Hypovolemic Shock
Although the evidence for POCUS in shocked patients doesn’t show a survival benefit it does support the view that it is a useful adjunct for clinicians in diagnosing and treating patients - Pete Hulme
HWN Suggests
Hypotension and Paradoxical Bradycardia
Relative or paradoxical bradycardia in the face of severe blood loss and hypotension fits squarely in the “it-just-ain’t-right” category. It isn’t right because it happens far more frequently than we recognize, and it contradicts what we have been taught about the body’s response to hemorrhage. A definite and significant subset of hypotensive patients will not mount a tachycardia response to hypotension, and a third or more of hypotensive trauma patients will present with bradycardia...
The truth is that even though there is an association between hemorrhage and tachycardia, it is actually unreliable and nothing like the four classes of hypovolemic shock described in that well-known…
Articles of Interest
Hypovolemic Shock & the Role of Early Volume Resuscitation
The term “shock” originates from the term “choc” which dates back to the 18th century, when French army surgeon Henri Francois Le Dran coined the term to describe the loss of vital functions leading to death, which he observed often in the soldiers on which he operated. About a century later, John Collins Warren reported shock as a “momentary pause in the act of death.” Although our understanding of the physiology related to shock is more informed today, a diagnosis of shock still carries the same urgency that it did when Henri and John Collins practiced.
Hypovolemic Shock and Fluid Resuscitation
With 15-30% blood loss patients show marked tachycardia, tachypnea, and a decrease in pulse pressure, which is the difference between systolic and diastolic blood pressure. Systolic pressure usually does not decrease until at least 30% of blood volume is lost, and the initial drop in pulse pressure is a result of increased diastolic pressure as a result of peripheral vasoconstriction. Noticeable changes in mental state begin to occur with greater than 30% blood loss, and systolic pressure will usually be decreased by this point. If more than 40% of blood volume is lost the patient will have cold, pale skin, an almost immeasurable pulse pressure, and may become unconscious.
Pediatric Hypovolemic Shock
Isotonic fluids are given as the initial fluid therapy for hypovolemic shock, regardless of the etiology of illness or serum osmolarity. For the patient in hypotensive shock, rapid fluid boluses in 20 ml/kg aliquots are provided to restore intravascular volume. Lactated Ringer’s solution and 0.9% sodium chloride serve as options for crystalloid fluid. Numerous normal saline fluid boluses may result in a hyperchloremic non-anion gap metabolic acidosis, which may obscure acidosis secondary to poor tissue perfusion. Lactated Ringer’s solution has the theoretical benefit of producing bicarbonate from lactate, provided that liver function is normal.
Resources
10 things you need to know about hypovolemic shock to save lives
Hypovolemic shock is the loss of volume...
MedCrave
Due to the severity and high mortality of hypovolemic shock, the presence of an experienced and multidisciplinary team is essential.
StatPearls
Hypovolemic shock is the most common type of shock in children, most commonly due to diarrheal illness in the developing world.
