HYPOVOLEMIC SHOCK

Authors: Mahda Rizki Iliana Irfandy C.S Lubis

Supervisor: dr. Yusmalinda,Sp.An

INTRODUCTION
Bleeding

Loss of fluid in the intravascular space Failure compensation

Frequent in indonesia

Need to study

Multiorgan failure

Hypovolemic shock

DISCUSSION

BASIC CONCEPT OF FLUIID AND ELECTROLYTE Fluid is the most part of the human body and its percentage is depends on gender, age, and degree of obesity.
Total Body Fluid Change by Age Age premature infants KgBW (%) 80

3 months
6 months 1-2 years 11-16 years Adults Adult (obese)

70
60 59 58 58-60 40-50

Adult (thin)

70-75

BASIC CONCEPT OF FLUIID AND ELECTROLYTE

BASIC CONCEPT OF FLUIID AND ELECTROLYTE Electrolytes are substances that dissociate in the liquid and conduct electricity.
Electrolytes Cations Anions

Extracellular: Na

Intracellular: K

Extracellular: Cl & HCO

Intracellular: PO4

BODY FLUIDS MOVEMENTS

1. Osmosis The movement of molecules (solutes) through a semipermeable membrane (permeable elective) from the lower levels towards the higher levels of solutions.
2. Diffusion The movement of molecules through pores. 3. Sodium potassium pump Pumps sodium ions out through the cell membrane and at the same time pumping potassium ions from outside to inside.

SODIUM POTASSIUM PUMP

VOLUME DEFICIT

VOLUME DEFICIT: DEHYDRATION

VOLUME DEFICIT: DEHYDRATION

Dehydration
Mild

Adults
4

Child
4-5

Moderate
Severe Shock

6
8 15-20

5-10
10-15 15-20

HYPOVOLEMIC SHOCK: DEFINITION

Medical condition in which fluid loss occurs rapidly and ended in the failure of some organ functions due to inadequate circulating volume and result in inadequate perfusion.

HYPOVOLEMIC SHOCK: ETIOLOGY

The main cause is blood loss
Causes Traumatic Non-traumatic

Penetrating

Blunt

Diabetes mellitus

Renal insufficiency

HYPOVOLEMIC SHOCK: ETIOLOGY

Causes of Hypovolemic Shock Loss of Blood Internally- rupture of vessels, spleen, liver, extrauterine pregnancy

Externally-

Trauma,

gastrointestinal,

pulmonary,renal blood loss Loss of Plasma Burn Wound, gastrointestinal losses

(diarrhea, ileus, pancreatitis) Loss of Fluids and Electrolytes Gastrointestinal (uncontrolled and renal losses mellitus,

diabetes

adrenocortical insufficiency)

HYPOVOLEMIC SHOCK: PATHOPHYSIOLOGY

Acute bleeding Hematology Cardiovascular Renal Neuroendocrine

Activates the coagulation cascade and vasoconstriction

Increased renin secretion Increase antidiuretic hormone (ADH)

Increased heart rate, myocardial contractility, and vasoconstriction.

HYPOVOLEMIC SHOCK: PATHOPHYSIOLOGY

HYPOVOLEMIC SHOCK: CLINICAL MANIFESTATIONS

Class I Blood loss mL <750 % <15% Heart Rate <100 (beat/min) Systolic blood Normal pressure Pulse pressure Capillary refill time Respiratory rate/min Urine output (ml/h) Mental Status Normal Delayed 14-20 >30 Slightly anxious Class II 750-1500 15-30% >100 Class III >1500-2000 >30-40% >120 Class IV >2000 > 40% >140

Normal

Decreased

Decreased

Decreased Delayed 20-30 20-30 Anxious

Decreased Delayed 30-40 5-15 Confused

Decreased Delayed >35 <5 Confused lethargic and

HYPOVOLEMIC SHOCK: MANAGEMENTS 1. Maximize oxygen delivery. 2. Control further blood loss. 3. Fluid resuscitation.
Indication for blood component therapy Component indication Usual dose Packed RBC Replacement Oxygen-carrying capacity Platelets Thrombocytopenia with bleeding Fresh frozen plasma Crycoprecipitate Coagulopaty Coagulopaty fibrinogen with 2-6 units IV 10-20 units IV 6-10 units IV of 2-4 units IV strating

HYPOVOLEMIC SHOCK: PROGNOSIS

Hypovolemic shock is a life-threatening condition and if not treated immediately, it can be irreversible. Prompt and adequate resuscitation is needed to save lives.

CONCLUSIONS

1. Shock hypovolemia is common circumstances that cause circulatory failure in children and adults. 2. The most common cause of hypovolemic shock is trauma. 3. Management of hypovolemic shock aims to meet the needs of circulation and tissue oxygenation.