hypovolemic shock

• Pathophysiology

  Rapid fluid loss = inadequate circulating volume in the intravascular space, tissues suffer from oxygen and nutrient deprivation
• Causes of shock

  • Severe burns
  • Diabetes insipidus
  • Severe vomiting/diarrhea
  • Massive GI bleed
  • Hemorrhage
  • Severe crushing injuries causing internal bleeding
  • internal and/or external loss of blood/fluids
• Progression of shock

  1. Progressive stage: hypotension, tachycardia, tachypnea, weak pulses

  2. Refractory stage: coma, severe hypotension, bradycardia, ARDS
• clinical manifestations

  tachycardia

  tachypnea

  restless, confused

  oliguria

  cool, slow cap refill, weak pulses

  hypoactive bowel sounds

  hypotension

  flat neck veins

  decreased CO and CVP

  hyperglycemia

  decreased H/H
• Management

  Maximize oxygenation, initiate fluids, ID and treat cause

  100% NRB, vent

  rapid fluids- 2 large bore IVs

  FAST- ultrasound and assessment for abdominal and thoracic bleeding

  surgery
• Hemoragic hypovolemia


  Minimize crystalloids

  1:1:1 blood products with FFP, PRBCs, Platelets

  crystalloids can worsen coagulopathy, alter Ph, and hypothermia

  Maintain a MAP of 50 to not dislodge clots
• Nonhemorrhagic hypovolemia

  isotonic crystalloids

  NS and LR
• meds

  Pressors/drips to increase BP like levopherd (norepinephrine)-gold standard

  or vasopressin, epinephrine, phenylephrine