Hypovolaemic Shock

Question 1

What is shock?

Answer 1

Circulatory failure resulting in inadequate organ perfusion.

Often defined by decreased BP (systolic <90 mmHg or mean arterial pressure (MAP) <65 mmHg)- with evidence of tissue hypoperfusion e.g. mottled skin, urine output of <0.5 mL/kg/h, serum lactate >2 mmol/L.

Question 2

What are the signs and symptoms of shock?

Answer 2

• Decreased BP (systolic <90 mmHg or mean arterial pressure (MAP) <65 mmHg)
• Evidence of tissue hypoperfusion e.g. mottled skin, urine output of <0.5 mL/kg/h, serum lactate >2 mmol/L
• Low GCS or agitation
• Pallor
• Cool peripheries
• Tachycardia
• Slow CRT
• Tachypnoea
• Oliguria

Question 3

What can cause hypovolaemic shock?

Answer 3

Hypovolemic= loss of intravascular volume

• Bleeding: trauma, ruptured AA or GI bleed
• Fluid loss: vomiting, burns, ‘third-space’ losses or heat exhaustion

Question 4

Briefly describt the A-E assessment for shock

Answer 4

With shock we are primarilty dealting with ‘C’ so get 2 large-bore IV access x 2 and check ECG for rate, rhythm and any signs of ischemia.

General review: cold and clamy suggests cardiogenic shock or fluid loss. Look for signs of anaemia or dehydration e.g. skin turgor, postural hypotension? Warm and well perfused with bounding pulses may point to septic shock.

CVS: usually tachycardic and hypotensive.

JVP: if raised cardiogenic shock is likely.

Check abdomen: any signs of trauma or aneurysm? Any evidence of GI bleed?

Question 5

Briefly describe the treatment for hypovolaemic shock

Answer 5

Identify and treat the underlying cause. Give IV fluid bolus 500ml 0.9% sodium chloride via large peripheral line, if shock improves, repeat, titrate to HR (<100 BPM), BP (SBP >90 mmHg) and urine output ( >0.5 mL/kg/h).

If no improvement after 2 boluses, consider referral to ITU.

Question 6

When treating a patient with hypovolaemic shock what HR, BP and urine output do we aim for?

Answer 6

HR (<100 BPM)

BP (SBP >90 mmHg)

Urine output ( >0.5 mL/kg/h)