Hypovolemic shock is a life-threatening condition caused by a reduction in circulating blood volume, resulting in decreased oxygen delivery. Early recognition is important to avoid tissue injury. Hypovolemic shock can be hemorrhagic, caused by blood loss from trauma or gastrointestinal bleeding, or non-hemorrhagic due to causes like burns, diarrhea, or excessive diuresis. Treatment involves rapid fluid resuscitation with crystalloids to restore circulating volume, with goals of maintaining an adequate blood pressure depending on the cause of shock. Lactate levels should be monitored to assess tissue perfusion.
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
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
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
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
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
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