Abstract
Objective
To review the clinical aspects of hemorrhagic shock and provide recommendations for
therapy.
Options
Early recognition of hemorrhagic shock and prompt systematic intervention will help
avoid poor outcomes.
Outcomes
Establish guidelines to assist in early recognition of hemorrhagic shock and to conduct
resuscitation in an organized and evidence-based manner.
Evidence
Medline references were sought using the MeSH term “hemorrhagic shock.” All articles
published in the disciplines of obstetrics and gynaecology, surgery, trauma, critical
care, anesthesia, pharmacology, and hemotology between 1 January 1990 and 31 August
2000 were reviewed, as well as core textbooks from these fields. Selected references
from these articles and book chapters were also obtained and reviewed. The level of
evidence has been determined using the criteria described by the Canadian Task Force
on Preventive Health Care.
Validation
These guidelines have been reviewed by the Clinical Practice Obstetrics Committee
and approved by Executive and Council of the Society of Obstetricians and Gynaecologists
of Canada.
Sponsors
The Society of Obstetricians and Gynaecologists of Canada.
Recommendations
- 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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Article info
Publication history
No. 115, June 2002 (Reaffirmed December 2018)
Footnotes
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.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of Society of Obstetricians and Gynaecologists of Canada.
