This worsening acidosis along with hypoxemia, if left uncorrected, eventually causes the loss of peripheral vasoconstriction, worsening hemodynamic compromise, and death. While prolonging heart and brain function, this also leads to other tissues being further deprived of oxygen causing more lactic acid production and worsening acidosis. As diastolic ventricular filling continues to decline and cardiac output decreases, systolic blood pressure drops.ĭue to sympathetic nervous system activation, blood is diverted away from noncritical organs and tissues to preserve blood supply to vital organs such as the heart and brain. Typically, there is a slight increase in the diastolic blood pressure with narrowing of the pulse pressure. The body compensates for volume loss by increasing heart rate and contractility, followed by baroreceptor activation resulting in sympathetic nervous system activation and peripheral vasoconstriction. In the latter process, pyruvate is produced and converted to lactic acid to regenerate nicotinamide adenine dinucleotide (NAD+) to maintain some degree of cellular respiration in the absence of oxygen.
As a result, mitochondria are no longer able to sustain aerobic metabolism for the production of oxygen and switch to the less efficient anaerobic metabolism to meet the cellular demand for adenosine triphosphate. Hemorrhagic shock is due to the depletion of intravascular volume through blood loss to the point of being unable to match the tissues demand for oxygen. Due to this, elderly patients are less likely to handle the physiological stresses of hemorrhagic shock and may decompensate more quickly. The remaining cases are divided among cardiovascular surgery, critical care, cardiology, obstetrics, and general surgery, with trauma utilizing over 75% of the blood products.Īs patients age, physiological reserves decrease, the likelihood of anticoagulant use increases, and the number of comorbidities increases. During one year, one trauma center reported 62.2% of massive transfusions occur in the setting of trauma. The preponderance of hemorrhagic shock cases resulting from trauma is high. Of this 40%, the greatest incidence was in the 20 to 24-year-old range. While trauma spans all demographics, it disproportionately affects the young, with 40% of injuries occurring in ages 20 to 39 years by one country’s account. In the United States in 2001, trauma was the third leading cause of death overall and the leading cause of death in those aged 1 to 44. Trauma remains a leading cause of death worldwide, with approximately half of these attributed to hemorrhage.
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