Die pathophysiologischen Mechanismen unterschiedlicher Formen des Schocks sind komplex und dynamisch, und führen unerkannt und unbehandelt rasch zu einem lebensbedrohlichen und häufig letal endenden Multi-Organversagen. Eine spezielle Form des Schocks ist der hypovoläme bzw. hämorrhagische Schock. Der vorliegende Beitrag behandelt die Pathophysiologie, die Notfalldiagnostik und das Notfall-Management dieser Schockform.
Abstract
Hypovolemic and hemorrhagic shock are life-threatening conditions that, if untreated, rapidly lead to multi-organ failure and death. These conditions result from significant intravascular fluid or blood loss, causing critical organ hypoperfusion. The underlying pathophysiology involves complex hemodynamic, inflammatory, and coagulation disturbances that may progress to irreversible organ dysfunction. Rapid diagnosis, early hemorrhage control, and targeted hemodynamic and hemostatic therapy are crucial to improve patient outcomes. Diagnosis is based on clinical symptoms, laboratory parameters, and imaging or endoscopic assessments. The primary therapeutic approach focuses on addressing the underlying cause while implementing fluid resuscitation and vasopressor support. In hemorrhagic shock, coagulation management is of paramount importance. Essential treatment principles include maintaining normothermia, a pH above 7.2, and normocalcemia. If no contraindications exist, permissive hypotension should be applied to limit ongoing bleeding. Early goal directed administration of tranexamic acid and fibrinogen is recommended to stabilize coagulation. For patients experiencing severe hemorrhagic shock, transfusion strategies must be optimized. A hemoglobin target of 7–9g/dL is generally recommended, and in cases requiring massive transfusion, a ratio of red blood cells, plasma, and pooled platelets of 4:4:1 should be used. Additionally, patients receiving effective anticoagulation require specific reversal agents to restore hemostasis. In summary, the successful management of hypovolemic and hemorrhagic shock depends on early recognition, rapid hemorrhage control, and individualized goal directed resuscitation and hemostatic strategies.
Schlüsselwörter
Schock - hypovoläm - hämorrhagisch - schwere Blutungen
Keywords
shock - hypovolemic - hemorrhagic - major bleeding
