Forensic Medical Aspects of Complications and Lesions of Target Organs with Hemorrhagic Shock

Hemorrhagic shock develops as a result of acute hemorrhage. Acute blood loss is the sudden blood outlet. The main clinical symptoms of the resulting decrease in circulating blood volume (CBV) (hypovolemia) are the pallor of the skin and visible mucous membranes, tachycardia and arterial hypotension. The cause of acute blood loss can be trauma, spontaneous bleeding, and surgery. The speed and volume of blood loss are of great importance. With a slow loss of even large amounts of blood (1000-1500 ml) compensatory mechanisms manage to turn on, hemodynamic disorders appear gradually and are not very serious. On the contrary, intensive bleeding with loss of a smaller volume of blood leads to severe hemodynamic disorders and, as a result, to hemorrhagic shock. The following stages of hemorrhagic shock are distinguished: Stage 1 (compensated shock), when blood loss is 15-25% CBV, the patient's consciousness is preserved, the skin is pale, cold, the blood pressure is moderately reduced, there is pulse of weak filling, moderate tachycardia to 90-110 beats / min. Stage 2 (decompensated shock) is characterized by an increase in cardiovascular disorders; the compensatory mechanisms of the organism are disrupted. The blood loss is 25-40% CBV, impaired consciousness before sopor, acrocyanosis, cold extremities, blood pressure sharply reduced, tachycardia 120-140 beats / min, pulse weak and thread, dyspnea, oliguria up to 20 ml / hour. Stage 3 (irreversible shock) is a relative term and largely depends on the resuscitation methods used. The patient's condition is extremely difficult. Conscience is sharply depressed until complete loss, the skin is pale, the "marbling" of the skin, systolic pressure is below 60 mm Hg, the pulse is determined only on the main vessels, a sharp tachycardia up to 140-160 beats / min. As an express diagnosis of the severity of shock, the concept of a shock index (SHI) is used – the ratio of the heart rate to the magnitude of the systolic pressure. At a shock of the 1st degree SHI = 1 (100/100); at a shock of the 2nd degree it is 1.5 (120/80), the shock of the 3rd degrees SHI=2 (140/70). Hemorrhagic shock is characterized by a general severe condition of the body, insufficient circulation of blood, hypoxia, metabolism violation and organs function. Hypotension, hypoperfusion (decrease in gas exchange) and hypoxia of organs and tissues are at the heart of the shock pathogenesis. The leading damaging factor is circulatory hypoxia. Relatively fast loss of 60% of CBV is considered deadly for a person, blood loss of 50% of CBV leads to failure of compensation mechanism, blood loss of 25% of CBV is almost completely compensated by the body. The ratio of the hemorrhage magnitude and its clinical manifestations: Blood loss 10-15% CBV (450-500 ml), there is no hypovolemia, BP is not lowered; Blood loss 15-25% CBV (700-1300 ml), mild hypovolemia, blood pressure lowered by 10%, mild tachycardia, pallor of the skin, cold extremities; Blood loss 25-35% CBV (1300-1800 ml), moderate severity of hypovolemia, blood pressure lowered to 100-90, tachycardia up to 120 beats / min, pallor of the skin, cold sweat, oliguria; Blood loss to 50% CBV (2000-2500 ml), severe degree of hypovolemia, blood pressure lowered to 60 mm Hg, pulse threadlike, unconscious or confused, sharp pallor, cold sweat, anuria; The blood loss of 60% of CBV is fatal