From the Guidelines
The latest sign of shock to occur in a patient with RTA, pelvic fracture, thigh wound with profuse bleeding, and hypovolemic shock is decreased urine output, which is a reflection of the body's inability to maintain perfusion to vital organs, but among the given options, the closest answer is tachycardia (option D). In hypovolemic shock, the body's compensatory mechanisms work in a specific sequence to maintain perfusion to vital organs. Initially, the body increases sympathetic tone, leading to peripheral vasoconstriction (increased arteriolar resistance) and venoconstriction (increased venous return) to maintain blood pressure, as seen in the American College of Surgeons Advanced Trauma Life Support classification of haemorrhage severity 1. Simultaneously, stress hormones like cortisol are released. Tachycardia occurs relatively early in shock as the heart attempts to increase cardiac output to compensate for decreased blood volume. As shock progresses, these compensatory mechanisms eventually fail. The other options represent either early compensatory mechanisms (increased cortisone level, increased arteriolar resistance) or are not accurate shock parameters (decrease in colloid osmotic pressure is not a primary feature of hypovolemic shock). Some key points to consider in the management of such patients include:
- The need for early surgical bleeding control in patients presenting with haemorrhagic shock and an identified source of bleeding, as recommended by the updated European guideline 1.
- The importance of prompt recognition and management of hypovolemic shock, as delayed treatment can lead to increased morbidity and mortality.
- The use of the American College of Surgeons Advanced Trauma Life Support classification of haemorrhage severity to guide management decisions, as it provides a framework for assessing the severity of bleeding and guiding treatment 1. It is essential to prioritize the management of hypovolemic shock and bleeding control to improve patient outcomes, as highlighted in the European guideline 1.
From the Research
Latest Sign of Shock to Occur
The latest sign of shock to occur in a patient with RTA, pelvic fracture, and thigh wound with profuse bleeding, and hypovolemic shock parameters is:
- Increased arteriolar resistance and decrease COP [(2,3,4)] This is because the body tries to compensate for the blood loss by increasing arteriolar resistance to maintain blood pressure, and the decrease in cardiac output (COP) is a late sign of shock.
Other Options
The other options are:
- Increase venous return: This is an early sign of shock as the body tries to compensate for the blood loss by increasing venous return to the heart [(5,6)]
- Increased cortisone level: This is a stress response to shock, but it is not a direct sign of shock [no direct reference]
- Tachycardia: This is an early sign of shock as the body tries to compensate for the blood loss by increasing heart rate [(2,3,6)]