Hemorrhagic Shock Follow-up

Updated: Mar 27, 2015
  • Author: John Udeani, MD, FAAEM; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Follow-up

Further Inpatient Care

The remainder of care is determined by the proximate course of the hemorrhagic shock.

Patients with hemorrhagic shock are at risk for acute tubular necrosis, acute lung injury, transfusion-related acute lung injury, infections (principally nosocomial and related to operative sites or indwelling catheters), and multiple organ dysfunction syndrome, with its attendant risk of death. Discussion of each of these entities is beyond the scope of this article.

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Inpatient & Outpatient Medications

Patients with hemorrhagic shock are often unable to mount an appropriate bone marrow response in the acute setting with regard to red blood cell production. Using erythropoietin (40,000 U/wk) in combination with supplemental iron and vitamin C to boost production is useful. This strategy has been used successfully to decrease red blood cell transfusions in a large multicenter trial in Canada.

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Transfer

In general, few indications exist to transfer a patient who is in shock to a specialized facility. Ideally, all hospitals and physicians should be prepared to initially treat and stabilize the patient with exsanguinating hemorrhage. After control of the bleeding and reversal of acute shock, patients may be transferred to facilities that can treat additional injuries.

The patient should be transferred by an advanced life support unit with the capability of blood transfusion en route.

The decision for air ambulance transport instead of ground transportation is one that involves consideration of proximity, difficulty with the ground route, time en route, weather conditions, and availability.

Patients may be transferred for ongoing management of the initial injury when the injury complex demands care that exceeds the resources or capabilities of the initially receiving facility. This transfer should be made from the transferring physician to the receiving physician without intermediaries.

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Complications

The primary complication is death.

The entire spectrum of organ failures may be the sequelae of resuscitated hemorrhagic shock.

The cascade of systemic inflammatory response syndrome (SIRS) progressing to multiple organ failure syndrome (as described by the late Roger Bone, MD) complicates the cases of approximately 30-70% of patients who present with hemorrhagic shock and survive their initial resuscitation.

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Prognosis

Prognosis is related to the ability to be resuscitated from shock, as well as the underlying illness or injury, not the presentation of hemorrhagic shock.

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Patient Education

For patient education resources, see the Shock Center and Public Health Center, as well as Shock and Cardiopulmonary Resuscitation (CPR).

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