Non-cavitary hemorrhage producing shock in trauma patients: incidence and severity

Intraperitoneal and intrathoracic bleeding, cavitary hemorrhage (CH), are recognized as major causes of hypovolemic shock in trauma patients. Blood loss from fractures and lacerations, non-cavitary hemorrhage (NCH), is not considered a common cause of shock. Of 466 trauma patients admitted during a 12-month period without spinal cord injury, burns, or ongoing CPR, 13.1% were admitted in hypovolemic shock. Of these 466 patients 55.7% had strictly non-cavitary sources of blood loss, most commonly long bone fractures and skin lacerations. There was no significant difference in the resuscitative fluid requirements, morbidity, or mortality between patients presenting in hypovolemic shock due to CH and NCH. Blood loss from NCH must be recognized as a significant source of hypovolemic shock in trauma patients.