What are the clinical features of hemorrhagic shock?
Nov 05, 2025
Source: Cainiu Health
Dr. Wang Lei
Introduction
In general, hemorrhagic shock is a critical condition caused by significant blood loss leading to a sudden reduction in circulating blood volume and inadequate tissue perfusion. Clinical features mainly include abnormal blood pressure, altered mental status, skin manifestations, decreased urine output, and circulatory disturbances. When the above signs appear, immediate hemostatic measures should be taken, blood volume rapidly restored, tissue hypoxia corrected, and the underlying disease actively treated.
In general, hemorrhagic shock is a critical condition caused by significant blood loss leading to a sudden reduction in circulating blood volume and inadequate tissue perfusion. Clinical features mainly include abnormal blood pressure, altered mental status, skin manifestations, reduced urine output, and circulatory disturbances. A detailed analysis is as follows:
1. Blood pressure abnormalities: In the early stage, systolic blood pressure may remain within the normal range, but diastolic pressure rises and pulse pressure narrows. As blood loss increases, systolic pressure gradually drops. When systolic pressure falls below 90 mmHg and pulse pressure is less than 20 mmHg, this indicates progression to a more severe stage of shock. Continued hypotension further exacerbates tissue hypoxia.
2. Altered mental status: Early signs may include restlessness, anxiety, and mental tension—compensatory responses of the body to hypoxia. If hypoxia is not promptly corrected, patients may progress to apathy, drowsiness, and eventually coma. Changes in consciousness reflect the degree of cerebral perfusion and oxygen deficiency.
3. Skin manifestations: The skin and mucous membranes appear pale and clammy, extremities feel cold, and capillary refill after pressing on the nail beds or lips is delayed. Some patients may develop mottled skin patterns, which are typical signs of peripheral vasoconstriction and insufficient microcirculatory perfusion.
4. Reduced urine output: Renal perfusion is highly sensitive to hemodynamic changes. During shock, renal blood flow decreases and glomerular filtration rate declines, resulting in oliguria. Typically, 24-hour urine output is less than 400 mL, and in severe cases, less than 100 mL. Urine output serves as an important indicator for assessing improvement in circulatory perfusion.
5. Circulatory disturbances: Patients develop tachycardia, often exceeding 100 beats per minute, with increased heart rate typically preceding the drop in blood pressure. This is accompanied by weak, rapid, and thready pulses that are difficult to palpate. Some patients may also exhibit rapid, shallow breathing; in severe cases, respiratory rhythm disturbances can occur due to hypoxia affecting the respiratory center.
When the above symptoms appear, immediate hemostasis, rapid volume replacement, and correction of tissue hypoxia are required. Simultaneously, active treatment of the underlying cause must be initiated to prevent further deterioration of the condition.
