Hypovolemic

Shock

Submitted to:

Dr. Sherwin Buluran

Submitted by:

Christian P. Ureta
BSN 2-3
 Circulatory shock, commonly known simply as shock, is a
serious, life-threatening medical condition characterized by a decrease
in tissue perfusion to a point at which it is inadequate to meet cellular
metabolic needs. As the blood carries oxygen and nutrients around the
body, reduced flow hinders the delivery of these components to the
tissues, and can stop the tissues from functioning properly.The process
of blood entering the tissues is called perfusion, so when perfusion is
not occurring properly this is called a hypoperfusional (hypo = below)
state.

A circulatory shock should not be confused with the emotional

state of shock, as the two are not related. Medical shock is a life-
threatening medical emergency and one of the most common causes
of death for critically-ill people. Shock can have a variety of effects, all
with similar outcomes, but all relate to a problem with the body's
circulatory system. For example, shock may lead to hypoxemia (a lack
of oxygen in arterial blood) or cardiac arrest (the heart stopping).

How the body works

Cells need two things to function: oxygen and glucose. This

allows the cells to generate energy and do their specific jobs.

Oxygen in the air enters the body through the lungs; where
oxygen molecules cross into the smallest blood vessels, the capillaries,
and are picked up by red blood cells and attached
to hemoglobin molecules. The red blood cells are pushed through the
body by the actions of the pumping heart and deliver the oxygen to
cells in all the tissues of the body. The hemoglobin then picks
up carbon dioxide, the waste product of metabolism, where it is then
taken back to the lungs and breathed back into the air, whereby the
whole cycle starts again.

Glucose is generated in the body from the foods we eat. It travels in

the blood stream as well, and using an insulin molecule that "opens the
door," it enters the cell to provide energy for cellular metabolism.
Types of shock

• Hypovolemic Shock

• Cardiogenic Shock

• Hemorrhagic Shock

• Neurogenic Shock

• Hypoglycemic Shock

Hypovolemic Shock
Hypovolemic shock is a condition in which the body doesn't have
enough blood volume to circulate throughout the body. The person
doesn't receive enough oxygen in vital organs.

What is going on in the body?

Blood, which contains fluid, cells, and other particles, carries

oxygen through the body. Oxygen is required to keep body tissues
alive. When there is a severe decrease in blood or total body fluid,
hypovolemic shock occurs. If this situation is not corrected right away,
the person will die.

What are the causes and risks of the condition?

Hypovolemic shock is usually caused by massive blood loss or

severe dehydration. Blood loss may be the result of gastrointestinal
bleeding, internal bleeding due to an injury, a hemorrhage, or severe
the amount of body surface area, also called BSA, that is injured\ \the
depth of destruction\ \the location of the burn\ . Dehydration may
follow severe diarrhea or vomiting. It can also be caused by excessive
sweating or an inadequate intake of oral fluids.

What are the signs and symptoms of the condition?

Hypovolemic shock can cause the following:

 • cold, pale skin

• confusion

• fainting

• low blood pressure

• rapid heartbeat

• reduced urine

output

Stages of Hypovolemic Shock

Most sources state that there are 4 stages of hypovolemic

shockhowever a number of other systems exist with as many as 5
stages.

The 4 stages are sometimes known as the "Tennis" staging of

hypovolemic shock, as the 4 stages of % volume of blood loss mimic
the scores in a game of tennis: 15, 15-30, 30-40, 40

Stage 1

 Up to 15% blood volume loss (750mls)[11]

 Compensated by constriction of vascular bed
 Blood pressure maintained
 Normal respiratory rate
  Pallor of the skin
 Slight anxiety

Stage 2

 15–30% blood volume loss (750–1500 ml)[11]

 Cardiac output cannot be maintained by arterial
constriction
 Tachycardia >100bpm
 Increased respiratory rate
 Blood pressure maintained
 Increased diastolic pressure
 Narrow pulse pressure
 Sweating from sympathetic stimulation
 Mildly anxious/Restless

Stage 3

 30–40% blood volume loss (1500–2000 ml)[11]

 Systolic BP falls to 100mmHg or less
 Classic signs of hypovolemic shock
 Marked tachycardia >120 bpm
 Marked tachypnea >30 bpm
 Decreased systolic pressure
 Alteration in mental status (Anxiety, Agitation)
 Sweating with cool, pale skin

Stage 4

 Loss greater than 40% (>2000mls)[11]

 Extreme tachycardia with weak pulse
 Pronounced tachypnea
 Significantly decreased systolic blood pressure of 70
mmHg or less
 Decreased level of consciousness
  Skin is sweaty, cool, and extremely pale (moribund)

Diagnosis & Tests

Shock is usually diagnosed based on a person's symptoms and a

physical exam. If the exact cause of shock is not clear, blood tests, X-
rays, and other tests may be done.

