Hemorrhagic Shock
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Hemorrhagic shock occurs when there is inadequate tissue perfusion and oxygenation due to loss of circulating blood volume from hemorrhage. The most common cause of shock in surgical or trauma patients is blood loss. As blood loss increases, the body responds through cardiovascular, neuroendocrine, microcirculatory, hormonal, cellular, and vicious cycle changes in an attempt to compensate, but tissue hypoxia continues to worsen.
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Hemorrhagic Shock
- 2. Shock Hemorrhagic shock Inadequate tissue Perfusion and Oxygenation The most common cause of shock in the surgical or trauma patient is loss of circulating volume from hemorrhage Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.
- 3. Normal blood volume 7% of body weight Guyton A C, Hall E J. Textbook of medical physiology. 11th ed. Philadelphia. Elsevier; 2006.
- 4. Stage of hemorrhagic shock In 70-kg Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.
- 5. Stage of hemorrhagic shock Longo D D, Kasper L D, Jameson L J, Fauci S A, Hauser L S, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. NewYork: Mc Graw-Hill; 2012.
- 7. Pathogenesis Cardiovascular response CVP EDV Cardiac output Baroreceptor SV Sympathetic HR Vasoconstriction Klabunde, RE, Cardiovascular Physiology Concepts, Lippincott Williams & Wilkins, 2004 Frank-Starling Mechanism Arterial pressure Contractility
- 8. Pathogenesis
- 9. Neuroendocrine response Pathogenesis Baroreceptor Chemoreceptor Adrenergic output α1, β1 receptor Vasoconstriction Hypothalamus Adrenocorticotropic hormone (ACTH) Glycogenolysis Gluconeogenesis insulin uptake of glucose amino acids elevates blood glucose Lipolysis Gluconeogenesis Glucagon Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.
- 10. Pathogenesis Microcirculation vascular resistance Muscle Skin Splanchnic circulation Blood flow Catecholamine Autoregulation of the heart, brain & kidney MAP ≤60 mmHg blood flow Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.
- 11. Pathogenesis Microcirculation Capillary hydrostatic pressure Capillary beds perfusion Intravascular oncotic pressure constant Starling’s law of capillary interstitial liquid exchange Longo D D, Kasper L D, Jameson L J, Fauci S A, Hauser L S, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. NewYork: Mc Graw-Hill; 2012.
- 13. Cellular response Pathogenesis Tissue poor perfusion Oxidative phosphorylation Anaerobic metabolism ATP Hydrogen ions Lactic acid Metabolic acidosis Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.
- 14. Pathogenesis
- 15. Vicious cycle of shock Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.
Editor's Notes
- ATP maintain cellular membrane potential, synthesis of enzymes and proteins, cell signaling, and DNA repair mechanisms leading to irreversible cell injury and death the blood lactate level rises from the normal value of about 1 mmol/L to 9 mmol/L or more. The resulting lactic acidosis depresses the myocardium, decreases peripheral vascular responsiveness to Catecholamines