat underlying cause: Address the source of bleeding, such as pelvic ring closure and stabilization in patients with pelvic ring disruption 1.
• Consider medications: Tranexamic acid (1 g IV over 10 minutes, then 1 g over 8 hours) can help reduce bleeding in trauma patients, and should be administered as soon as possible 1. The goal is to restore tissue perfusion and prevent organ failure, with rapid recognition and treatment being crucial for improving outcomes in hemorrhagic shock.

From the FDA Drug Label

The provided drug labels do not directly address the symptoms and treatment of hemorrhagic shock.

The FDA drug label does not answer the question.

From the Research

Symptoms of Hemorrhagic Shock

• Hemorrhagic shock is a condition produced by rapid and significant loss of intravascular volume, which may lead sequentially to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death 2, 3
• Signs and symptoms of shock appear only after the state of shock is well established and the compensatory mechanisms have started to fail 3
• Hemorrhagic shock can be rapidly fatal 2, 3

Treatment of Hemorrhagic Shock

• The primary goals are to stop the bleeding and to restore circulating blood volume 2
• Resuscitation may well depend on the estimated severity of hemorrhage 2
• The use of intravenous fluids, crystalloids or colloids, and blood products can be life saving in those patients who are in severe hemorrhagic shock 2
• A hemoglobin level of 7-8 g/dl appears to be an appropriate threshold for transfusion in critically ill patients with no evidence of tissue hypoxia 2
• Maintaining a higher hemoglobin level of 10 g/dl is a reasonable goal in actively bleeding patients, the elderly, or individuals who are at risk for myocardial infarction 2
• Hemodynamic resuscitation is acknowledged to be contingent on a number of factors other than volume expansion 4
• The development of hemoglobin-based oxygen carriers (HBOCs) introduces a method of replenishing the intrinsic oxygen-carrying capacity of blood 4
• Management of hemorrhagic shock is based on a timely, rapid, definitive source control of bleeding/s and on blood loss replacement 5
• Stopping the hemorrhage from progressing from any named and visible vessel is the main stem fundamental praxis of efficacy and effectiveness and an essential, obligatory, life-saving step 5
• Blood loss replacement serves the purpose of preventing ischemia/reperfusion toxemia and optimizing tissue oxygenation and microcirculation dynamics 5
• Prompt recognition and management of patients experiencing haemorrhage and developing haemorrhagic shock is vital to ensure optimal outcomes 6