Hemorrhagic Shock

Question 1

What is class I of hemorrhagic shock

Answer 1

0-15% blood loss (<750 mL)
1. Minimal tachycardia
2. No changes in BP, pulse pressure, or respiratory rate
3. Urine output >30mL (normal)
4. Slight anxiety

Question 2

What is Class II of hemorrhagic shock

Answer 2

Loss of 15-30% (750-1500mL) (moderate)
1. Tachycardia (100-120BPM)
2. Delayed capillary refill
3. Urine output (20-30mL/hr)
4. Tachypnea (20-30 breaths/min)
5. Blood pressure may be normal

Question 3

What is class III of hemorrhagic shock

Answer 3

Loss of 30-40% (1500-2000mL)
1. Tachycardia (>120bpm)
2. Blood pressure decreased (SBP <90mmHG)
3. Tachypnea (30-40 breaths/min)
4. Urine output (5-15)
5. Anxious and confused

Question 4

What is class IV of hemorrhagic shock

Answer 4

loss >40% (>2000mL)
1. Tachycardia (>140bpm)
2. Decreased BP (diastolic may be immeasurable)
3. Tachypnea (>40 breaths/min)
4. Urine output (negligible)
5. Lethargic

Question 5

What is the treatment of hemorrhagic shock

Answer 5

Identify and control hemorrhage
1. Restore circulating volume
2. Isotonic crystalloid infusion
3. Lactated ringer preferred / normal saline
*give IV fluids for resuscitation of hypotension then only until blood is available
*avoid vasopressors

Question 6

When are blood transfusions used for hemorrhagic shock

Answer 6

Used for patients with acute severe hemorrhage
*SBP <60
*CNS dysfunction
*ventilatory failure
*ongoing hemorrhage
*failure to respond to IV fluids

Question 7

What does a unit of Packed Red Blood Cell (PRBC) or whole blood to the the hematocrit

Answer 7

Raises hematocrit by 3-4%

Question 8

What needs to happen if the patient is not responding to crystalloid infusion NS or LR 1-2L

Answer 8

Blood transfusion

Question 9

What type of PRBC is used

Answer 9

Typed-crossed PRBC
*if not enough time then un-crossmatched O-neg PRC
*will keep Hct around 30-40%