Hyovolemic shock

Hypovolemic shock is a life-threatening emergency 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.
Hypovolemic shock is a dangerous condition that happens when suddenly lose a lot of blood or fluids from body. This drops blood volume, the amount of blood circulating in body. That’s why it’s also known as low-volume shock.

1. Hypovolemic shock 9/14/2022 1 hypovolemic shock PREPARED BY: RN Arpana Bhusal BNS Emergency Nursing

2. Hypovolemic shock 9/14/2022 hypovolemic shock 2

3. Contents 9/14/2022 hypovolemic shock 3 Introduction Definition Causes Pathophysiology Sign and symptoms Stages Diagnosis Emergency management Complication

4. Introduction Hypovolemic shock is a life-threatening emergency 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 . Hypovolemic shock is a dangerous condition that happens when suddenly lose a lot of blood or fluids from body. This drops blood volume, the amount of  blood  circulating in body. That’s why it’s also known as low-volume shock. 9/14/2022 4 hypovolemic shock

5. Definition Hypovolemic shock is defined as a decreased in the intravascular blood volume to such an extent that effective tissue perfusion cannot be maintained 9/14/2022 5 hypovolemic shock

6. Causes Hemorrhage Non hemorrhage Hemorrhage External hemorrhage Trauma Hematoma Intrnal hemorrhages GI bleeding Hemothorax/ hemoperitoneum 9/14/2022 6 hypovolemic shock

7. Non haemorrhage Vomiting, Diarrhea Polyuria Dehydration Burns 9/14/2022 7 hypovolemic shock

8. Hypovolemic shock pathophysiology 9/14/2022 hypovolemic shock 8 Decrease blood volume ( intravascular volume) Decrease venous return Decrease stroke volume Decrease cardaic output Decrease tissue perfussion

9. Clinical feature Anxiety  or agitation Cool, clammy skin Confusion Decreased or no urine output Generalized weakness Pale skin color(pallor) 9/14/2022 9 hypovolemic shock

10. Cont.. Rapid breathing Sweating, moist skin Unconsciousness(lack of responsiveness) The greater and more rapid the blood loss, the more severe the symptoms of shock. 9/14/2022 10 hypovolemic shock

11. Hypovolemic Shock Stages 9/14/2022 hypovolemic shock 11 CLINICAL ASSESSMENT OF HYPOVOLEMIC SHOCK

12. Stages of Hypovolemic shock 9/14/2022 hypovolemic shock 12

13. Hypovolemic Shock Diagnosis We can check patient’s temperature, pulse, breathing, and blood pressure . check the color and feel of skin . If patients awake and alert, we can ask about past medical issues and overall health of patients . If patient was in shock because of an ectopic pregnancy or something else related to reproductive organs, the health care team will also do a pregnancy test and ask about your last menstrual period and any recent vaginal bleeding . 9/14/2022 13 hypovolemic shock

14. Hypovolemia management 9/14/2022 hypovolemic shock 14 Identify and treat the underlying cause of hypovolemia . Hypovolemia shock management Goal 1. Maximizing oxygen delivery 2.Control further blood loss 3. Fluid resuscitation

15. Cont It may need more tests, including: Imaging studies such as X-rays, ultrasounds, or CT scans Blood (hematocrit, serum BUN,and Potassium) urine tests(decrease urine output, increased urine osmolarity and increase specific gravity) Heart tests like echocardiogram and electrocardiogram (ECG) ABG ( blood PH, PaO2, PaCO2 ) 9/14/2022 15 hypovolemic shock

16. Emergency management 9/14/2022 hypovolemic shock 16 Establish patent airway. Ensure adequate ventilation and oxygenation Control any external bleeding. Assess the bleeding part Pressure to the bleeding part Elevation of the bleeding part splinting for fractures extremities Secure venous access- large bore cannula in both hand Intravenous fluid administration to replace the lost fluid

17. Initial fluids Start 2 IV lines with large gauze needles (16- 18) in both hands Warmed isotonic Crystalloid solution are used for initial resuscitation The usual initial dose is 1 liters in 15 – 20 min for an adult, follow with second liter so that 1500 ml is infused in the first hour . 9/14/2022 17 hypovolemic shock

18. Crystalloid solution O.9 Nacl Ringer Lactate Advantages : availability , safety and low cost Initial loses are replaced Disadvantages Rapid movement from the intravascular to the extra vascular space, resulting in tissue edema 9/14/2022 18 hypovolemic shock

19. Colloid solutions Include albumin, hydoxyethyl starch ,dextrans and gelatin More effective in rapidly restoring intravascular volume, requiring less to correct Hypovolemia. Limitation Caries the risk of reaction Are far more expensive Nonetheless , the interstitial fluid deficit associated with hypovalemic shock may be better treated with a crystalloid solution or combination of colloids and crystalloids 9/14/2022 19 hypovolemic shock

20. Management according to stages 9/14/2022 hypovolemic shock 20 CLASS I HEMORRHAGE Blood volume loss of up to 15 percent. • The heart rate is minimally elevated or normal, and there is no change in blood pressure, pulse pressure, or respiratory rate. Usually don’t require blood. CLASS II HEMORRHAGE 15 to 30 percent blood volume loss • Manifested clinically as Tachycardia ,Tachypnea ,Decreased pulse pressure. Skin may be cool and clammy, and capillary refill may be delayed. • most stabilized with crystalloid, few may require blood ….

21. Cont 9/14/2022 hypovolemic shock 21 CLASS III HEMORRHAGE 0 to 40 percent blood volume loss, resulting in a significant drop in blood pressure and changes in mental status Stop bleeding & blood transfusion CLASS IV HEMORRHAGE More than 40 percent blood volume loss life threatening. Rapid fluid transfusion and surgical intervention depending on initial fluid response.

22. Medication 9/14/2022 hypovolemic shock 22 Vasoactive drugs Desmopressin Antidiarrheal drugs Anti emetics

23. Blood transfussion and other product With hemorrhage shock, blood product can be life saving 9/14/2022 23 hypovolemic shock

24. Reassessment: Response to initial fluids 9/14/2022 24 hypovolemic shock

25. Adjuvant therapies Supplement oxygen/mechanical ventilation Prevention of hypothermia Treatment of any electrolyte abnormality, specially hypocalcaemia , hypokalemia , hypomagnesaemia Correction of acid base abnormality , severe metabolic acidosis Corticosteroid , in case of adrenal failure 9/14/2022 25 hypovolemic shock

26. Complication Cardiopulmonary arrest. Dysrhythmias. Renal failure. Multisystem organ failure. Stroke. Death. 9/14/2022 26 hypovolemic shock

27. Reference Brunner and Siddhartha's (2004), ‘medical and surgical nursing,” 7 th edition, J.B Lippincott co, Philadelphia, page no:2056-2057. 2june 2020 https://www.webmd.com/a-to-z-guides/hypovolemic-shock .8july 2021 3Aug2078https://www.ncbi.nlm.nih.gov/books/NBK513297/ . 8july2020 9/14/2022 27 hypovolemic shock

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