Flashcards in Hypovolaemia Deck (21):
What is shock?
Inadequate organ perfusion and tissue oxygenation
What is hypovolaemic shock?
Inadequate intravascular fluid volume caused by significant blood/fluid loss leading to inadequate tissue perfusion
How do you recognise hypovolaemic shock?
Increased HR to maintain BP
Pallor, cold, clammy skin
Level of consciousness
Decreased urine output (
How do you assess a pt who you suspect has hypovolaemic shock?
Monitor urine output and colour
FBC, U+E, coagulation, glucose, Creat
Hb and sodium levels are depleted
What is absolute hypovolaemia?
Direct loss of whole blood e.g bleeding from injury
What is relative hypovolaemia?
Shift of fluid or blood between intravascular and extrovascular spaces
What are the 4 responses to acute hypovolaemia?
1. Haematological (coagulation cascade limiting blood loss, clot formation, contraction of blood vessels)
2. Cardiovascular (low BP, increased HR and myocardial contractility, peripheral vasoconstriction)
3. Renal (increased levels of renin, secretion of aldosterone to increase BP)
4. Neuroendocrine (anti diuretic hormone, vasoconstriction and increased water re-absorption in kidneys)
What are the 4 stages of shock?
1. Initial - 750 mls loss
3. Progressive - compensatory mechanisms start to fail, beginning of organ failure
4. Decompensated - irreversible cellular and organ damage leading to imminent death
What are the key factors of the initial stage of shock?
Elevated lactate level
Subtle changes in vital signs and appear anxious
What are the key factors of the compensated stage of shock?
Decrease in pulse pressure
Increased pallor and cool extremities
What are the key factors of the progressive stage of shock?
Very pale with cool clammy skin
What are the key factors of the decompensated stage of shock?
RR increased or decreased with hypoventilation
What is classed as significant deterioration?
Failure to manage and detect fluid imbalance
Which conditions are common for pt to significantly deteriorate?
Common in post op, severe vomiting and diarrhoea, paralytic ileus, GI fistula, sepsis, hyperglycaemia and renal failure
What happened during dehydration?
Increased osmotic pressure and redistribution of water and sodium between intercellular and extra cellular spaces
What is the non urgent treatment for a pt who need fluid replacement?
Administrate free water e.g 4% dextrose, 5% dextrose, balanced isotonic fluids (Hartmann)
What is the treatment for hypovolaemia?
Hartmans or Ringers Lactate
First line crystalloid resuscitation
What is the post op fluid treatment?
Support maintenance of both intracellular and extra cellular spaces
What is AKI?
A rapid decline in renal filtration function and urine output 6 consecutive hours
What are the 3 distinct categories of AKI?
1. Prerenal (severe hypovolaemia, hypotension and reduced blood flow to the kidneys)
2. Intrinsic (ischaemic, cytotoxic or inflammatory injury causing function damage)
3. Post renal (physical obstruction urine damage)