Hypovolemic Shock PDF

Shock-Hypovolemic Classification and Precipitating factors Absolute Hypovolemia External loss of whole blood Hemorrhage from trauma, surgery, GI loss (vomiting, diarrhea and bleeding) Loss of other body fluids Excessive diuresis, diabetes insipidus, fistula drainage and diabetes mellitus Relative hy...

Shock-Hypovolemic Classification and Precipitating factors Absolute Hypovolemia External loss of whole blood Hemorrhage from trauma, surgery, GI loss (vomiting, diarrhea and bleeding) Loss of other body fluids Excessive diuresis, diabetes insipidus, fistula drainage and diabetes mellitus Relative hypovolemia Pooling of blood or fluids Bowel obstruction Fluid shifts- Burn injuries, ascites Internal bleeding Fractures of long bones, ruptured spleen, hemothorax, severe pancreatitis Massive vasodilation- Sepsis Hemodynamics in shock Shock-Hypovolemic Clinical Manifestations Cardiovascular Pulmonary Renal Skin Neurologic Gastrointestinal Shock-Hypovolemic Diagnostic Findings CBC-D Decreased hematocrit Decreased hemoglobin Increased Lactate Increased Urine specific gravity Electrolytes-changes Hypovolemic/Hemorrhagic shock Management of Hypovolemic Shock Stop the loss of fluid https://www.dhs.gov/stopthebleed Restore the circulating volume- goal is to keep the SBP >90 Fluid resuscitation Types (Table 66-7, pg 1597) 3:1 rule (3 mL of isotonic crystalloid for every 1 mL of estimated blood loss) Shock- Distributive Classification and Precipitating factors Neurogenic Shock Hemodynamic consequence of spinal cord injury and/or disease at or above T5 Spinal anesthesia Vasomotor center depression Severe pain, drugs, hypoglycemia, injury Anaphylactic Shock Hypersensitivity (allergic reaction) Contrast media, blood/blood products, drugs, insect bites, anesthetic agents etc Septic Shock Infection-pneumonia, peritonitis, urinary tract, respiratory tract, invasive lines etc At risk patients-Older adults, children < 12 months, patients with chronic diseases, patients receiving immunosuppressive therapy, malnourished, diabetes mellitus and debilitated patients Distributive Shock Neurogenic Shock Decreased cardiac output Decreased CVP and PAOP Decreased SVR Decreased venous oxygen saturation (SvO2 or ScvO2) Hypotension and bradycardia Anaphylactic shock Decreased cardiac output Decreased CVP and PAOP Decreased SVR Decreased venous oxygen saturation (SvO2 or ScvO2) Hypotension and tachycardia Distributive shock Early septic shock Increased cardiac output Decreased CVP and PAOP Decreased SVR Increased venous oxygen saturation (SvO2 or ScvO2) Normal or decreased blood pressure, tachycardia, and hyperthermia Late septic shock Decreased cardiac output Variable CVP and PAOP Variable SVR Decreased venous oxygen saturation (SvO2 or ScvO2) Hypotension, tachycardia, and hypothermia Shock-Distributive Clinical Manifestations Cardiovascular Pulmonary Renal Skin Neurologic Gastrointestinal Shock-Distributive Diagnostic Findings Based on the cause Decreased or increased WBC Decreased Platelets Increased Lactate (2.0-4.0 mmol/L) >2 mmol/L * used as a marker for tissue hypoperfusion. Resuscitation should be targeted to normalize lactic acid Increased Blood glucose Increased Urine specific gravity Decreased Urine NA+ Positive Blood cultures Shock-Septic (Distributive) SIRS- Systemic Inflammatory Response Syndrome Fever >100.9 F, HR > 90, RR > 22, WBC > 12,000, Glucose >140 mg/dL, change in cognition, SPB < 100 mmHg Sepsis- SIRS + infection Severe Sepsis- Sepsis + organ dysfunction, hypoperfusion or decreased BP with lactic acidosis