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Similar to Cardiac arrest where every minute counts, in Hypovolemic Shock too the time is extremely precious. You might be able to hold your breath for one minute, but then your survival instinct kicks in and compels you to take a deep breath so that your body can receive the oxygen it needs to survive. The critically ill patients depend on doctors to apply this same level of urgency to their care when minutes can make the difference between life and death.
Shock is a medical emergency which can result in organ damage and death. A complex physiological response is triggered by decreased tissue perfusion. Hypovolemic shock results from loss of circulating blood volume leading to reduced end- organ perfusion, inadequate oxygen delivery, and ultimately, tissue death. Hemorrhage shock is the most common cause of hypovolemic shock and the leading cause of preventable trauma death.
Dr Hrushikesh Vaidya, India’s Leading Pulmonologist, Medical Director and Chairman Horizon Group of Hospitals said “Shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. It is a serious life-threatening medical condition with about 20 per cent mortality rate. This type of shock can cause many organs to stop working. Losing about a fifth or more of the normal amount of blood in your body causes hypovolemic shock. Most deaths from shock occur in the field or within 2 hours after hospital arrival and since up to 65% of patients presenting with severe hemorrhagic shock will die, early recognition and immediate intervention are the key to survival.”.
Blood loss can be due to:
- Bleeding from cuts
- Bleeding from other injuries
- Internal bleeding, such as in the gastrointestinal tract
The amount of circulating blood in your body may drop when you lose too many other body fluids. This can be due to Burns, Diarrhoea, Excessive perspiration, or Vomiting
Dr Hrushikesh Vaidya says “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 a rapid heart rate. 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 even begin before the actual diagnosis”.
Symptoms
- Anxiety or agitation
- Cool, clammy skin
- Confusion
- Decreased or no urine output
- General weakness
- Pale skin colour
- Rapid breathing
- Sweating, moist skin
- Unconsciousness
If internal bleeding occurs, a person may experience symptoms such as
- Bloody urine
- Bloody stool
- Bloody Vomit
- Abdominal Pain
- Abdominal swelling
- Chest pain
If anyone experiences any of the symptoms mentioned above, they should seek immediate medical attention.
The greater and more rapid the blood loss, the more severe the symptoms of shock. Severe trauma, such as a gunshot wound or major car accident, can cause heavy bleeding. When bleeding does not stop, it can lead to hemorrhagic shock. Treatment usually involves managing the bleeding and taking measures to help prevent multiple organ damage.
Further discussing on the complications, Dr Hrushikesh Vaidya said “Common complications of hemorrhagic shock include kidney damage, other organ damage, and death. Some people may also develop gangerene due to decreased circulation to the limbs. This infection may result in amputation of the affected limbs. The outlook will depend on the amount of blood loss and the type of injury. The outlook is best in people with no pre-existing health conditions who haven’t had severe blood loss. Seeking medical help as soon as you notice symptoms of shock will help improve your outlook overall”.
Four Different Stages of Shock
The American College of Surgeons Advanced Trauma Life Support divides hemorrhagic shock into four categories. The organization bases each stage on how much blood loss an otherwise healthy person weighing 70 kilograms sustains. As a point of reference, a person who weighs 70 kg typically has about 5 liters of blood in their body.
The four hemorrhagic shock stages are as follows:
- An individual has lost up to 15% – about 750 ml of their total blood volume. Their blood pressure, respiratory rate and pulse pressure do not change. Their heart rate is typical or slightly elevated.
- A person has lost 15-30% of their blood around 750-1500 ml. Heart and respiratory rates increase. The heart rate is likely to be between 100-120 beats per minute. Blood pressure remains unchanged, or it may slightly decrease.
- A person has lost 30-40% of their blood around 1500-2000 ml. A significant drop in blood pressure occurs. The heart rate is more than 120 BPM and there is a significant rise in respiratory rate. Confusion and other mental symptoms may occur.
- A person has lot more than 40% of their blood over 2000 ml. Another significant drop in blood and pulse pressure occurs. The mental status of the person becomes increasingly altered and the heart rate stays over 120 BPM.
If the reason for shock is not obvious, or it’s internal, doctor may recommend various tests to diagnose the cause that may include x-rays, blood tests, ultrasound, CT scan, MRI etc. The doctor may also order a complete blood count after addressing the site of the bleeding. The results of this test will let the doctor know whether a blood transfusion is necessary. The doctor may also order a blood transfusion without doing a CBC if there is a large amount of blood loss from the injury. A blood transfusion is given by transferring donor blood into the patient’s body intravenously.
Conclusion
Preventing shock, is easier than trying to treat it, once it happens. Quickly treating the cause, will reduce the risk of developing severe shock. Early first aid, can help control shock.
