Hypovolemic shock

Question 1

What is hypovolemic shock?

Answer 1

Loss of > 20% of intravascular fluid volume

Question 2

What are the causes of hypovolemic shock?

Answer 2

(Hemorrhagic) Trauma, GI bleed, post-partum haemorrhage

(Non-hemorrhagic) Vomiting, burns, third-space loss

Question 3

What are the clinical features of hypovolemic shock?

Answer 3

Weak pulse, tachycardia, tachypnea
Cold, clammy extremities
Cap refill >2 secs
Hypotension with narrow pulse pressure

Question 4

What is the classification of hypovolemic shock?

Answer 4

(Class 1) Blood loss <15%, heart rate <100 bpm, normal BP and pulse pressure, normal cap refill, 14-20 RR, >30mL/h urine output, normal/anxious
(Class 2)Blood loss 15-30%, heart rate >100 bpm, normal BP and narrow pulse pressure, > 2 secs cap refill, 20-30 RR, 20-30mL/h urine output, anxious/hostile
(Class 3) Blood loss 30-40%, heart rate 120-140 bpm, low BP and narrow pulse pressure, > 2 secs cap refill, >30 RR, 5-20mL/h urine output, anxious/confused
(Class 4) Blood loss 40%, heart rate >140 bpm, unrecordable and v narrow pulse pressure, no cap refill, >35 RR, zero urine output, confused/unresponsive

Question 5

How is hypovolemic shock diagnosed?

Answer 5

Focused Assessment with Sonography for Trauma (FAST) scan

Hemoglobin and hematocrit decreases in compensatory stage

Question 6

What is the treatment for hypovolemic shock?

Answer 6

Stop bleeding 
Fluid resuscitation (fluid bolus 10-15mL/kg crystalloid)