All right, for this uh video we are just covering hypoalmic shock. Hypoalmic shock can result from either internal or external losses. Your examples of external losses are going to be trauma, surgery, diaresis, diarrhea, vomiting, and diabetes incipitus. For your internal losses, you have internal hemorrhage, burns, which creates a fluid shift, a sites, and dehydration. For your clinical manifestations here, you're going to see decreased intravascular volume, which is going to decrease preload, uh, which is going to decrease ventricular filling, and then you will have decreased stroke volume and decreased cardiac output. All of this in turn leads to a decreased tissue perfusion. So how do we fix this? Well, first we're going to apply oxygen, meet some of those metabolic demands for our patients, and then we're going to start fluid resuscitating our patient, trying to restore that intravascular uh volume either with fluids, crystalloids like NS or LR, colloids like albumin or blood products. So depending on the type of loss, you should have at least two large bore IVs or an IO if you absolutely need it. If your patient is hypoalmic from blood loss, uh your provider is going to be the one to estimate how much blood the patient's lost and then order the amount of blood to be transfused. Another recommendation is to administer 3 mls of a crystalalloid solution for every 1 ml of estimated blood loss. Uh so if you calculate that you could be giving large volumes of fluid. So you need to be on the lookout for signs of fluid overload. If we need to redistribute volume uh like for ascites we can give our colloids which are elbumin but the main thing to focus on here is treating and correcting the underlying cause. So if it's from nausea vomiting we need to pro provide antiimetics. If it's from diarrhea we need antidiarals. If your patient is hemorrhaging we need to put pressure on the site tourniquet that patient. um internal bleeds, they need emergency surgery for that. We can temporarily increase vascular tone using vasopressors, but we should always try fluid or IV fluids first. Um vasopressors are only going to be given if our patient is not responsive to fluid. So here you can see the different kinds of fluids that we use or blood products um and some of the advantages and disadvantages of them. For lactated ringers uh this is helpful uh because it is widely available. Any facility is going to have LR as well as your normal saline. Some of your disadvantages of the LR, you need a large volume to be infused. So over resuscitation will result in that pulmonary edema and abdominal compartment syndrome. Same kind of issues with our NS over resuscitation resulting in pulmonary edema and compartment syndrome still requiring a large volume. Think back that we needed 3 mls of these colloids or crystalloids, excuse me, um for every 1 ml of blood loss. So you could be getting like I said a large portion um of fluid resuscitation seeing those pulmonary edema pro complications. Um other issues with your normal saline hyper nutriia hypocalemia hypercchlormic metabolic acidosis. So just think of what you're giving and how that can affect the intravascular volume and fluid and electrolyte shift. Colloids like your albamin 5% or 25% it's a rapidly go it's rapidly going to expand the plasma volume in the blood. However, it is expensive. It is a human um product. Limited blood or uh be limited albumin supply and it can cause heart failure. For your blood products it will just depend on what is needed by the patient. We have plasma, packed red blood cells, platelets, cryoprecipitate. This is going to rapidly replace the volume for blood loss. So again, think back to the reason that your patient is experiencing hypoalmic shock. Your patient's going to need a type and cross. Uh normally for our patients who are experiencing um extreme blood loss, we will do the type and screen and any other labs that are needed. But while we're waiting on that, the mass transfusion protocol is going to allow us to give O negative blood to this patient until we can get confirmation. But because we're giving so much blood, you need to be aware of transfusion related complications like transfusion related acute lung injury or trolley if you've ever heard that one. Any sort of hemolytic reactions and transfusion associated circulatory overload. And that's going to be it for your hypoalmic shock.