eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Shock, Hemorrhagic: Follow-up

Author: William P Bozeman, MD, Associate Professor, Associate Director of Research, Department of Emergency Medicine, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Sep 18, 2008

Follow-up

Further Inpatient Care

  • Admit the patient to an ICU, surgical ICU, or pediatric ICU.
  • Patients with hemorrhagic shock should be admitted to an intensive care or monitored setting appropriate for the underlying condition and physiologic state.

Transfer

  • In hospitals without facilities to provide definitive care, patients should be stabilized as much as possible and transferred to a facility with a higher level of care.

Complications

  • Coagulopathies may occur in severe hemorrhage. Fluid resuscitation, while necessary, may exacerbate coagulopathies.
  • Sepsis and multiple organ system failure occur days after acute hemorrhagic shock.
  • Death is a possible complication.

Patient Education

  • For excellent patient education resources, visit eMedicine's Shock Center. Also, see eMedicine's patient education article Shock.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize occult hemorrhage
  • Assumption that hypotension after trauma is due to head injury
  • Failure to perform a rectal examination
  • Failure to diagnose the cause(s) of hemorrhage
  • Inadequate resuscitation (Therapy for hemorrhagic shock should be rapidly initiated and aggressively pursued.)
  • Failure to make appropriate consultations in a timely fashion

Special Concerns

  • Pregnancy: Optimization of perfusion in the mother is the treatment of choice for the fetus.
  • Pediatric: Compensatory mechanisms may be effective in children. Hypotension is a late finding and represents significant hemorrhage.
  • Geriatric: Medications and underlying diseases may modify responses to hemorrhage.
 


More on Shock, Hemorrhagic

Overview: Shock, Hemorrhagic
Differential Diagnoses & Workup: Shock, Hemorrhagic
Treatment & Medication: Shock, Hemorrhagic
Follow-up: Shock, Hemorrhagic
References
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References

  1. National Center for Injury Control and Prevention. Ten Leading Causes of Death by age group. 2004. Center for Disease Control and Prevention; [Full Text].

  2. Cocchi MN, Kimlin E, Walsh M, Donnino MW. Identification and resuscitation of the trauma patient in shock. Emerg Med Clin North Am. Aug 2007;25(3):623-42, vii. [Medline].

  3. Tsang BD, Panacek EA, Brant WE, Wisner DH. Effect of oral contrast administration for abdominal computed tomography in the evaluation of acute blunt trauma. Ann Emerg Med. Jul 1997;30(1):7-13. [Medline].

  4. Ward KR, Ivatury RR, Barbee RW, Terner J, Pittman R, Filho IP. Near infrared spectroscopy for evaluation of the trauma patient: a technology review. Resuscitation. Jan 2006;68(1):27-44. [Medline].

  5. Bickell WH, Wall MJ, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. Oct 27 1994;331(17):1105-9. [Medline].

  6. Gonzalez EA, Moore FA, Holcomb JB, Miller CC, Kozar RA, Todd SR. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. Jan 2007;62(1):112-9. [Medline].

  7. Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. Oct 2004;8(5):373-81. [Medline]. [Full Text].

  8. Wilson M, Davis DP, Coimbra R. Diagnosis and monitoring of hemorrhagic shock during the initial resuscitation of multiple trauma patients: a review. J Emerg Med. May 2003;24(4):413-22. [Medline].

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Further Reading

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Keywords

blood loss, hemorrhage, shock, shocklike state, hemorrhagic shock, spontaneous hemorrhage, trauma, clinical hemorrhagic shock, acute bleeding, severe hemorrhagic shock, sepsis, bleeding disorders, intracranial hemorrhage, abdominal aortic aneurysm, AAA, intra-abdominal hemorrhage, retroperitoneal hemorrhage, retroperitoneal bleeding, abdominal bleeding, organ failure

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Contributor Information and Disclosures

Author

William P Bozeman, MD, Associate Professor, Associate Director of Research, Department of Emergency Medicine, Wake Forest University School of Medicine
William P Bozeman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and National Association of EMS Physicians
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston
Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, Past-President, American Academy of Emergency Medicine; Chairperson, Department of Emergency Medicine, Edward Hospital; Assistant Professor of Emergency Medicine, Rush Medical College and Cook County Hospital
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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