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Hemorrhagic Shock, Emergency Medicine

Theodore C. Chan Reviewed 06/2017



  • Loss of effective circulating blood volume resulting in inadequate perfusion

  • Blood loss exceeds ability to compensate and tissue and organ perfusion decrease. At the tissue level, hyp...


Signs and Symptoms

  • Class I hemorrhage: Loss of up to 15% of blood volume (up to 750 mL in 70 kg adult):

    • HR <100

    • SBP normal

    • Respiratory rate (RR) 14–20

    • Increased or normal pulse pressure

    • Slight ...

Differential Diagnosis

  • Cardiac tamponade

  • Tension pneumothorax

  • Cardiogenic shock

  • Sepsis

  • Adrenal insufficiency

  • Neurogenic shock


  • Treatment should be initiated as soon as shock state recognized while simultaneously identifying underlying bleeding source

  • The goal is to restore tissue and organ perfusion and to control so...



Admission Criteria

All patients with hemorrhage should be admitted to the appropriate service. 

Discharge Criteria


Issues for Referral


Pearls and Pitfalls

  • Severity of hemorrhagic shock class and volume loss can be determined by vital signs and careful physical exam

  • Fluid resuscitation should balance goal of restoring organ perfusion a...

Additional Reading

  • American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support. 9th ed. Chicago, IL: American College of Surgeons; 2012.

  • Curry  N, Davis  PW. What's new in resusci...



  • 459.0 Hemorrhage, unspecified

  • 865.04 Injury to spleen without mention of open wound into cavity, massive parenchymal disruption

  • 958.4 Traumatic shock

  • 864.05 Injury to liver without mention of o...

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