- 1Clinicians should be familiar with the clinical signs of hemorrhagic shock (III-B).
- 2Clinicians should be familiar with the stages of hemorrhagic shock (III-B).
- 3Clinicians should assess each woman's risk for hemorrhagic shock and prepare for the procedure accordingly (III-B).
- 4Resuscitation from hemorrhagic shock should include adequate oxygenation (II-3A).
- 5Resuscitation from hemorrhagic shock should include restoration of circulating volume by placement of two largebore IVs, and rapid infusion of a balanced crystalloid solution (I-A).
- 6Isotonic crystalloid or colloid solutions can be used for volume replacement in hemorrhagic shock (I-B). There is no place for hypotonic dextrose solutions in the management of hemorrhagic shock (I-E).
- 7Blood component transfusion is indicated when deficiencies have been documented by clinical assessment or hematological investigations (II-2B).They should be warmed and infused through filtered lines with normal saline, free of additives and drugs (II-3B).
- 8Vasoactive agents are rarely indicated in the management of hemorrhagic shock and should be considered only when volume replacement is complete, hemorrhage is arrested, and hypotension continues. They should be administered in a critical care setting with the assistance of a multidisciplinary team (III-B).
- 9Appropriate resuscitation requires ongoing evaluation of response to therapy, including clinical evaluation, and hematological, biochemical, and metabolic assessments (III-B).
- 10In hemorrhagic shock, prompt recognition and arrest of the source of hemorrhage, while implementing resuscitative measures, is recommended (III-B).
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- Shock in the gynecologic patient.(editors)in: Rock JA Thomson JD Te Linde's operative gynecology. 8th ed. Lippincott-Raven, 1997: 245-261
- Canadian Task Force on the Periodic Health Exam.Canada Communication Group, Ottawa1994: xxxvii
- Prevention and management of postpartum hemorrhage.J Soc Obstet Gynaecol Can. 2000; 22: 271-281
- Shock.(editor)in: Schwartz SI Principles of surgery. 7th ed. McGraw-Hill, 1999: l01-l22
- Fluid resuscitation in traumatic hemorrhagic shock.Crit Care Clin. 1992; 8: 323-340
- Current status of resuscitation: solutions including hypertonic saline.Adv Surg. 1995; 28: 133-170
- Hemodynamic resuscitation.Crit Care Clin. 1993; 10: 715-726
- Early and late acute respiratory distress syndrome: two distinct clinical entities.J Trauma. 1999; 46: 361-368
- Shock-associated right colon ischemia and necrosis.J Trauma. 1995; 39: 1171-1174
- The presence of hemorrhagic shock increases the rate of bacterial translocation in blunt abdominal trauma.J Trauma. 1998; 44: 171-174
- Hemorrhagic shock: update in pathophysiology and therapy.Acta Anaesthesiol Scand Suppl. 1997; 111: 42-44
- Outcome after hemorrhagic shock in trauma patients.J Trauma. 1998; 45: 545-549
- Cytokines and adhesion molecules in elective and accidental traumarelated ischemia/reperfusion.J Trauma. 1998; 44: 874-882
- Hemorrhagic shock. Number 235. April 1997 (replaces no. 82, December 1984). American College of Obstetricians and Gynecologists.Int J Gynaecol Obstet. 1997; 57: 219-226
- Resuscitation from severe hemorrhage.Crit Care Med. 1996; 24: S12-S23
- Shock.In: The American College of Surgeons, editor. Advanced trauma life support. 1990: 59-73 (editorAdvanced trauma life support)
- Control of pelvic hemorrhage.(editors)in: Rock JA Thomson JD Te Linde's operative gynecology. 8th ed. Lippincott-Raven Publishers, 1997: 197-232
- The safety of intraoperative autologous blood collection and autotransfusion during Cesarean section.Am J Obstet Gynecol. 1998; 179: 715-720
- Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's Witness.Ann Intern Med. 1992; 117: 1042-1048
- Hypovolemic shock.Crit Care Clin. 1993; 9: 239-259
- Update on trauma care in Canada. 4. Resuscitation through the three phases of hemorrhagic shock after trauma.Can J Surg. 1990; 33: 451-456
- Crystalloid or colloid: does it matter?.J Clin Anesth. 1989; 1: 464-471
- A review of the efficacy and safety of 7.5% NaCI/6% dextran 70 in experimental animals and in humans.J Trauma. 1994; 36: 323-330
- Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCI versus 7.5% NaCI with added dextran: a controlled trial.J Trauma. 1993; 34: 622-632
- Early fluid resuscitation in haemorrhagic shock.Eur J Emerg Med. 1994; 1: 83-85
- Effects of resuscitation fluids on nonadaptive immune responses.Transfusion. 1997; 37: 953-959
- Resuscitation following trauma and hemorrhagic shock: is hydroxyethyl starch safe? [editorial; comment].Crit Care Med. 1995; 23: 795-797
- Comparison of colloids and crystalloids in resuscitation from hemorrhagic shock.Surg Gynecol Obstet. 1982; 154: 577-586
- Human albumin solution for resuscitation and volume expansion in critically ill patients.Cochrane Database Syst Rev. 2000; 2CD001208
- Guidelines for red blood cell and plasma transfusion for adults and children.Can Med Assoc J. 1997; 156: S1-S54
- Hemostasis, surgical bleeding and transfusion.(editor)in: Schwartz SI Principles of surgery. 7th ed. McGraw-Hill, 1999: 77-100
- Management of massive transfusion.Acta Anaesthesiol Scand Suppl. 1997; 111: 205-207
- The effect of hemorrhagic shock on the clotting cascade in injured patients.J Trauma. 1989; 29: 1416-1421
- Fresh frozen plasma supplement to massive red blood cell transfusion.Ann Surg. 1985; 202: 505-511
- Blood component therapy. Number 199- November 1994 (replaces no. 78, July 1984). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists.Int J Gynaecol Obstet. 1995; 48: 233-238
- The development of hemoglobin solutions as red cell substitutes.Int Anesthesiol Clin. 1995; 33: 115-129
- Hemoglobin-based oxygen-carrying resuscitation fluids [editorial; comment].Crit Care Med. 1995; 23: 801-804
- Resuscitation for haemorrhagic shock.Br J Surg. 1993; 80: 213
- Are victims of injury sometimes victimized by attempts at fluid resuscitation? [editorial; comment].Ann Emerg Med. 1993; 22: 225-226
- Hypotensive resuscitation.Shock. 1996; 6: 311-316
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
All people have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate and tailored to their needs.
This guideline was written using language that places women at the centre of care. That said, the SOGC is committed to respecting the rights of all people-including transgender, gender non-binary, and intersex people-for whom the guideline may apply. We encourage healthcare providers to engage in respectful conversation with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs and individual needs of each patient and their family should be sought and the final decision about the care and treatment options chosen by the patient should be respected.