Hypovolaemic Shock

Question 1

What is hypovolaemic shock?

Answer 1

When the circulatory system is too depleted to allow adequate circulation to tissue = hypoxia = ischaemic injury

Question 2

What are the causes of hypovolaemic shock?

Answer 2

• Haemorrhagic - blood loss -revealed or occult
• Burns
• Diarrhoea and vomiting
• Small bowel obstruction = 3rd space fluid
• Iatrogenic diuretics

Question 3

What are the signs of hypovolaemic shock?

Answer 3

• > 2s cap refill
• Reduced JVP
• Tachycardia (compensating)
• Hypotensive
• Clammy peripheries
• Tachypnoea (metabolic acidosis)
• Hx of blood/fluid loss

Question 4

What is stage 1 relating to blood volume loss?

Answer 4

Class 1 10-15% blood loss: *physiological compensating, no clinical change

Question 5

What is stage 2 relating to blood volume loss?

Answer 5

Class 2 15-30% blood loss: *postural hypotensive, generalised vasoconstriction, reduction in urine 20-30ml/hr

Question 6

What is stage 3 relating to blood volume loss?

Answer 6

Class 3 30-40% blood loss: *hypotension, tachycardia >120bpm, tachypnoea, urine output <20ml/hr and patient confused

Question 7

What is stage 4 relating to blood volume loss?

Answer 7

Class 4: 40% blood loss:

*marked hypotension, tachycardia, tachypnoea, no urine output and patient comatosed

Question 8

What are the symptoms of hypovolaemic shock?

Answer 8

• Postural hypotension
• Feel cold
• Anxious
• Syncope
• SOB
• N&V

Question 9

What is the management of hypovolaemic shock?

Answer 9

1. A-E assessment
2. FLuid challenge 500ml 0.9% NaCl
3. Oxygen 15L
4. G&S and Crossmatch bloods if bleeding
5. IV Analgesia
6. Surgical intervention to stop bleed/burns etc.

Question 10

Why do hypovolaemic shock patients present with tachypnoea?

Answer 10

• As lack of blood to cells results in cellular dysfunction and lactic acid production
• Results in metabolic acidosis
• Tachypnoea = to blow of CO2 and compensate

Question 11

What is different about the JVP in cardiogenic shock compared to hypovolaemic shock?

Answer 11

• JVP raised in cardiogenic shock, as the SVR compensate and increases
• JVP low in hypovolaemic shock as not enough vascular fluid content

Question 12

How many pints of blood does an average adult have?

Answer 12

10 pints (8-10% of body weight)

Question 13

How many ml is in 1 unit of blood?

Answer 13

250-270ml

Question 14

When prescribing a blood transfusion what must you do?

Answer 14

• Send cross match off
• Use O- in the mean time if urgent
• Gain consent unless unconscious fill out specific form
• Write each unit out separately as all have specific unit code