2 Hemorrhage and Shock
Recognize early signs of hemorrhagic shock, respond to external and suspected internal bleeding, and prioritize urgent trauma resuscitation.
How hemorrhage causes shock
Hemorrhage is a major cause of preventable death after trauma. occurs when blood loss reduces tissue perfusion and oxygen delivery, making prompt recognition and treatment important.
Recognize shock early
Do not wait for low blood pressure or test results before acting on suspected shock. Early findings can include a rapid pulse, cool or clammy skin, restlessness, altered mental status, rapid breathing, and weak peripheral pulses.
Blood pressure can remain near normal during . Interpret the whole clinical picture: a patient who is anxious, pale, cool to the touch, and has a rapid pulse may have compensated despite a normal blood pressure.
Consider hidden bleeding
Assess for concealed blood loss even when there is no visible bleeding. Possible internal bleeding sites include the chest, abdomen, pelvis, and thighs.
For example, a painful, swollen thigh accompanied by increasing restlessness and a rapid, weak pulse warrants treating as a possibility. Alert the trauma team, continue the primary assessment, and prepare for interventions under the team's direction. Do not wait for imaging before reporting a change in condition or delay resuscitation when shock is suspected.
Control external bleeding
For severe external bleeding, apply firm, direct pressure. If life-threatening bleeding from an extremity continues despite direct pressure, apply a according to training and protocol. Activate emergency help and continue monitoring the patient; do not repeatedly lift or remove dressings to inspect the wound, and do not delay hemorrhage control.
Prioritize trauma resuscitation
Address immediate threats while assessment and resuscitation proceed together. Control accessible bleeding, support airway and breathing, activate the trauma response, identify likely internal bleeding sources, and prepare for blood-based resuscitation and definitive hemorrhage control according to protocol.
For patients requiring major transfusion, follow the facility's . Prevent heat loss and reassess the patient's response frequently. Do not delay treatment to complete a full head-to-toe examination, obtain imaging, or give oral fluids and wait.