Have you ever been watching a movie or a medical drama where a character was shot or injured in a car accident? The patient is wheeled into an emergency room and you hear someone in scrubs declare in an urgent voice, “they’re in shock” or “they’re going into shock”. Even if we as the audience don’t know what this means, we see a sudden rush of activity around the patient, hear extras shouting, and maybe a character in a white coat shouts an order like “get them into the OR, stat!” I’m a registered nurse and I used to work in an ER. While the real thing isn’t always like it appears on TV, it’s true that someone going into shock is very serious and dangerous to the patient. Shock deserves the medical term “stat,” meaning “urgent” or “immediately,” because their body is struggling to keep blood pumping and is starting to shut down. Without quick and correct treatment, a patient in shock can suffer organ failure, then death.

Trauma is a leading cause of death worldwide, with approximately half of trauma deaths being attributed to hemorrhage. Hemorrhage refers to bleeding from a damaged blood vessel. In one year, a hospital trauma center reported than 62.2% of their largest blood transfusions were the result of trauma injuries, and 75% of all blood and plasma used in their center went to trauma patients.

Picture of bandage on blue background.

What is Hemorrhagic Shock?

Shock is the body’s reaction when organs and tissues aren’t getting enough blood to function properly. This can be caused by an interruption in the cardiovascular system and may require surgery to treat.

There are 4 types of shock:

  • Hypovolemic shock – drop in the volume of blood
  • Cardiogenic shock – damage to the heart or surrounding muscles
  • Distributive shock – dilation of blood vessels causing blood pressure to drop
  • Obstructive shock – a blockage in the large blood vessels impairing blood flow

Hemorrhagic shock is a type of hypovolemic shock caused by a drop in blood volume that impairs the body’s ability to pump blood through the body’s circulatory system. The term is based on the word hemorrhage, which refers to bleeding from a damaged blood vessel.

What happens to the body during Hemorrhagic Shock?

As a personal injury and medical malpractice attorney, I most often see cases involving hemorrhagic shock because hemorrhagic shock is the result of sudden or dramatic blood loss.

In the body, the most critical systems and organs are inside the head and torso. When our bodies sense a sudden or dramatic loss of blood volume, they divert blood inward to critical organs by constricting outer blood vessels, reducing the flow to noncritical tissues. These noncritical parts of the body are no longer receiving oxygen or adequate oxygen, and metabolism in the cells switches from aerobic (with oxygen) to (anaerobic). A byproduct of anaerobic metabolism is the creation of lactic acid, which builds up and can poison the tissues in large quantities. The greater the loss of blood, the higher the likelihood of shock and the more serious the risk of permanent harm due to lactic acidosis. Delayed treatment, misdiagnosis, and other negligent delays in the properly treatment can also result in permanent harm, including permanent tissue damage, organ failure, coma, and death.

Symptoms of Hemorrhagic Shock

When hemorrhagic shock sets in, the body reacts to the loss of blood volume and the resulting lack of oxygen in the body in any of the following ways:

  • Low blood pressure
  • Rapid heart rate
  • Rapid breathing rate
  • Weak pulse
  • Pale or mottled skin
  • Cold extremities
  • Decrease in urine output
  • Confusion
  • Altered mental state
  • Anxiety
  • Loss of consciousness
  • Coma
  • Death

Is Hemorrhagic Shock serious?

All forms of shock are extremely serious. Hemorrhagic shock sets in when tissues or organs are being starved of oxygen-rich blood due to a drop in blood volume. Trying to function without oxygen, cells release lactic acid that, in large amounts, can poison you. Also, the longer tissues goes without oxygen, the more likely they are to be permanently damaged. Even if the bleeding responsible for the hemorrhagic shock stops, without a blood transfusion, there isn’t enough volume of blood to reach impacted cells and organs. When this occurs, organ failure, scarring, and permanent tissue damage can result. Without urgent and proper treatment, coma and death are possible.

One study showed that, among 208 patients with hemorrhagic shock, 54% died. An initial 31% died within 2 hours of arriving at the emergency room; 12% died 2 to 24 hours after arrival; and 11% died after 24 hours. Among those who survived 24 hours or longer, 39% developed an infection and 24% experienced organ failure.

Picture of blood cells and vessels.

