When a patient is hemorrhaging, either externally or internally, as shock progresses from the compensatory phase there is damage done at the cellular level to the circulation which lead to irreversible damage. People who die from trauma either die in the first moments, within the first hour or within the first few days from conditions such as acute respiratory distress syndrome, kidney failure or sepsis. Studies have shown that the shock syndrome must be stabilized by a surgeon in the operating suite prior to an hour after the injury to prevent long-term tissue damage to organs such as the kidney and the liver. This hour has become known as the golden hour . To fully understand the importance of time in the first hour lets review the shock syndrome.
Shock is a normal compensatory mechanism hat kick in when the body senses a loss of fluid.
It involves a logical sequential shunting of blood away from organs with lesser need, such as the skin and muscles, to organs with greater need, such as the heart, lungs and brain. The objective is to keep the brain well profused at all costs thus the brain is the king in this natural pecking order. The shock syndrome is generally broken down into two phases the, the compensatory phase and the decompensatory phase. During the compensatory phase the patient is tachycardic, pale, thirsty, restless, may have normal to delayed capillary refill, increased respirations and an elevated diastolic pressure. We usually do not pay too much attention to the diastolic pressure although it is a measure of the overall residual pressure in the systemic system, which tends to increase as the body begins to vasoconstrict the vessels.