Scribd
Upload
146 views25 pages

Hypovolemic Shock

This document discusses shock, defined as decreased circulating blood volume resulting in reduced tissue perfusion. It describes hemorrhagic and non-hemorrhagic forms and their etiologies. Treatment involves stopping ongoing losses, rapid volume replacement with crystalloids or colloids, inotropic support if needed, and vasopressor therapy only temporarily in some cases of hemorrhagic shock until surgery can be performed. Monitoring includes clinical parameters and labs to guide therapy and assess response.

Uploaded by

Manushi Henadeera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
146 views25 pages

Hypovolemic Shock

This document discusses shock, defined as decreased circulating blood volume resulting in reduced tissue perfusion. It describes hemorrhagic and non-hemorrhagic forms and their etiologies. Treatment involves stopping ongoing losses, rapid volume replacement with crystalloids or colloids, inotropic support if needed, and vasopressor therapy only temporarily in some cases of hemorrhagic shock until surgery can be performed. Monitoring includes clinical parameters and labs to guide therapy and assess response.

Uploaded by

Manushi Henadeera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 25

Shavindri Prasadini De Silva

Kursk State Medical University


4th year 1st semester
Group 26
 DEFINITION
 ETIOLOGICAL FACTORS
 MECHANISM
 PATHOGENESIS
 SYMPTOMS
 TREATMENT
 syndrom characterized by decreased
circulating blood volume (hypovolemia),
which results in reduction of effective
tissue perfusion pressure and generalized
cellular dysfunctions.
Forms:
 Hemorrhagic shock
 Non-hemorrhagic hypovolemic shock

 Hemorrhagic:
 External blood loss (wounds)
 Exteriorization of internal bleeding (hematemesis, melena, epistaxis,
hemoptysis,etc.)
 Internal bleeding (hemothorax, hemoperitoneum,etc. )
 Traumatic shock
 Non-hemorrahagic:
Digestive losses (vomiting, diarrhea, nasogastric
suction, billiary, digestive fistula, etc )
Renal losses (diabetes mellitus, polyuria caused by
diuretics overdose, osmotic substances, polyuric
phase of acute renal failure, etc.)
Skin losses (intense physical effort, overheated
enviroment, burns, etc.)
Third space losses (peritonites, intestinal oclussion,
pancreatits, ascitis pleural effusions, etc.)
 Intense thirst
 Tachycardia
 Tachypnea
 Small pulse wave
 hTA (blood hypotension)
 Agitation, anxiety , confusion, coma
 Oliguria
 Cold extremities
 Profuse sweating
 Collapsed peripheral veins
 Delayed return of color to the nail bed
+ History of hemorrhagic or non-hemorrhagic losses
Class I Class II Class III Class IV

Blood loss- ml < 750ml 750-1500ml 1500-2000ml >2000ml

Blood loss-% <15% 15-30% 30-40% >40%

Pulse rate <100/min < 100/min 120-140/min >140/min

BP N N  

Pulse wave N   


amplitude
Capillary refill N + + +

Respiratory rate 14-20/min 20-30/min 30-40/min >40/min

Urinary output >30ml/oră Oliguria Oligoanuria Anuria

Mental status Mild anxiety Anxiety Confused Lethargy


HR BP CO CVP PAOP SVR Da-vO2 SvO2

Hypovolemic
shock
↑     ↑ ↑ 

Cardiogenic
shock
↑   ↑ ↑ ↑ ↑ 

Septic shock
↑  ↑N N N   ↑
ABBREVIATIONS:
 HR – heart rate
 BP – arterial blood pressure
 CO – cardiac output
 CVP –central venous pressure
 PAOP – pulmonary artery occlusion pressure
 SVR – systemic vascular resistance
 Da-v O2 – oxygen arterial-venous difference
 SvO2 – mixed venous blood oxygen saturation
 Initial treatment of shock states
 Causative treatment – STOP losses
 Volume repletion
 Inotropic therapy
 Vasomotor therapy
 Causative treatment – STOP losses
◦ essential role
◦ surgical treatment (when appropriate)
◦ emergency surgery for ongoing hemorrhage
 volume replacement
◦ Vascular access site
◦ Solutions for volume replacement
◦ Rhythm of administration
 Volume replacement – SITE of VASCULAR
ACCESS
◦ Peripheral vascular access
 Multiple access (2-4 veins)
 Large peripheral catheters
 External jugular vein
Advantages:
 Short time of instalation
 Requires basic knowledge and simple matherials
 Minor complications (hematomas, cutaneous seroma, etc.)
Disadvantages:
 The diameter of peripheral catheter must be adapted for peripheral
veins dimensions
 Vascular access can be lost (restless patient, during transportation);
must be changed at 24-48 hours;
 no catecholamines administration (except in emergency for a short
time period,until a central venous access is available)
◦ Central venous access
 After peripheral vascular access is established and
volume replacement is initiated
Advantages:
 Reliable and long lasting venous access (7-10 days)
 Allows CVP measuring and guiding of treatment
 Allows the administration of catecholamines and
hypertonic substances
Disadvantages:
 Risk of complication (at instalation – pneumothorax,
cervical or mediastinal hematoma, cardiac dysrhytmias;
during utilization – infection, gas embolism)
Colloid sollutions
 Dextrans: Dextran 70, Dextran 40
 Gelatines: Gelofusin, Haemacel, Eufusin
 Hetastarch: Haes, Voluven, Refortan
 Human albumin 5%, 20%
◦ Advantages:
 Good volume effect
 Long duration of volume effect
◦ Disadvantages:
 expensive
 risk for anaphylactic reactions
 interfere with blood groups determination
 can induce/ aggravate coagulation disorders
Blood and blood products are not volume solutions
 Only isogroup isoRh blood
 Only after restauration of intravascular volume with cristalloid
/colloid solutions;
 For correction of oxygen transport
 In case of posthemorragic anemia (after volume replacement) or
ongoing hemorrhage
 In case of massive blood transfusion – add fresh-frozen plasma and
platelet concentrate
Volume replacement
RHYTHM OF ADMINISTRATION
◦ Rhytm of administration depends on:
 Ongoing losses / stopped losses
 Rhytm of losses – rapid (minutes, hours) or slow (days) instalation
◦ For the patient with hypotension – normal saline (2000 ml
in the first 15-30 minutes)
◦ after the first 15-30 minutes - volume replacement
continues depending on the clinical and hymodinamic
parameters (BP, HR, etc..)
Volume replacement –
MONITORING THE TREATMENT
EFFICIENCY
◦ Clinical parameters
 normalisation of BP, HR, pulse amplitude, skin colour and
temperature, mental status, urinary output
◦ Hemodynamic parameters
 Normalization of CVP, PCPB, DC, RVS, so
◦ Laboratory parameters
 Normalization of acid-base balance, liver, renal tests, Hb şi Ht, so
 Inotropic support
◦ Only after volume replacement
◦ Used to improve cardiac output
◦ Dobutamine
 inotropic positive support
 peripheral arterial vasodilatation
Vasopressor therapy
 NOT RECOMMENDED (may aggravate peripheral hypoperfusion
and metabolic acidosis)

EXCEPTIONS
 Only temporary
 In case of ongoing hemorrhage, which outruns the possibilities of
volume replacement
 Only until surgical procedure stops the hemorrhage (emergency
surgical treatment)
 Noradrenaline, dopamine, adrenaline

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy