Contents
It covers the four stages of shock. They include the initial stage, the compensatory stage, the progressive stage, and the refractory stage.
- Hemorrhagic shock, resulting from acute hemorrhage without major soft tissue injury.
- Traumatic hemorrhagic shock, resulting from acute hemorrhage with soft tissue injury and, in addition, release of immune system activators.
Three goals exist in the emergency department treatment of the patient with hypovolemic shock as follows: (1) maximize oxygen delivery – completed by ensuring adequacy of ventilation, increasing oxygen saturation of the blood, and restoring blood flow, (2) control further blood loss, and (3) fluid resuscitation.
Compensatory – Almost immediately, the compensatory stage begins as the body’s homeostatic mechanisms attempt to maintain CO, blood pressure, and tissue perfusion. Progressive – The compensatory mechanisms begin failing to meet tissue metabolic needs, and the shock cycle is perpetuated.
The initial stage of shock is characterized by hypoxia and anaerobic cell respiration leading to lactic acidosis. The compensatory stage is characterized by the employment of neural, hormonal, and biochemical mechanisms in the body’s attempt to reverse the condition.
Severe fluid loss makes it difficult for the heart to pump enough blood to your body. As the fluid loss increases, hypovolemic shock can lead to organ failure. This requires immediate emergency medical attention.
Monitor weight. Monitor daily weight for sudden decreases, especially in the presence of decreasing urine output or active fluid loss. Monitor vital signs. Monitor vital signs of patients with deficient fluid volume every 15 minutes to 1 hour for the unstable patient, and every 4 hours for the stable patient.
Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Shock is divided into four main types based on the underlying cause: low volume, cardiogenic, obstructive, and distributive shock. Low volume shock, also known as hypovolemic shock, may be from bleeding, diarrhea, or vomiting. Cardiogenic shock may be due to a heart attack or cardiac contusion.
Simply elevating a patient’s legs may be effective in cardiogenic or neurogenic shock, but in hypovolemic shock, a patient must be properly placed in Trendelenburg’s position.
A narrow pulse pressure in a hypovolemic shock patient indicates a decreasing cardiac output and an increasing peripheral vascular resistance. The decreasing venous volume from blood loss and the sympathetic nervous system attempt to increase or maintain the falling blood pressure through systemic vasoconstriction.
The Trendelenburg position (TP) is defined as “a position in which the head is low and the body and legs are on an inclined or raised plane” [2] and is traditionally being used to manage hypotension and hypovolemic shock. The intervention is named after a German surgeon, Dr.
Cardiovascular Resuscitation Clinical signs of hypovolemic shock include prolonged capillary refill time, tachycardia or bradycardia, hypotension, pale mucous membranes, and decreased urine output.
With an injury, the most obvious sign of hypovolemic shock is a lot of bleeding. But you won’t see it when the bleeding is happening inside your body because of an aortic aneurysm, organ damage, or ectopic pregnancy. Other signs of hypovolemic shock include: Rapid heartbeat.
Cardiogenic shock is caused by inadequate contractility of the heart. One of the key differences between hypovolemic and cardiogenic shock is the work of breathing. In both cases, there will be tachypnea, but in hypovolemic shock the effort of breathing is only mildly increased.
Shock is an acute diffuse reduction in effective tissue perfusion that leads to an imbalance of oxygen supply and demand, anaerobic metabolism, cellular dysfunction, metabolic disarray, and eventually death.
Laboratory evidence of hypovolemia a. blood urea/plasma creatinine ratio is 1:10 or less (For example, a ratio of 1:5 would suggest hypovolemia) Page 2 b.
- Decreased Cardiac Output.
- Deficient Fluid Volume.
- Ineffective Tissue Perfusion.
- Anxiety.
Decreased or no urine output. Generalized weakness. Pale skin color (pallor) Rapid breathing.
The first changes in vital signs seen in hypovolemic shock include an increase in diastolic blood pressure with narrowed pulse pressure. As volume status continues to decrease, systolic blood pressure drops. As a result, oxygen delivery to vital organs is unable to meet the oxygen needs of the cells.
Causes for hypoperfusion include low blood pressure, heart failure or loss of blood volume. Ischemia can affect any organ of the body. Intermittent ischemia of the heart muscle (cardiac ischemia) is called angina.
This differentiation is very necessary as the management to both forms of shock vary—while hypovolemic shock requires aggressive fluid resuscitation to treat hypotension and a thorough evaluation to exclude any ongoing blood loss, the choice of therapy in neurogenic shock is vasopressors to overcome low blood pressure, …
Crystalloid is the first fluid of choice for resuscitation. Immediately administer 2 L of isotonic sodium chloride solution or lactated Ringer’s solution in response to shock from blood loss.
Trendelenburg position is typically used for lower abdominal surgeries including colorectal, gynecological, and genitourinary procedures as well as central venous catheter placement.
Lay the person down and elevate the legs and feet slightly, unless you think this may cause pain or further injury. Keep the person still and don’t move him or her unless necessary.