Hemorrhagic Shock

After a serious injury accident, the victim may be bleeding severely and losing a lot of blood. Losing enough blood can lead to shock, where there is not enough blood in the body to continue transporting oxygen to the body's organs and tissues. If blood loss is not treated, the injury victim can suffer organ failure and death. 

Hemorrhagic shock can be caused by trauma, like a car accident, or through surgical complications. When hemorrhagic shock is not properly diagnosed or treated because of medical malpractice, the patient may suffer permanent damage or death. 

What is Hemorrhagic Shock?

Hemorrhagic shock is a type of hypovolemic shock. Hypovolemic shock is caused by a drop in fluid volume that impairs the body's ability to pump blood through the circulatory system. Hemorrhagic shock specifically involves the loss of blood volume. Generally, the greater the loss of volume of blood, the more serious the risk of harm from hemorrhagic shock. 

The American College of Surgeons Advanced Trauma Life Support (ATLS) has developed 4 categories of hemorrhage by the percentage of total blood volume lost. The calculation is based on 7% of the body mass or 70 ml/kg. 

Class 1 Hemorrhage: 

  • Volume loss up to 15% of total blood volume (approximately 750 mL)
  • Heart rate normal or mild increase
  • Pulse normal
  • Blood pressure normal
  • Respiratory rate normal

Class 2 Hemorrhage: 

  • Volume loss from 15% to 30% of total blood volume (750 mL to 1500 mL)
  • Heart rate elevated
  • Diminished peripheral pulses
  • Blood pressure normal
  • Respiratory rate mild increase
  • Cool extremities, mottled skin, and delayed capillary refill
  • Irritable, confused, and combative

Class 3 Hemorrhage:

  • Volume loss from 30% to 40% of total blood volume (1500 mL to 2000 mL)
  • Significant tachycardia (rapid heart rate)
  • Thready peripheral pulses
  • Low blood pressure 
  • Metabolic acidosis
  • Moderate tachypnea (increased breathing rate)
  • Cool extremities, mottled skin, and prolonged capillary refill
  • Irritable, lethargic, and diminished pain response

Class 4 Hemorrhage: 

  • Volume loss greater than 40%
  • Severe tachycardia 
  • Thready central pulses
  • Significant hypotension (low blood pressure)
  • Significant acidosis
  • Severe tachypnea 
  • Cold extremities, pallor, and cyanosis
  • Lethargic or coma

Signs and Symptoms of Hemorrhagic Shock

Signs and symptoms of hemorrhagic shock are generally based on how the body responds to the loss of blood volume and lack of oxygen throughout the body. Symptoms of hemorrhagic shock may include: 

  • Low blood pressure
  • Rapid heart rate
  • Rapid breathing rate
  • Anxiety
  • Weakened peripheral pulses
  • Pale or mottled skin
  • Cold extremities
  • Decrease in urine output
  • Confusion
  • Loss of consciousness 
  • Coma
  • Death 

One of the more obvious signs of hemorrhage is a significant amount of blood loss. This could be blood loss from a wound, or other opening, including the ears, anus, or vagina. However, blood loss can also occur hidden from plain sight, including internal hemorrhages, such as: 

  • Intracranial hemorrhage
  • Cerebral hemorrhage
  • Pulmonary hemorrhage 
  • Gastrointestinal bleed

Treatment of Hemorrhagic Shock

In a healthcare setting, there are some ways to help identify hemorrhagic shock. As above, some important measurements include heart rate, breathing rate, blood pressure, and oxygen saturation. 

However, these measurements individually may not indicate hemorrhagic shock. Heart rate and blood pressure may differ widely for individuals going into shock based on age, medications, and other cardiopulmonary issues. 

The shock index, which involves the ratio of heart rate to systolic arterial pressure, may be a strong predictor of the impact of blood loss on the patient. Lactate levels may also be a strong predictor for blood transfusion requirements in trauma victims suffering blood loss. 

Other blood tests, including hemoglobin and international normalized ratio (INR) values, may also be useful in determining the need for blood transfusions. Thrombocyte and electrolyte levels (including calcium and potassium) should also be monitored. 

Treatment may involve stopping the source of the bleeding and transfusion of blood products, including blood plasma, blood platelets, and packed red blood cells (RBCs). 

Other Causes of Shock After a Traumatic Accident

Hemorrhage is the most common cause of shock in trauma patients but other types of shock may also occur after an accident, including obstructive shock. For example, in a car accident, blunt trauma, or a penetrating injury to the body may cause a leak of air into the pleural space, leading to increased pressure inside the body. 

Head or spinal cord trauma can also cause neurogenic shock, through damage to the central nervous system. Trauma to the heart can also result in cardiogenic shock. In complex accidents and injuries, there may be multiple causes of shock. 

Hemorrhagic Shock in the Body 

The body reacts to the loss of blood volume by shifting the precious blood and oxygen away from noncritical tissues to areas like the heart and brain. This is done through peripheral vasoconstriction to reduce the flow to outer blood vessels, rapid breathing, and heart rate to deliver blood to the tissues. 

When there is a lack of oxygen available, cells change from aerobic metabolism to anaerobic metabolism, which creates lactic acid and can lead to lactic acidosis. As this continues, more tissue is cut off which further worsens lactic acidosis. Without proper treatment, hemorrhagic shock can lead to organ failure, tissue damage, and death. 

Medical Malpractice Causing Hemorrhagic Shock

Medical mistakes and medical errors can be a direct cause of hemorrhagic shock. If a doctor negligently performs a surgery, cutting vital tissue, arteries, or veins, and is unable to control the bleeding, the patient can go into hemorrhagic shock in a very short time.

Examples of doctors causing hemorrhagic shock include plastic surgery operations, where the patient suffered severe bleeding, the doctor was not able to stop or slow the bleeding, and the patient had to be referred to emergency care to get a blood transfusion. This can cause permanent tissue damage, organ damage, scarring, and emotional harm.

Hemorrhagic shock can also occur after a surgery. If the patient was not properly treated and monitored after surgery, the patient's wounds may reopen, causing internal bleeding and leading to shock. In some cases, this occurs after a patient returns home to recover from surgery, not knowing they are suffering internal hemorrhage until it is too late.  

Shock and Medical Malpractice Attorneys

If you or a loved one suffered blood loss after surgery or the doctor did not properly monitor your vitals, leading to hemorrhagic shock, you should talk to an experienced medical malpractice attorney about getting compensation for your injuries, medical bills, and pain and suffering. Do not hesitate to contact Gilman & Bedigian today for a free consultation.

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