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Hemorrhagic (Hypovolemic) Shock

What Is Hemorrhagic Shock?

Hemorrhagic shock occurs when the body begins to shut down due to large amounts of blood loss. People suffering injuries that involve heavy bleeding may go into hemorrhagic shock if the bleeding isn’t stopped immediately.

Common causes of hemorrhagic shock include:

  • severe burns
  • deep cuts
  • gunshot wounds
  • trauma
  • amputations

According to the National Trauma Institute, hemorrhagic shock is the second leading cause of death in people with traumatic injuries. Hemorrhagic shock is one of many kinds of medical shock, which are different from emotional (non-medical) shock.

What Causes Hemorrhagic Shock?

When heavy bleeding occurs, there’s not enough blood flow to the organs in your body. Blood carries oxygen and other essential substances to your organs and tissues. When heavy bleeding occurs, these substances are lost more quickly than they can be replaced and organs in the body begin to shut down.

As your heart shuts down and fails to circulate an adequate amount of blood through your body, symptoms of shock occur. Blood pressure plummets and there’s a massive drop in body temperature, which can be life-threatening.

Signs of Hemorrhagic Shock

All symptoms of shock are life-threatening and should be treated as a medical emergency. Symptoms of hemorrhagic shock may not appear immediately.

Symptoms include:

  • anxiety
  • blue lips and fingernails
  • low or no urine output
  • profuse (excessive) sweating
  • shallow breathing
  • dizziness
  • confusion
  • chest pain
  • loss of consciousness
  • low blood pressure
  • rapid heart rate
  • weak pulse

External hemorrhaging (bleeding) will be visible. Symptoms of internal bleeding, however, may be hard to recognize until symptoms of shock appear.

Signs of internal hemorrhaging include:

  • abdominal pain
  • blood in the stool
  • blood in the urine
  • vaginal bleeding (heavy, usually outside of normal menstruation)
  • vomiting blood
  • chest pain
  • abdominal swelling

Seek medical attention immediately if you have any signs of hemorrhaging or of hemorrhagic shock. Have someone drive you to the hospital or call 911. DO NOT drive to the hospital on your own if you’re bleeding profusely or if you have any symptoms of shock.

Emergency Care and First Aid

Call 911 if someone is bleeding heavily or has symptoms of shock. If the person doesn’t have a head injury, neck injury, or spine injury, lay them on their back with their legs elevated 12 inches from the ground. Do not elevate their head.

Remove any visible dirt or debris from the injury site. DO NOT remove embedded glass, a knife, stick, arrow, or any other object stuck in the wound.

If the area is clear of debris and no visible object is protruding from it, tie fabric such as a shirt, towel, or blanket around the site of injury to minimize blood loss. Apply pressure to the area. If you can, tie or tape the fabric to the injury. Wait for emergency personnel arrive.

How Is Hemorrhagic Shock Diagnosed?

There are often no advance warnings of shock. Instead, symptoms tend to arise only when you’re already experiencing shock. A physical examination can reveal signs of shock, such as low blood pressure and rapid heartbeat. Someone in shock may also be less responsive when asked questions by an emergency room doctor.

While heavy bleeding is immediately recognizable, internal bleeding sometimes isn’t found until someone shows signs of hemorrhagic shock. Shock requires immediate attention, so treatment may begin before diagnosis. If the reason for shock is not obvious or it’s internal, various tests may be used to diagnose the cause, including:

  • X-rays
  • blood tests
  • ultrasound
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)

Your doctor may order a complete blood count test after addressing the site of the bleeding. These results will let them know whether a blood transfusion is necessary. Your doctor may also order a blood transfusion without doing a complete blood count test if there’s a large amount of blood loss from the injury.

A blood transfusion is given by transferring donor blood into your body using an IV. You may be given medications, such as dopamine, to increase your blood pressure.

Long-Term Outlook

Some people may also develop gangrene due to decreased circulation to the limbs. This infection may result in amputation of the affected limbs.

Common complications of hemorrhagic shock include:

  • kidney damage
  • other organ damage
  • death

Your outlook will depend on the amount of blood you lost and the type of injury you sustained. The outlook is best in healthy people who haven’t had severe blood loss.


Content licensed from:

Written by: April Kahn
Medically reviewed on: Dec 17, 2015: Mark R Laflamme MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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