Hypovolemic shock

Hypovolemic shock . Also known as hemorrhagic shock, it is a syndrome of multifactorial etiology but which has in common the reduction of blood volume. It is triggered by an inadequate systemic acute perfusion due to an imbalance between oxygen demand and supply to tissues due to inadequate supply or misuse on a cellular scale , leading to tissue hypoxia and dysfunction of vital organs determined by a reduction in circulating blood volume. This renders the heart unable to pump enough blood to the body.

Table of Contents

Summary

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1 Pathophysiology
2 Classification
3 Complications
4 Symptoms it produces
5 First aid
6 Physical exam
7 Complementary exams
8 General measures
9 Specific measures
10 Steps to follow while medical help arrives
11 Source

Pathophysiology

The initial primary injury is loss of circulating effective volume. It is a cyclical process that, once triggered, generates a sequence of phenomena, each of which unfavorably affects the next. The deterioration of blood flow to vital organs and tissues causes insufficient supply or inadequate distribution of oxygen, responsible for the serious alterations that this state of microcirculatory failure generates.

Classification

For hemorrhages

Internal: Traumatic, broken vessels or solid viscera, complications of pregnancy (Ectopic), coagulation disorders.
External: Pulmonary, gastrointestinal (ulcers, varicose veins), trauma, renal (infections, tumors)

By fluid depletion

External losses: Vomiting, diarrhea , cutaneous burns, polyuria (diuretics, Diabetes)
Internal losses: Pancreatitis, intestinal occlusion, ascites, generalized edema from burns, dehydration .

Complications

Kidney damage
Brain damage
Gangrene of arms or legs, sometimes leading to amputation
Heart attack

Symptoms it produces

Trauma or burns

Damage Scheme

Abdominal pain
Diarrhea
Vomiting
Amenorrhea
Bleeding
Thirst
Pain at injury site
Anxiety or agitation
Cold, clammy skin
Confusion
Decreased or absent urinary output
General weakness
Pale-colored skin (paleness)
Fast breathing
Sweating, clammy skin
Loss of consciousness

First aid

Loosen clothing or objects that press on your neck, chest, or waist.
Anti-shock position, lying on your back with your legs raised no more than 45º.
Avoid heat loss.
Insist on the control of bleeding.
Transfer to a health center, monitoring vital signs.

Physical exam

Low blood pressure (main sign). Decrease in systolic blood pressure below 90 mmHg or reduction by 30 mmHg of previous blood pressure levels in hypertensive patients
Profuse sweat
Cold, clammy skin
Mucous skin pallor
Visible external bleeding
It is related to the amount of volume loss
Weak and filiform radial pulse. The absence of peripheral pulses indicates greater severity. The presence of bradycardia suggests significant hemodynamic deterioration and the possibility of cardiac arrest
Superficial polynea
Oliguria or oligoanuria: It is one of the early signs that suggest inadequate renal perfusion
Peritoneal reaction in processes of intra-abdominal origin
Distal cyanosis
Poor capillary refill
Lightness (peripheral vasoconstriction)
Trauma, injury and / or fracture areas
Mental confusion

Complementary exams

Blood count: Normal hemoglobin at the beginning, decreases if bleeding
Hematocrit: Normal or decreased in acute bleeding
Blood group and factor
Glycemia
Creatinine
Abdominal UTS: If intra-abdominal cause of shock is suspected, blood or fluid may appear
Chest x-ray if hemothorax is suspected
Ionogram if possibilities
Gasometry

General measures

Horizontal rest or Trendelemburg of 10º
Leaky airway. If necessary, intubation of the patient
Improve the patient’s oxygenation. For this you need:

Measurement of Hb saturation by pulse oximetry if available
Oxygen therapy at 3-5 L per minute per mask with a reservoir or nasal catheter if the measured saturation decreases (remember that shock patients have increased oxygen demands)

Monitor:

Blood pressure
Heart rate (presence, frequency and quality)
Breathing frequency
Temperature
Neurological state
Pass bladder catheter to measure urine output if necessary

Inspection of the skin and search for external wounds with signs of bleeding and control of these. If there is an open fracture zone, immobilize the site and try to contain bleeding
Adequate intravenous access. Use 1 or 2 short and thick peripheral routes since the picture is recognized. Use trocars. According to the magnitude of the picture, perform a deep venous approach
Bladder catheterization and measuring hourly urine output
Levine probe open to bottle
Measure Central Venous Pressure (PVC) and take into account that:
Low indicates need for volume delivery (normal value: 8-12 cm H2O)
PVC that persists low or in decrease suggests persistence of blood loss and requires careful observation of the patient and also increases volume administration
Lower the temperature with antipyretics if the patient has fever (present in hypertonic dehydration)

Specific measures

If the patient does not improve oxygenation with oxygen therapy and has respiratory distress or respiratory depression, intubate for mechanical ventilation. Please note: Glasgow Coma Scale less than 8 points, signs of acute respiratory failure (PaO2 <60, PaO2 / FiO2 ratio <200 and / or PCO2 retention) or signs of muscle fatigue
Correction of alterations of the basic acid balance, especially of metabolic acidosis. If metabolic acidosis with pH less than 7.20 use sodium bicarbonate: 0.3 meq x kg x EB of the blood gas. Pass half of the calculated dose and repeat blood gas to assess the need to administer the rest of the calculated • Use of antishock pants, if available, taking into account:

If there is shock and trauma to the chest, the use of this can aggravate bleeding and increase the possibility of death.
It is very useful in patients with unstable pelvic fractures where it can stabilize the fracture and inhibit peritoneal hemorrhage.
Blood volume replacement:

Steps to follow while medical help arrives

Keep the person warm and comfortable to avoid hypothermia.

Shock

Have the person lie down horizontally and raise their feet about 12 inches (30 cm) to increase circulation. However, if your head, neck, back, or leg injury is present, do not change your position unless you are in immediate danger.
Do not give liquids by mouth.
If the person has an allergic reaction, treat the reaction if you know how to do it.
If the person needs to be moved, try to keep the person lying down, head down, and feet elevated. Stabilize the head and neck before moving a person with suspected spinal injury.