Understanding Hypovolemic Shock Management

Apr 12, 2025

Hypovolemic Shock Lecture by Nurse Orion Colin

Introduction

  • Focus: Hypovolemic shock
  • Definition: Occurs due to low blood volume in the intravascular space.
  • Importance: Decrease in cardiac output leading to decreased oxygen to cells, causing cell death and shock symptoms.

Causes of Hypovolemic Shock

  • External Fluid Loss: Major injuries causing bleeding.
  • Internal Fluid Shift: Such as internal bleeding or third-spacing due to burns, fractures, or pancreatitis.

Types of Hypovolemic Shock

  1. Relative Hypovolemic Shock
    • Inside fluid shift, concealed.
    • Causes: Internal bleeding, third-spacing, vasodilation in sepsis.
  2. Absolute Hypovolemic Shock
    • External fluid loss, visible.
    • Causes: Surgery, vomiting, urination, diarrhea.

Pathophysiology

  • Decrease in blood volume reduces venous return and cardiac preload.
  • Low preload affects stroke volume, reducing cardiac output.
  • Decreased oxygen supply leads to anaerobic metabolism and lactic acid buildup.

Signs and Symptoms

  • Class 1: <15% volume loss, asymptomatic.
  • Class 2: 15-30% loss, mild symptoms, activation of compensation mechanisms.
  • Class 3: 30-40% loss, failure of compensatory mechanisms, severe symptoms.
  • Class 4: >40% loss, critical condition, high risk of death.

Hemodynamic Monitoring

  • Central venous pressures and pulmonary capillary wedge pressures are low in hypovolemic shock.
  • Monitoring essential to avoid fluid overload during treatment.

Nursing Interventions

  • Fluid Replacement: Using crystalloids, colloids, or blood products.
  • Oxygenation: Prevent respiratory failure.
  • Monitoring: Vital signs, urine output, mental status.
  • IV Access: At least two large-bore IVs.
  • Positioning: Modified Trendelenburg to increase venous return.

Treatment Options

  • Fluids:
    • Crystalloids: Normal saline, lactated Ringer's.
    • Colloids: Albumin, hetastarch.
    • Blood Products: Packed RBCs, platelets, fresh frozen plasma.
  • Care During Administration: Warm fluids to prevent hypothermia.

Conclusion

  • Vital to recognize signs of hypovolemic shock early.
  • Treatment focuses on restoring fluid volume and correcting underlying causes.
  • Continuous monitoring and adjusted interventions are key to managing hypovolemic shock.