Hypovolemic Shock

Overview

Hypovolemic shock is a condition characterized by a decrease in circulating blood volume, leading to inadequate perfusion of tissues and organs. It can be classified into two primary categories:

1. Hemorrhagic (Loss of Blood)
2. Non-Hemorrhagic (Loss of Fluids)

Hemorrhagic Causes

• Postpartum Hemorrhage: Common during/after childbirth.
• Upper GI Bleed: Due to esophageal varices, peptic ulcer disease.
• Trauma: Puncture wounds, crush injuries, multiple lacerations.
• Aneurysm: Ruptured aneurysms in the head or abdomen.

Non-Hemorrhagic Causes

• Vomiting/Diarrhea: Loss of body fluids.
• Diuresis/Sweating: Excessive fluid loss through urine or sweat.
• Burns: Fluid loss from burn injuries.
• Third Spacing: Fluid shifts to interstitial spaces, e.g., edema, ascites.

Pathophysiology

• Decrease in Intravascular Fluids: Reduces preload to the heart.
• Decreased Stroke Volume: Cardiac output = Heart rate x Stroke volume.
• Decreased Cardiac Output: Leads to reduced blood pressure (hypotension) and decreased perfusion, causing tissue ischemia.

Signs and Symptoms

• Hypotension: Low blood pressure due to fluid/volume deficit.
• Tachycardia: Increased heart rate to compensate for hypotension.
• Tachypnea: Increased respiratory rate to enhance oxygen delivery.
• Dry Heaves/Oliguria: Lack of fluid results in decreased urine output.
• Altered Mental Status: Due to inadequate brain perfusion.
• Pale, Sweaty, Clammy Skin: Signs of decreased perfusion.
• Anxiety: Due to lack of oxygen.

Management

Hemorrhagic Shock

• Blood Transfusion: RBCs, fresh frozen plasma, platelets.
• Type and Screen: Ensure correct blood type match.
• Two Nurse Verification: For blood transfusion safety.
• Treat the Cause: Surgical intervention if needed.

Non-Hemorrhagic Shock

• Fluid Replacement: Normal saline or lactated ringers.
• Vasopressors: To constrict blood vessels and increase blood pressure.
• Monitor Fluids: Using Ino (Input and output), urinary catheter.
• NPO: If necessary, especially in GI-related issues.

Additional Monitoring & Interventions

• Vital Signs: Monitor frequently (e.g., Q15 min).
• Neurostatus: Regular checks to assess improvement.
• Capillary Refill: Should be less than 3 seconds if perfusion is adequate.
• Skin Color and Condition: Improvement indicates better perfusion.
• Positioning: Head of bed < 30 degrees, Trendelenburg or elevated legs to improve venous return.

Summary

It's crucial to differentiate between hemorrhagic and non-hemorrhagic hypovolemic shock for appropriate management. Both conditions require careful monitoring and various interventions to stabilize the patient and ensure adequate tissue perfusion.