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HEMORRHAGIC SHOCK Recently, Sean Taylor, a safety with the Washington Redskins football team, died after being shot in the upper leg. His femoral artery – the largest artery in the leg – was severed and he lost a significant amount of blood in a very short period of time. He experienced hemorrhagic shock at the crime scene and apparently never regained consciousness as he was flown to Miami’s Jackson Memorial Hospital – one of Florida’s finest trauma centers. Taylor died after six hours of surgery in which surgeons attempted to repair the femoral artery. Blood was transfused into his body, but because he had lost the majority of his blood prior to arrival, it was simply too late. Hemorrhagic shock associated with trauma patients is a fairly common problem seen in emergency departments, so let’s look more closely at this potentially fatal condition. What is hemorrhagic shock? Shock is defined as a state of low arterial blood perfusion to tissues in the body. This may be caused by poor heart or brain function, or severe overwhelming infection. But the most common cause of shock is a lack of blood supply due to hemorrhage. As with Taylor, an artery may be severed and shock will result when blood pours out much faster than the body can tolerate. When this occurs, the body is unable to compensate for the rapid loss of blood. The lack of blood supply leads to inadequate oxygen to all the body’s organs. The brain is deprived of oxygen and the heart will begin to pump faster in order to try and compensate for the lower blood volume. When the body is severely insulted by loss of blood, the heart, kidneys, liver, and brain may never recover. Eventually, the body is unable to keep up with this state and death will occur. Depending on the trauma, death may occur within a minute or two of the onset of severe bleeding, or hours later. What are the symptoms? Hemorrhage may be obvious with external bleeding. A clinician would expect to see shock develop with obvious trauma. But other forms of harder-to-detect hemorrhage may occur. In the emergency department, a common source of internal bleeding is the gastrointestinal tract. In this case the symptoms may not be as obvious as blunt, external trauma. The body’s attempt to compensate for acute blood loss leads to several symptoms. Some early signs may be an increased pulse rate and lower blood pressure. As the shock state progresses, a person may become pale, sweaty, ill appearing, and anxious. With internal bleeding, there may be obvious swelling or the passage of blood from the rectum. Many times, all of the pieces of the clinical puzzle must be put together in order to make the diagnosis. What is the treatment? Obtaining the patient’s history of illness or trauma is important, followed by a rapid assessment. Airway, breathing, and circulatory issues must be addressed. Supplemental oxygen must be provided. If a patient exhibits low blood pressure, an intravenous line will be started and fluids will be infused. With obvious bleeding and rapid failure of body functions, blood products may be ordered and administered. With external bleeding, direct pressure to the wound will generally stop the hemorrhage. If possible, elevation of the injured part above the level of the heart will also slow the bleeding. These measures should be applied within the first few minutes of assessment. It is important to note that the very young and very old will experience faster decompensation – or failure of body functions. Bleeding must be controlled and prompt medical care is critical. In the event that one is faced with a hemorrhagic situation, 911 should be activated in order to receive immediate medical care. As with Taylor, time is of the essence. Unfortunately, despite valiant efforts, Taylor did not survive. |
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