MANAGEMENT OF HYPOVOLEMIC

SHOCK
Nurin Najibah Bt Un
Supervisor :Dr Azhar
 DEFINITION
 a systemic state in which there is low tissue perfusion causing
inadequate delivery of oxygen and glucose necessary for aerobic
cellular metabolism. This result in anaerobic cellular respiration,
in which if perfusion not restored in a timely fashion, cell death
ensues.

 Hypovolemic shock is due to reduced circulating volume, which

may be due to hemorrhagic causes or non hemorrhagic causes.
 CAUSES OF HYPOVOLEMIC SHOCK
 Haemorrhagic cause most likely due to trauma which cause bleeding
(internal or external bleeding)
 Non haemorrhagic causes include poor fluid intake(dehydration),
excessive fluid loss (severe diarrhea and vomiting, excessive urinary
loss),evaporation, or third spacing loss where fluid is lost into GI tract
and interstitial space, as for example in bowel obstruction or
pancreatits.
 Hypovolemic shock is the most common type of shock which can be
classified to certain levels.
 CLINICAL FEATURES
 Skin- cold, clammy, pale, CRT < 2s
 Kidney- oliguria, anuria
 Brain- drowsiness, confusion , irritabiity
 Pulse- tachycardia, narrowed pulse pressure, weak or therady
pulse, bradycardia n severe hypovolemia
 Sweating
 Blood pressure may be maintained initially but later hypotensive
 CLASSIFICATION OF HYPOVOLEMIC
SHOCK
COMPENSATED MILD MODERATE SEVERE/
DECOMPENSAT
ED
LACTIC ACIDOSIS + ++ ++ +++
URINE OUTPUT Normal Normal Reduced Anuric
CONSCIOUS LEVEL Normal Mild anxiety Drowsy comatose

RESPIRATORY RATE Normal Increased Increased Laboured

PULSE RATE Mild Increased Increased Increased Increased

BLOOD PRESSURE Normal Normal Mild hypotension Severe

hypotension
CLASSES OF HAEMORRHAGIC SHOCK
 MANAGEMENTS

 Resuscitation of patient is the first step in the managements.

 Management depends of the causes of the shock
(haemorrhagic or non haemorrhagic)
 MANAGEMENTS
 1. AIRWAY
-check airway for any clots/secretion and suck out the same
 2. BREATHING

-monitor spo2, give oxygen supplements

 3. CIRCULATION

-check for the pulse and other signs of shock. Make sure there are at
least 2 functioning iv lines.
 4. IV FLUIDS
 At least 2L crystalloids resuscitation in adult / 20cc/kg x2 in
paeds
 Whole bloods/blood products , activate MTP (MASSIVE
TRANSFUSION PROTOCOL) when it necessary

 5. FIND THE CAUSES AND :

-Stop the bleeding
-restore volume
-correct any electrolyte/acid-base distubances
REASSESS IF THE FLUIDS IS ADEQUATE BY:

-check urine output

-vital signs
-skin perfusion
-pulse oximetry
--acidemia
THANK YOU