Chapter 25: Shock- Hypovolemic Flashcards
What is the definition?
Decreased intravascular volume
What are the common causes?
- Hemorrhage
- Burns
- Bowel obstruction
- Crush injury
- Pancreatitis
What are the signs?
Early—
- Orthostatic hypotension
- mild tachycardia
- anxiety
- diaphoresis
- vasoconstriction (decreased pulse pressure with increased diastolic pressure)
Late—
- Changed mental status
- decreased B
- marked tachycardia
What are the signs/symptoms with:
Class I hemorrhage
- <15% or 750 cc blood loss
- Mild anxiety, normal vital signs
What are the signs/symptoms with:
Class II hemorrhage
- 15% to 30% or 750 to 1500 cc blood loss
- Normal systolic BP with decreased pulse pressure, tachycardia, tachypnea,anxiety
What are the signs/symptoms with:
Class III hemorrhage
- 30% to 40% or 1500 to 2000 cc blood loss
- Tachycardia (heart rate >120), tachypnea (respiratory rate >30), decreased systolic BP, decreased pulse pressure, confusion
Class IV hemorrhage
- >40% or >2000 cc blood loss
- Decreased systolic BP, tachycardia (heart rate >140), tachypnea (respiratory rate>35), decreased pulse pressure, confused and lethargic, no urine output
What is the treatment?
- Stop the bleeding
- Volume: IVF (isotonic LR)
- then blood products as needed
How is the effectiveness of treatment evaluated:
Bedside indicator?
- Urine output
- BP
- heart rate
- mental status
- extremity warmth
- capillary refill
- body temperature
How is the effectiveness of treatment evaluated:
Labs?
pH, base deficit, and lactate level
Why does decreased pulse pressure occur with early hypovolemicshock?
Pulse pressure (systolic–diastolic BP) decreases because of vasoconstriction,resulting in an elevated diastolic BP
What is the most common vital sign change associated with early hypovolemic shock?
Tachycardia
What type of patient does not mount a normal tachycardic responseto hypovolemic shock?
Patients on β-blockers, spinal shock (loss of sympathetic tone), enduranceathletes
Should vasopressors be used to treat hypovolemic shock?
No