What can be done to prevent the condition?

In many cases, hypovolemic shock cannot be prevented. It often

occurs after an accident or severe illness. Dehydration can sometimes
be prevented by drinking enough fluids. A drink that balances essential
salts and sugars, such as a commercial hydration solution, helps if the
vomiting or diarrhea is severe.

What are the long-term effects of the condition?

Without rapid, effective treatment, hypovolemic shock can lead

to irreversible brain and kidney damage. It can also cause cardiac
arrest, and ultimately death.

What are the risks to others?

Hypovolemic shock is not contagious, and poses no risk to

others.

Treatment & Monitoring

Emergency treatment for hypovolemic shock includes prompt

replacement of fluid and/or blood. Usually, this is done through a
needle in a vein known as an IV. Any bleeding sites must be found so
that blood loss can be controlled.

People in shock are very ill and may need to be put on a ventilator,
or artificial breathing machine. Medicines may be needed to support
blood pressure or treat other complications. Surgery may be needed to
treat any injuries that are present.

How is the condition monitored?

Depending on the person's health status, monitoring may include

physical exams, blood tests, and X-rays. Any new or worsening
symptoms should be reported to the healthcare provider.
 GENERIC NAME DOSAGE MECHANISM INDICATION CONTRAINDI ADVERSE NURSING RESPONSIBILITIES
OF ACTION S CATIONS REACTIONS

DOPAMINE Shock Naturally To correct Pheochromocyt CV: Hypotension, Assessment & Drug Effects
HYDROCHLORID Adult/Child: IV occurring hemodynamic oma; ectopic beats,
E 2–5 mcg/kg/min neurotransmit imbalance in tachyarrhythmi tachycardia, • Monitor blood pressure, pulse,
increased shock as or peripheral pulses, and urinary
(doe'pa-meen) ter and anginal pain,
gradually up to syndrome due ventricular output at intervals prescribed
20–50 immediate to MI fibrillation. palpitation,
by physician. Precise
mcg/kg/min if precursor of (cardiogenic Safe use during vasoconstriction measurements are essential for
Dopastat, Intropin, necessary norepinephrin shock), pregnancy (indicated by accurate titration of dosage.
Revimine e. Major trauma, (category C), disproportionate • Report the following
Renal cardiovascular endotoxic lactation, or rise in diastolic indicators promptly to
Failure effects
septicemia children is not physician for use in decreasing
Classifications: pressure), cold
Adult: IV 2–5 (septic shock), established. or temporarily suspending
AUTONOMIC mcg/kg/min produced by open heart extremities; less
dose: Reduced urine flow rate
NERVOUS SYSTEM direct action surgery, and frequent: aberrant
in absence of hypotension;
AGENT; ALPHA- on alpha- and CHF. conduction, ascending tachycardia;
AND BETA- beta- bradycardia, dysrhythmias; disproportionate
ADRENERGIC adrenergic widening of QRS rise in diastolic pressure
receptors and complex, elevated (marked decrease in pulse
AGONIST
on specific blood pressure. GI: pressure); signs of peripheral
(SYMPATHOMIMET ischemia (pallor, cyanosis,
IC) dopaminergic Nausea, vomiting.
mottling, coldness, complaints
receptors in CNS: Headache. of tenderness, pain, numbness,
mesenteric Skin: Necrosis, or burning sensation).
and renal tissue sloughing
vascular beds with extravasation, • Monitor therapeutic
gangrene, effectiveness. In addition to
piloerection. Other: improvement in vital signs and
Azotemia, urine flow, other indices of
adequate dosage and perfusion
dyspnea, dilated
of vital organs include loss of
pupils (high pallor, increase in toe
doses). temperature, adequacy of nail
bed capillary filling, and
reversal of confusion or
comatose state.