The 4 levels of Hemorrhagic Shock

The American College of Surgeons Advanced Trauma Life Support (ATLS) classifies hemorrhages by the percentage of total blood volume lost. The classes described below are based on a hypothetical patient who is healthy and weighs around 154 lbs. Because blood comprises about 7% of our total body weight, the hypothetical patient has a volume of about 5 liters of blood. A larger or smaller individual would have different blood volume as their normal and the below categories would have to be scaled for them.

Class 1: Up to 15% of total blood volume lost

Symptoms: Heart rate elevated slightly or normal

Class 2: 15%-30% blood lost of total volume

Symptoms: Heart and respiratory rates rise, pulse pressure decreases slightly

Class 3: 30%-40% blood lost of total volume

Symptoms: Significant drop in blood pressure, significant rise in heart and respiratory rates, tachycardia (over 120 beats per minute), confusion, altered mental state, urine output declines

Class 4: Over 40% of total blood volume lost

Symptoms: hypotension, very little pulse pressure, pronounced tachycardia, increasingly altered mental state, urine output minimal or absent

A patient may have lost 2 liters of blood but not be in class 4 if they, based on their size and weight, has a higher normal blood volume than 5 liters. A child who has lost only half a liter of blood may be in a class 4 hemorrhage because the proportion of their blood that they lost is so high.

Causes of Hemorrhagic Shock

The blood loss resulting in hemorrhagic shock can be the result of external or internal wounds. They can be caused by an injury in a workplace, on a construction site, or during a car accident, or result from a surgery error.

Examples of injuries that could cause hemorrhagic shock:

  • Falls
  • Blunt force trauma
  • Impalements
  • Cuts
  • Loss of limbs or digits
  • Broken bones

When someone suffers complex injuries, they may suffer multiple types of shock at once.

Examples of medical malpractice that can cause hemorrhagic shock:

  • Wrong surgery conducted
  • Surgery conducted on wrong site
  • Wrong patient receives surgery
  • Cutting through an artery
  • Lack of adequate monitoring after surgery
  • Misdiagnosis
  • Delayed treatment
  • Dismissal of patient’s complaints or pain, numbness, lightheadedness, or tingling
  • Untreated or unnoticed hemorrhage during or after surgery
  • Untreated or unnoticed hemorrhage during or after labor

I remember a case in which a surgeon didn’t close their patient properly during a routine surgery, causing them to bleed into their belly until they went into hemorrhagic shock. By this time, the skin over the affected area was purple, essentially a massive bruise. The patient was rushed into emergency surgery and the damage and bleeding were repaired in time to save the person’s life, but the error still resulted in a prolonged hospital stay, additional medical bills, tissue damage and permanent scarring, anxiety, and pain and suffering.

What are my legal options after Hemorrhagic Shock?

Accidents and injuries happen, so hemorrhagic shock can and will occur and some cases. However, you may have grounds for a medical malpractice lawsuit [https://dellaconalaw.com/areas-of-practice/medical-malpractice-lawyer/] if a medical provider like a doctor, surgeon, or nurse was negligent of your condition, didn’t act urgently as the standard of care warranted, or caused the bleeding by being careless and cutting an organ or artery during surgery.

There are 4 basic requirements in a medical malpractice case. All 4 must be proven.

  1. A relationship existed between the healthcare professional and the patient.
  2. The medical professional was negligent, not upholding the standard of care.
  3. The medical professional’s negligence caused the injury to the patient.
  4. The patient suffered actual injuries as a result of the negligence.

You may have grounds for a personal injury lawsuit if you were involved in an accident that was someone else’s fault or if you sustained a workplace injury that resulted in your hemorrhagic shock.

What if my loved one died from Hemorrhagic Shock?

I’m so deeply sorry for your loss. Losing a loved one in a medical setting is so heartbreaking. As a nurse, I often felt helpless after a patient passed away, but as a lawyer, I’m able to help families like yours. The best way for us to know if what happened to your family member was the result of negligence is for us to sit down together and go over what happened. There are restrictions on who can file a lawsuit in wrongful death lawsuits, so I wrote an article with all the specifics. Call my office today to set up a free consultation with me. When you come in, bring all the documentation you have and write down all your questions ahead of time. The statute of limitations on wrongful death lawsuits is 2 years, so please call my office right away.

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