Hypovolaemia

Question 1

What is shock?

Answer 1

Inadequate organ perfusion and tissue oxygenation

Question 2

What is hypovolaemic shock?

Answer 2

Inadequate intravascular fluid volume caused by significant blood/fluid loss leading to inadequate tissue perfusion

Question 3

How do you recognise hypovolaemic shock?

Answer 3

Increased RR
Increased HR to maintain BP
Confusion
Pallor, cold, clammy skin
Decreased
Level of consciousness
Decreased urine output (

Question 4

How do you assess a pt who you suspect has hypovolaemic shock?

Answer 4

Monitor urine output and colour
ECG
FBC, U+E, coagulation, glucose, Creat
Hb and sodium levels are depleted

Question 5

What is absolute hypovolaemia?

Answer 5

Direct loss of whole blood e.g bleeding from injury

Question 6

What is relative hypovolaemia?

Answer 6

Shift of fluid or blood between intravascular and extrovascular spaces

Question 7

What are the 4 responses to acute hypovolaemia?

Answer 7

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)

Question 8

What are the 4 stages of shock?

Answer 8

1. Initial - 750 mls loss
2. Progressive - compensatory mechanisms start to fail, beginning of organ failure
3. Decompensated - irreversible cellular and organ damage leading to imminent death

Question 9

What are the key factors of the initial stage of shock?

Answer 9

Elevated lactate level

Subtle changes in vital signs and appear anxious

Question 10

What are the key factors of the compensated stage of shock?

Answer 10

Increased RR
Increased HR
Decrease in pulse pressure
Increased pallor and cool extremities

Question 11

What are the key factors of the progressive stage of shock?

Answer 11

Very pale with cool clammy skin
Tachyonoeia
Tachycardia 
Hypotensive
Confused
Urine output

Question 12

What are the key factors of the decompensated stage of shock?

Answer 12

RR increased or decreased with hypoventilation

Tachycardia arrhythmias/bradycardia

Question 13

What is classed as significant deterioration?

Answer 13

Failure to manage and detect fluid imbalance

Question 14

Which conditions are common for pt to significantly deteriorate?

Answer 14

Common in post op, severe vomiting and diarrhoea, paralytic ileus, GI fistula, sepsis, hyperglycaemia and renal failure

Question 15

What happened during dehydration?

Answer 15

Increased osmotic pressure and redistribution of water and sodium between intercellular and extra cellular spaces

Question 16

What is the non urgent treatment for a pt who need fluid replacement?

Answer 16

Administrate free water e.g 4% dextrose, 5% dextrose, balanced isotonic fluids (Hartmann)

Question 17

What is the treatment for hypovolaemia?

Answer 17

Hartmans or Ringers Lactate

First line crystalloid resuscitation

Question 18

What is the post op fluid treatment?

Answer 18

Support maintenance of both intracellular and extra cellular spaces

Question 19

What is AKI?

Answer 19

A rapid decline in renal filtration function and urine output 6 consecutive hours

Question 20

What are the 3 distinct categories of AKI?

Answer 20

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)

Question 21

What is hypovolaemia?

Answer 21

Reduced intravascular circulating volume