Hemorrhagic shock NEJM

Question 1

Pathobiology?

Answer 1

Question 2

Classes of shock ?

Answer 2

Question 3

DCR?

Answer 3

Question 4

Pathogenesis of hypocalcemia and blood transfusion ?

Answer 4

All these blood products contain the anticoagulant
citrate, which the liver rapidly metabolizes
in healthy persons. However, in patients
with hemorrhagic shock who are receiving a
large volume of blood products, citrate may become
toxic, with life-threatening hypocalcemia
and progressive coagulopathy.48,58 Thus, empirical
calcium dosing during large-volume transfusions
(e.g., 1 g of intravenous calcium chloride
after transfusion of the first 4 units of any blood
product) should be paired with frequent measurements
of electrolyte levels.