Résumé
Haemorrhagic shock is a life-threatening manifestation of intravascular volume depletion due to acute blood loss. It may manifest in patients with blunt or penetrating trauma, as well as gastrointestinal, urological, vascular, or obstetric pathologies. Early recognition and prompt treatment of haemorrhagic shock are vital. Delays in recognition and definitive treatment may lead to irreversible shock, multiorgan failure, and death. The initial evaluation of the patient should focus on the history of presenting complaints and align this with potential sources of bleeding. Falling haemoglobin levels, although important as a diagnostic marker of bleeding, is a late finding. The Shock Index (SI) may be a better indicator of the severity of injuries, need for blood transfusion, and emergent operative management compared to hypotension alone. A ‘chain of survival’ has been described for haemorrhagic shock, commencing in the prehospital setting and continuing with resuscitation, definitive interventions, and post-haemostasis management in the hospital. Priorities in the hospital are restoration of intravascular volume and definitive control of haemorrhage. Hospitals should have established massive transfusion protocols to ensure the timely delivery of blood products to the resuscitation room. Published guidelines can assist clinicians with optimal transfusion strategies and haemodynamic targets. Definitive care may include interventions such as endoscopy, angiography, or surgical exploration.