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Critical Care
Published in: Critical Care 5/2004

01-10-2004 | Review

Clinical review: Hemorrhagic shock

Authors: Guillermo Gutierrez, HDavid Reines, Marian E Wulf-Gutierrez

Published in: Critical Care | Issue 5/2004

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Abstract

This review addresses the pathophysiology and treatment of hemorrhagic shock – a condition produced by rapid and significant loss of intravascular volume, which may lead sequentially to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. Hemorrhagic shock can be rapidly fatal. The primary goals are to stop the bleeding and to restore circulating blood volume. Resuscitation may well depend on the estimated severity of hemorrhage. It now appears that patients with moderate hypotension from bleeding may benefit by delaying massive fluid resuscitation until they reach a definitive care facility. On the other hand, the use of intravenous fluids, crystalloids or colloids, and blood products can be life saving in those patients who are in severe hemorrhagic shock. The optimal method of resuscitation has not been clearly established. A hemoglobin level of 7–8 g/dl appears to be an appropriate threshold for transfusion in critically ill patients with no evidence of tissue hypoxia. However, maintaining a higher hemoglobin level of 10 g/dl is a reasonable goal in actively bleeding patients, the elderly, or individuals who are at risk for myocardial infarction. Moreover, hemoglobin concentration should not be the only therapeutic guide in actively bleeding patients. Instead, therapy should be aimed at restoring intravascular volume and adequate hemodynamic parameters.
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Metadata
Title
Clinical review: Hemorrhagic shock
Authors
Guillermo Gutierrez
HDavid Reines
Marian E Wulf-Gutierrez
Publication date
01-10-2004
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2004
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc2851

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