The patient in shock--clinical picture and pathophysiology

The diagnosis of hemorrhagic shock can be made on the basis of a good knowledge of the clinical picture of the bleeding patient. The necessary lab tests must be carried out over a period of time to establish their evolution and thus the degree of shock. At present, attention is being focused on the microcirculation. In shock, tissue is starved of oxygen and nutrients, resulting in the liberation by degenerating cell structures of numerous substances that have an effect on vascular tone. Decompensation is accompanied by consumption coagulopathy, which also has an influence on the microcirculation. The inhibitor potential is very important here. The patient must be out of shock before endoscopy can be considered.