Hemorrhagic (Hypovolemic) Shock

Written by April Kahn | Published on June 22, 2012
Medically Reviewed by George Krucik, MD

What is Hemorrhagic Shock?

Hemorrhagic shock occurs when the body begins to shut down due to heavy blood loss. People suffering injuries that cause heavy bleeding may go into hemorrhagic shock if the bleeding isn’t stopped immediately. Common causes of hemorrhagic shock are:

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

According to the Mayo Clinic, hemorrhagic shock is the leading cause of death in people with traumatic injuries (MayoClinic).

What Causes Hemorrhagic Shock?

When heavy bleeding occurs, there is not enough blood flow to the organs in your body. Blood carries oxygen and other essential substances to your organs and tissues. When these substances are lost more quickly than they can be replaced, 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 is 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. Internal bleeding symptoms may be hard to recognize until symptoms of shock appear. However, external hemorrhaging (bleeding) will be visible. Symptoms of hemorrhagic shock may not appear immediately. Symptoms include:

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

The sign of external hemorrhaging is bleeding profusely at the site of injury.

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

If you have any signs of hemorrhaging or of hemorrhagic shock, seek medical attention immediately. Have someone drive you to the hospital or call 911. Do not drive to the hospital on your own if you are 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 does not 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 around the site of injury such as a shirt, towel, or blanket to minimize blood loss. Apply pressure to the area. If you can, tie or tape the fabric to the injury. Wait until emergency personnel arrive.

How Is Hemorrhagic Shock Diagnosed?

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

While heavy bleeding is immediately recognizable, internal bleeding sometimes isn’t found until someone shows signs of hemorrhagic shock. The doctor may order a complete blood count test after closing your bleeding wound. These results will let him or her know whether a blood transfusion is necessary. The doctor may also order a blood transfusion if there is a large amount of blood loss from the injury, even without doing a complete blood count test. A blood transfusion is given by transferring donor blood into your body using an intravenous (IV) line. You may be given medications, such as dopamine, to increase your blood pressure.

Long-Term Outlook

Your outlook will depend on the amount of blood you lost and the type of injury you sustained. The outlook is best in healthy patients who haven’t had severe blood loss. Common complications of hemorrhagic shock include:

  • kidney damage
  • other organ damage
  • death

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

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