Page 304 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 289

Circulation

Hemorrhagic Shock

What Went Wrong?
Hemorrhagic shock is the most common shock in trauma patients. It is a type
of hypovolemic shock that occurs when blood is lost in such large amounts that
the organs and tissues cannot be supplied with oxygen or nutrients to sustain
life. In traumatic injuries from penetrating and/or blunt trauma emanating from
the MOI, forces rupture or tear organ structures, which causes the decreased
blood volume. Compensatory mechanisms go into play to maintain blood vol-
ume to the brain and heart.
Catecholamines are released, causing the heart rate to speed up and breath-
ing to increase to maintain cardiac output and oxygenated hemoglobin. Com-
pensation in the early stages can maintain cardiac output, but if the cause is not
corrected and enough blood is lost, decomposition occurs where the BP cannot
be maintained and vital organ circulation is lost.

Prognosis
Prognosis is good if early treatment is initiated in the prehospital stage. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Interpreting Test Results
Serial hemoglobin and hematocrit to determine if blood replacement is
needed
Respiratory acidosis from retaining pCO
2
Metabolic acidosis from decreased excretion of HCO and lactic acidosis
3
Decreased glomerular filtration rate from decrease in kidney blood flow
Hypoglycemia
BUN and creatinine to determine if renal function has been compromised
due to low blood flow

Hallmark Signs and Symptoms (Early)
• Tachycardia (one of the first signs)
• Hypotension
• Thready pulse

• Restlessness
• Decreased urinary output