HYPOVOLEMIC SHOCK redeemer 3.pptx

About shock

1. HYPOVOLEMIC SHOCK BY REDEEMER DAMPTEY 5/11/23

2. OUTLINE Definition Incidence Etiology Pathophysiology Symptom Management Complicated

3. DEFINITION Emergency condition in which severe blood or other fluid loss makes the unable to pump enough blood to the body. A clinical manifestation of cellular function due to inadequate perfusion and consequent cellular hypoxia. Resulting from effective circulatory volume.

4. INCIDENCE Approximately 150 per hundred thousand in the USA Difficulty to determine in Ghana Due to variation in data recording

5. ETIOLOGY Acute hemorrhage Internal : Ruptured spleen, haemothorax External: Open wound, crush injury Loss of Plasma : extensive burns Loss of extracellular fluid : diarrhea, intestinal obstruction RAPTURED SPLEEN

6. PATHOPHYSIOLOGY Average adult person has 4-5L 25%(100ml) must be loss for shock to occur Reduction in venous return Activation of compensatory mechanism Vasoconstriction More forceful contraction If reduction continues compensatory mechanism fails. Reduction in tissue perfusion Worsened hypoxia

7. PATHOPHYSIOLOGY Cellular dysfunction Cell death Release of inflammatory cytokines Damage of endothelium Increased capillary permeability Plasma exudation Coagulopathy Leukocyte activation Vasodilation

8. PATHOPHYSIOLOGY Leukocyte activation Vasodilation Hypovolemia Multiple organ dysfunction

9. SYMPTOM Tachycardia Hypotension Pale mucous membrane Collapsing veins Respiratory depression Confusion Low urinary output Cold extremities

10. MANAGEMENT History taking Physical examination: colour of mucous membrane mental state: restless, coma or anxiety hydration: skin moist or dry State of veins: collapsing or filled Respiration : Rate and depth Prescence of bleeding external wound. Check vital signs: pulse , temperature, blood pressure

11. MANAGEMENT Check vital signs: pulse , temperature, blood pressure Oxygen therapy Set a line with large bore cannula Take blood for grouping and cross matching start IV fluids ( Ringers Lactate) Manage urine output

12. MANAGEMENT FLUID MANAGEMENT Acute haemorrhage: whole blood- 1.5 -2L IV Fluid: Ringers lactate in first 30-45mins followed by 5%dextrose in same period. Plasma loss: Fresh Frozen Plasma (human albumin solution dextran ,haemaccel) Extracellular fluid: Ringers lactate

13. MANAGEMENT INVESTIGATION LABORATORY – Hemoglobin(reduced) Electrolyte-Na+, k+ P H- Acidosis- Increased H+ Base deficit: low HCO3- hematocrit- low IMAGING – x-ray ,CT in acute haemorrhagic shock to check for internal bleeds.

14. COMPLICATION Pulmonary insufficiency Cardiac failure/arrest Cerebral failure Renal failure Metabolic acidosis Liver failure