Hypovolemic Shock Hypovolemic shock refers to a medical or surgical condition in which rapid fluid loss results in multiple organ

failure due to inadequate perfusion. Most often, hypovolemic shock is secondary to rapid blood loss (hemorrhagic shock). It is defined as approximately 1 Liter or 1/5 loss of circulating volume). The following is the sequence of events that under perfused tissue goes through: Rapid blood loss Decreased in the total blood volume Decreaced in preload, afterload and CO Decreaced in amount of the blood flow to the peripheral part of the body. Profound ischemia for unperfused tissue causes a switch to anaerobic metabolism > Lactic acid accumulation and Tissue necrosis

There are 3 Stages in Hypovolemic Shock: Compensated, Uncompensated and Irreversible: Compensated The body is still able to compensate for the decrease in perfusion. Cardiac Output and systolic blood pressure are maintained. Uncompensated The bodys compensation mechanisms are starting to fail. Blood pressure begins to decrease and patient condition worsens. Irreversible Cell and tissue ischemia leads to organ death due to lack of perfusion. This process may begin on day one and continue to occur for up to three weeks after the initial insult. Under such circumstances, the patient should be re-evaluated to determine whether some reversible causes of the persistent shock may have been overlooked.

Treatable Causes of Hypovolemic Shock: Hemorrhage y Laceration of a vein or artery y Open wounds y Fractured pelvis (may be associated with 1500cc blood loss) y Fractured femur (may be associated with 500-1000cc blood loss)

Upper/Lower GI Bleed Pnuemo/Hemothorax Saline or Combined Saline/Water Loss y Gastrointestinal losses (vomiting, diarrhea) y High Fever y Excessive sweating y Diuretics Third Spacing (Fluid shifts): y Soft tissue trauma y Sepsis y Peritonitis (intestinal obstruction) y Ascites y Burn injuries
y y

Other causes of hypovolemic shock include:

y y y y y

Inadequate fluid administration (even if the patient clinically appears to be overloaded with fluid) Inadequate ventilation or oxygenation Adrenal insufficiency Hypothermia Hypocalcemia