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MD Guide to Hypovolemic Shock Causes, Symptoms, and Treatment
- 1. Hypovolemic Shock Ivan De Paz MD WRH
- 3. SHOCK Hippócrates 400 BC 1740 choc por Henry francois 1743 Clarke shock Sudden worsening of patient’s clinical status after trauma Collins - Temporary pause in the process of dying HIPPOCRATES
- 4. SHOCK 1861 Samuel Gross Alternative etiologies besides hemorrhage
- 5. FACTS Shock is a life-threatening condition of circulatory failure. The effects of shock are initially reversible, but rapidly become irreversible, resulting in multiorgan failure (MOF) and death
- 6. DEFINITION A state of cellular and tissue hypoxia due to reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen utilization
- 8. CHARACTERISTICS OF SHOCK Hypotension Altered mental status Oliguria Tachypnea Cool clammy skin Delayed capillary refill Metabolic acidosis
- 10. Hypovolemic shock Decrease in venous return due to a loss of circulating volume (internal or external) Early recognition of the condition is vital, if subsequent tissue injuries are to be avoided
- 11. Hypovolemic Shock Hemorrhágic VS non hemorrhágic Generally, is the first differential in the hypoperfused patient Blood volume adult 66 ml/kg ♂ y 60 ♀ Patient that lost 30-40% of total blood volume can develop cardiac arrest In Non Trauma patients, most of the hemorrhages are located in the abdomen
- 12. Non Hemorrhagic Gastroenteritis Burns Fistulas Excessive Diuresis
- 13. Hemorrhagic TRAUMATIC Vs NON TRAUMATIC Solid Organ Injury Lung Parenchyma Injury Myocardial injury Vascular Injury Retroperitoneal Bleeding Duodenal Ulcer Renal injury Long bone fracture/ pelvic fracture Scalp lacerations Epistaxis
- 14. Hemorrhagic Gastrointestinal Esophageal varices Peptic ulcer Mallory Weiss Syndrome Gastric CA/ colon Vascular Lesions (AV Malformations) Ulcerative colitis Ischemic colitis
- 15. Hemorrhagic REPRODUCTIVE ORGANS Vaginal Bleeding cancer Miscarriage Fibroids Retained placentae placenta previa Ectopic pregnancy Ruptured ovarian cyst
- 18. Categories of acute blood loss I < 15% Loss Compensated Tachycardia II Loss 15-30% Compensatory mec fail Orthostatic changes III Loss of 30-40% Begining of shock Hipotension IV Loss greater than 40% Marked hipotensión + oliguria Altered mental status Critical care medicine. principles of diagnosis and management in the adult
- 19. Class II Hemorrhage Compensatory mechanisms begin to fail Tachycardia Tachypnea Decreased pulse pressure Delayed capillary refill SBP changes minimally if at all Skin may be cool and clammy
- 20. Class III Hemorrhage Significant Drop in blood pressure Changes in mental status Heart rate >120x’ Tachypnea Urine output decreased Capillary refill delayed
- 21. Class IV Hemorrhage Marked hypotension Abnormal mental status Heart rate >120x’ Narrow pulse pressure Urine output minimal Capillary refill delayed Skin is cold and pale
- 22. Management • Crystalloid Solutions • at least 1-2 liters • Delayed therapy can lead to ischemic injury and possibly to irreversible shock
- 23. Goals of treatment • Uncontrolled hemorrhage due to Trauma MAP > 40 mmhg • TBI without systemic hemorrhage MAP >90 mmhg • All other shock states MAP >65 mmhg
- 24. Lactate levels Measure lactate levels in all cases were shock is suspected Levels typically > 2 mEq/L in shock states Can be performed every 2 hours (1st 8 hrs) & then every 8-12 hrs
- 25. Challenges Docs no longer touch patients, they order tests A good history and detailed PE are needed A high index of suspicion Identify your patient’s basal status and work towards specific goals
- 27. Learn from the mountain goat
- 28. Mumtaz mahal
- 30. Thank you
Editor's Notes
- Hipocrates en el 400 BC realiza una descripción del choque refiriéndose a un paciente con nariz afilada, ojos ahuecados, sienes sumidas, orejas frias y contraídas, con la piel de la cara seca, tensa y con perdida de la coloración del rostro. Choc- which was used by the French army surgeon Henri Francois Le Dran to describe the collapse of vital functions culminating in death that he observed in soldiers who had been struck by missiles An innapropiate translation used by the English physician Clarke in 1743 introduced the word shock Jhon Collins indica que el shock es una pausa momentánea en el acto de la muerte
- Excessive pallor of the countenance, the weakened or absent pulse, the confused state of mind, the nausea or vomiting and the excessive bodily postration
- Soap 2 trial septic shock was the most frequent cause of shock for 62% of patients, followed by cardiogenic in 17% and hypovolemia in 16%
- Oliguria (less than 0.5 ml/kg/hr)
- Class I generally well tolerated. Tachycardia the most obvious sign Compensatory mechanisms begin to fail with a loss of 20-25 %
- Average doctor treats full blown disease Good doctor finds disease early Superior doctor prevents disease