Hemorrhagic shock occurs when significant blood loss reduces the body’s ability to deliver oxygen and nutrients to vital organs. It is one of the leading causes of preventable death following traumatic injury and requires rapid recognition and intervention.

Hemorrhagic shock may result from external bleeding, internal bleeding, or a combination of both. Maintain a high index of suspicion for acute hemorrhage, particularly in patients with significant mechanisms of injury. 

Common causes of hemorrhagic shock include:

  • Uncontrolled external hemorrhage
  • Penetrating trauma
  • Internal chest injuries
  • Abdominal injuries
  • Pelvic fractures
  • Long bone fractures

Assessment findings may include:

  • Altered mental status
  • Anxiety or restlessness
  • Pale, cool, or clammy skin
  • Tachycardia
  • Weak peripheral pulses
  • Delayed capillary refill
  • Increasing respiratory rate
  • Hypotension (late finding)

Management priorities include:

  • Rapid identification of bleeding
  • Immediate hemorrhage control
  • Prevention of heat loss
  • Early recognition of deterioration
  • Rapid transport to definitive care

Patients may compensate for blood loss for a period of time before rapidly deteriorating. Continuous reassessment is essential throughout patient care.

Remember: Not all bleeding is visible. Consider internal hemorrhage whenever the patient’s condition does not match the apparent injuries.

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