Acute Hemorrhagic Shock State Management in Urgent Patients


Patients in the ICU setting face a range of threats. Being extraordinarily vulnerable, they may fail to recover in case of another health problem development. Acute Hemorrhagic Shock (AHS) is one of the conditions that may lead to a rapid and uncontrollable increase in the number of lethal outcomes among ICU patients. AHS is nowadays considered one of the primary factors contributing to a rise in patient deaths in ICU.

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The goal of the study is to determine which one of the current frameworks used to prevent and address the problem of AHS development in ICU patients should be deemed as the most efficient one. MAP and SI are compared in the research so that the most efficient method could be determined. To identify the tool that will lead to the most successful patient outcomes, one will have to consider a quasi-experimental setting design.

It is assumed that the adoption of SI as the means of preventing and managing the issue of AHS in the ICU setting will become the most efficient one. The opportunities for embracing a wide array of internal and external factors, which it offers, are bound to become the foundation for diagnosing the issue and determining the methods of addressing it.

Background Information

Acute Hemorrhagic Shock State Is a Critical Issue

Clinical Problem Definition

The Population That Is Affected by AHS

The patients with a general trauma can be viewed as the target population of the research. Even though virtually anyone can be exposed to the threat of trauma, homeless people are usually viewed as the ones that are affected by AHS to the greatest degree. Therefore, people with poor financial, economic, or social background can be deemed as the focus of the study (Michel et al., 2016).

Magnitude of the Problem

ACS Statistics

Although new models of care emerge on a regular basis, the issue of AHS remains one of the causes of mortality in the United States. For instance, a recent study points to the fact that 2.3% to 4% of deaths in the U.S. in 2013 were caused by AHS (Kahl et al., 2013). Therefore, there are sufficient reasons for concern among the U.S. nurses. It is crucial to control the development of AHS in ICU patients so that the mortality rates could be reduced and the patient outcomes could be improved.

Available Interventions

Overview and Comparison

It should be noted that there are several approaches toward the measurement of the possibility of negative patient outcome in the instances of an acute hemorrhagic shock (AHS). As a rule, these tools include the measurement of the patient’s vitals. However, one of the approaches stands out as a more comprehensive one (Kim et al., 2013).

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Shock Index

Defined as the correlation between HR and systolic BP, SI is often viewed as one of the all-embracive and, therefore, comprehensive approaches toward the identification of AHS and its early prevention (Berger et al., 2013). The use of SI, as well as reverse SI (BP/HR), helps identify dangerously ill patients and tend to their needs in a manner as efficient and expeditious as possible (Chuang et al., 2016).


Mean Arterial Pressure (MAP) can be viewed as an important index of AHS in ICU patients. Seeing that bleeding, which can be viewed as the primary symptom of AHS, affects the levels of artery pressure, the changes in the arterial pressure levels are bound to reflect the development of AHS. Therefore, it can be used as the means of identifying the problem and preventing it successfully (DeLano & Schmid-Schonbein, 2014).


Blood pressure (BP) can be considered another essential index that will help determine whether the patient is under the threat of having AHS (Johnson et al., 2014). The reasons for the test to work in the ICU setting are rather evident – indicating the levels of pressure applied to the walls of blood vessels in the patient’s circulatory system, BP shows whether the patient is likely to lose a significant amount of blood within a specific amount of time (Bougle, Harrois, & Duranteau, 2013). In other words, it helps determine whether the coronary perfusion pressure is high enough for the patient to lose a lot of blood and, therefore, experience AHS.

Heart rate

Last but definitely not least, the use of heart rate (HR) index should be viewed as a possible tool for determining whether the patient is likely to experience AHS in the ICU setting.

Significance of a Research Synthesis


The reasons for conducting the study are quite obvious. As stated above, AHS often leads to fatal outcomes. Furthermore, the tendency for the percentage of deaths inflicted by AHS to increase has been spotted. Therefore, it is imperative to determine which of the frameworks is the most efficient one so that the ultimate strategy toward addressing the issue could be designed.

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Putting the Problem in an Answerable PICOT Question

In order to find the best tool for identifying the symptoms of AHS in ICU patients at the earliest stages of the disease development, as well as prevent the problem, manage it successfully, etc., one will have to consider comparing two of the most efficient tools identified above. As stated after a thorough overview of the available resources, the use of SI, as well as the incorporation of MAP methods, is typically considered the most efficient way of addressing AHS issues in ICU patients (Sterling, Jones, Coleman, & Summers, 2014). However, the choice of the best method will hinge on not only the level of efficacy but also the time taken to define the health issue in question. Therefore, an elaborate analysis will be a necessity.


ICU Patients

The ICU patients of the Get with teh Guidelines (GWTG) Program are the target population which the current study targets. The patients will be represented by 54,434 people, among which 74.2% white (40,411 people), 15.1% Black (8,234 people), 7.8% Hispanic (4,257 people), and 2.9% Asian (1,523 people) patients will participate in the research (Mehta et al., 2014). The fact that the patients belong to different cultures means that extraneous variables such as age will also have to be considered in the course of research. Particularly, it will be desirable to consider comparing the clinical outcomes in different groups so that accurate conclusions regarding the success of applying the MAP and IS tools should be made. Cultural factors will also have to be taken into consideration when addressing the issue.


