HYPOVOLEMIC SHOCK With a focus on pregnant women

Hypovolemic shock

1. HYPOVOLEMIC SHOCK Dr KANDEKE

2. SHOCK It is a clinical condition due to an inability of the circulatory system to provide adequate tissue perfusion causing cellular hypoxia and organ damage It is a systemic disorder affecting multiple organ systems Perfusion may either be decreased throughout the body or distributed poorly Types includes hypovolemic, cardiogenic, distributive and obstructive shock

3. Obstetric shock vs Shock in obstetrics Obstetric shock : Life threatening cardiovascular collapse syndrome associated with pregnancy, childbirth, and puerperium (obstetrics causes) and is the most significant cause of high maternal mortality Shock in obstetrics: refers to indirect non-obstetrics causes of shock (polytrauma, anaesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes)

4. HYPOVOLEMIC SHOCK Shock due to loss of circulating blood volume ( haemorrhagic shock) (in >90%) or non- haemorrhagic events with volume loss (in <10%)

5. PATHOPHYSIOLOGY Loss of intravascular fluid volume reduced preload and stroke volume reduced cardiac output

6. CAUSES OF HYPOVOLEMIC SHOCK

7. CLINICAL FEATURES OF HYPOVOLEMIC SHOCK Symptoms : Early : Palpitation , dizziness , thirst , weakness , sweating . Late : Restlessness , air hunger , altered consciousness . Signs : Hypotension ( SBP < 90 mmHg or MBP < 60 mmHg ) Rapid weak pulse ( thready pulse ) Pallor Cyanosis of the fingers Cold clammy sweaty dimness of vision and impaired sensorium Mental confusion Oliguria or anuria

8. CLASSIFICATION OF HEMORRHAGIC SHOCK

9. CLASSIFICATION USING SHOCK INDEX

10. MANAGEMENT PRINCIPLES OF MANAGEMENT Giving supplemental oxygen Arresting the bleeding Replacing fluid losses.

11. COMPLICATIONS Cardiopulmonary arrest Dysrhythmias Renal failure Multisystem organ failure Stroke Death

12. TAKE HOME MESSAGES High index of suspicion: calculate shock index for all patients Appropriate fluid management for hypovolemic and septic shock patients Shock is an emergency: approach the management of shock as a team. ALWAYS CALL FOR HELP Display SHOCK PROTOCOL on the wards