SHOCK

HEMORRHAGIC
Ami Citraning Ayu
Pembimbing : dr. Asep Hermana, Sp.B FINACS

DEFINITION

Shock is the clinical syndrome that results

from inadequate tissue perfusion.
(Longo, Harrisons Principles of Internal Medicine 18th
Edition)

Circulatory shock means generalized

inadequate blood flow through the body, to
the extent that the body tissues are damaged
because of too little flow, especially because
of too little oxygen and other nutrients
delivered to the tissue cells.
(Arthur C. Guyton, Text Book of Medical Physiology
11th Edition)

Hemorrhagic
(HEM-or-ij ; rhregnynai = bursting forth)
Loss of a large amount of blood; can be
either internal (from blood vessels into
tissue) or external (from blood vessels
directly to the surface of the body)
(Tortora, Gerard J. Principles of Anatomy and Physiology
12th edition)

SHOCK HEMORRHAGIC..
Condition of reduced tissue perfusion,
resulting in the inadequate delivery of
oxygen and nutrients that are necessary for
cellular function. Whenever cellular oxygen
demand outweighs supply, both the cell and
the organism are in a state of shock.

(medscape)

EPIDEMIOLOGY
United States
Accidental injuries remain the leading cause
of death in individuals aged 1-44 years.
Hemorrhagic shock is a leading cause of
death among trauma patients

PATOPHYSIOLOGY..

CLASSIFICATION..

(schwartzs Principles of surgery, 9th Edition)

EXAMINATION
Appearance : Pale, diaphoretic
Injuries : Open wounds, bruising, or bony instability consistent with blood
loss
Mental status : Progressive deterioration from normal to agitated to
lethargic to comatose
Vital signs : Decreased SSP 100 mmHg), narrow pulse pressure, tachycardia,
tachypnea, nonfunctional pulse oximeter, progressive hypothermia
Pulses : Diminished or absent, poor capillary refill
Renal : Diminished urine output
Laboratory : Decreased pH, abnormal base deficit, elevated lactate,
elevated osmolarity, elevated prothrombin time (PT)

DIFFERENTIAL DIAGNOSIS FOR SHOCK IN

TRAUMA
Etiologies of Shock in Trauma Associated Physical Examination
Clues
Hemorrhage/volume loss
Narrow pulse pressure, slowing
of external bleeding without intervention
Tension pneumothorax
Deviated trachea, absent unilateral
breath sounds, distended neck veins,
narrow pulse pressure, pulsus paradoxus
Pericardial tamponade
Distended neck veins, muffled heart
sounds, narrow pulse pressure
Myocardial contusion
Tachycardia out of proportion to other
injuries, abnormal electrocardiogram or
Neurogenic shock
Spinal injury above T6, bradycardia, warm
extremities

MANAGEMENT
The appropriate priorities in these patients are
:
(a) secure the airway
(b) control the source of blood loss
(c) fluid teraphy
(d) Transfusion of packed red blood cells
-target hemoglobin of 7 to 9 g/dL
(schwartzs Principles of surgery, 9th Edition)

Fluid replacement

Most use isotonic crystalloid IV fluids (0.9% NaCl,

Ringer lactate) in the initial resuscitation phase.
Use of colloids (5%albumin, purified protein
fraction, fresh-frozen plasma [FFP], and synthetic
colloid solutions [hydroxyethyl starch or dextran 70])
continue to be advocated by some.
Standard therapy in the hemodynamically unstable
patient: 20-40 mL/kg given rapidly (over 10-20 min).
(Emergency Medicine Manual, 6th Edition)

MEDICATION

Tranexamic acid (TXA) is an inexpensive

antifibrinolytic drug that promotes blood
clotting by preventing blood clots from
breaking down
Vasopressin : agents augment both coronary
and cerebral blood flow during the low-flow
state associated with shock
(medscape)

ILLUSTRATION