Shock Index

Shock Index (SI) will become the primary intervention tool and the main focus of the research. The Patients’ heart rate (HR) will be measured along with their systolic blood pressure (BP). Afterward, the correlation between the two will be used to determine the possible worsening of the patients’ state.



MAP will be used as the point of comparison. As explained above, MAP is typically viewed as the second best strategy in addressing the issues associated with AHS development in ICU (Barry et al., 2016). Therefore, it is reasonable to assume that it should be compared to the application of SI.


Worsening Detection

It is expected that one of the methods mentioned above will help detect the development of AHS in patients faster than the other. Furthermore, it is quite plausible that the use of the specified tools may help prevent the instance of AHS successfully.


Onset of Clinical Decline

As far as the time frame of the experiment is concerned, the point at which the participants start showing negative outcomes should be viewed as the length of the study.


In other words, the PICOT question can be put in the following way: In the ICU patient with AHS, is the shock index more predictive than the MAP in the worsening of the clinical status within the first hours of clinical decline?

It is expected that the answer to the specified question will help reduce the mortality rates among ICU patients with AHS considerably. Even though an array of tools has been designed for meeting the needs of the target population, the efficacy of the measures take in the ICU environment leaves much to be desired. Thus, a uniform approach must be developed so that every nurse could meet the needs of ICU patients accordingly and prevent any instances of AHS development in the target environment. Furthermore, the answer to the PICOT question provided above may help locate innovative strategies for managing the needs of ICU patients that are under the threat of developing AHS.


Barry, N., Mubang, R. N., Wojda, T. R., Evans, D. C., Sharpe, R. P., Hoff, W. S…. & Stawicki, S. P. (2016). An exploratory, hypothesis-generating, meta-analytic study of damage control resuscitation in acute hemorrhagic shock: Examining the behavior of patient morbidity and mortality in the context of plasma-to-packed red blood cell ratios. International Journal of Academic Medicine, 2(2), 159-172. Web.

Berger, T., Green, J., Horeczko, T., Hagar, Y., Garg, N., Suarez, A…. & Shapiro, N. (2013). Shock Index and Early Recognition of Sepsis in the Emergency Department: Pilot Study. The Western Journal of Emergency Medicine, 14(2), 168–174. Web.

Bougle, A., Harrois, A., & Duranteau, J. (2013). Resuscitative strategies in traumatic hemorrhagic shock. Annals of Intensive Care, 3(1). Web.

Chuang, J. F., Rau, C. H., Wu, S. C., Liu, H. T., Hsu, S. Y., Hsieh, H. Y…. & Hsieh, C. H. (2016). Determination of normal ranges of shock index and other haemodynamic variables in the immediate postpartum period: A cohort study. PloS One, 11(12). Web.

DeLano, F. A., & Schmid-Schonbein, J. W. (2014). Pancreatic digestive enzyme blockade in the small intestine prevents insulin resistance in hemorrhagic shock. Shock, 41(1). Web.

Johnson, B. D., Helmond, N. V., Curry, T. B., Buskirk, C. M. V., Convertino, V. A., & Joyner, M. J. (2014). Reductions in central venous pressure by lower body negative pressure or blood loss elicit similar hemodynamic responses. Journal of Applied Physiology, 117(2), 131-141. Web.

Kahl, J. E., Calvo, R. Y., Sise, M. J., Sise, C. B., Thorndike, J. F., & Shackford, S. R. (2013). The changing nature of death on the trauma service. The Journal of Trauma and Acute Care Surgery, 75(2), 195-201. Web.

Kim, J. A., Choi, J. Y., Yoo, T. K., Kim, S. K., Chung, K., & Kim, D. W. (2013). Mortality prediction of rats in acute hemorrhagic shock using machine learning techniques. Medical & Biological Engineering & Computing, 51(9), 1059-1067. Web.

Mehta, R. H., Cox, M., Smith, E. E., Xian, Y., Bhatt, D. L., Fonarow, K. C., & Peterson, E. D. (2014). Race/ethnic differences in the risk of hemorrhagic complications among patients with ischemic stroke receiving thrombolytic therapy. Stroke, 45(8). Web.

Michel, P., Wähnert, M., Freistühler, M., Laukoetter, M. G., Rehberg, S., Raschke, M. J., & Garcia, P. (2016). Acute transfusion-related abdominal injury in trauma patients: a case report. Journal of Medical Case Reports, 10(2), 294-299. Web.

Sterling, S. A., Jones, A. E., Coleman, T. G., & Summers, R. L. (2014). Theoretical analysis of the relative impact of obesity on hemodynamic stability during acute hemorrhagic shock. Archives of Trauma Research, 4(3). Web.

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