Hypotension

Question 1

What is Orthostatic Hypotension?

Answer 1

Postural (or orthostatic) hypotension is a condition in which standing leads to an abnormally large drop in blood pressure, which can result in symptoms such as light-headedness, dizziness, blurring of vision, fainting and falls

Question 2

Orthostatic Hypotension Management?

Answer 2

if postural hypotension is suspected after an initial assessment, when the history is typical and there are no features suggesting an alternative diagnosis, then the person should have their blood pressure measured lying and standing (with repeated measurements while standing for 3 minutes)

Non-pharmacological treatments include increasing water and salt intake, or using compression garments or bandages and physical manoeuvres to counter the drop in blood pressure

Question 3

What is Hypovolemic Shock?

Answer 3

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

Question 4

What are the stages of Hypovolemic Shock?

Answer 4

An average 70kg person has around 6L of blood volume.

1. Loss of up to 750 cubic centimeters (cc) or milliliters (mL) of blood, up to 15% of your total volume. Your blood vessels narrow slightly to keep blood pressure up. Your heart rate is normal, and your body makes as much urine as usual.
2. Loss of 750 to 1,500 cc of blood. Your heart rate rises. Your body starts to pull blood away from your limbs and intestines and sends it to vital organs like your heart and brain. Your blood pressure and urine are regular, but you may feel some anxiety.
3. Loss of 1,500 to 2,000 cc of blood, about a half-gallon. Your blood pressure drops. Your body stops making as much pee. Your limbs are cold and clammy, and your skin is pale. You may become confused or flustered.
4. Loss of more than 2,000 cc of blood, more than 40% of your total blood volume. Your heart is racing, but you feel sluggish. Your blood pressure is very low. Your body is making little or no pee.

Question 5

How can you diagnose Hypovolemic Shock?

Answer 5

ABCDE approach
You may need more tests, including:

Imaging studies such as X-rays, ultrasounds, or CT scans (IF Haemodynamically unstable)

WHEN Stable:
Blood and urine tests
Heart tests like echocardiogram and electrocardiogram (ECG)

Question 6

How do you manage a Hypovolemic Shock?

Answer 6

Hypovolemic Shock Treatment
The first step is to get you to the emergency room as quickly as possible. Along the way, someone should try to stop any visible bleeding. ENSURE ALL BLOOD THINNERS/ ANTICOAG is stopped.

Your medical team will try to:

Get as much oxygen as possible to all parts of your body
Stop, or at least control, blood loss
Replace blood and other fluids
You’ll get fluids through an IV, a bag of liquid attached to a needle that goes directly into a vein. Most people who lose more than 30% of their blood volume will also need a blood transfusion. Many will need some kind of surgery, especially if they have internal or gynecological bleeding.