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Hypovolemic
Shock
Abdullatiff Sami AL-Rashed
Block 3.2
Collage of Medicine, KFU
Al-Ahsa, Saudi Arabia
Presentation Outline
The Case
Mustafa a 22 years old Saudi medical student was
driving his car at a speed of 145 Km/Hour without
fastened his seatbelt when he was involved in a single-
vehicle automobile accident.
Mustafa a 22 years old Saudi medical student was
driving his car at a speed of 145 Km/Hour without
fastened his seatbelt when he was involved in a single-
vehicle automobile accident.
When attended to by Red Crescent emergency team
personnel, no information was available about the time
of the accident
When attended to by Red Crescent emergency team
personnel, no information was available about the time
of the accident
The Case
He was found to be agitated and complaining of
abdominal pain. His airway was patent
He was found to be agitated and complaining of
abdominal pain. His airway was patent
At the scene, he was breathing at 32 breaths/ min
with BP of 90/60 mmHg and a pulse of 130 Bpm.
At the scene, he was breathing at 32 breaths/ min
with BP of 90/60 mmHg and a pulse of 130 Bpm.
He was placed in a hard cervical collar on a back
board and transported to the emergency room
He was placed in a hard cervical collar on a back
board and transported to the emergency room
The Case
Upon arrival his vital signs were the same, with
temp. of 36 C. His abdomen was markedly
distended. His hands and feet were cold, his legs
mottled.
Upon arrival his vital signs were the same, with
temp. of 36 C. His abdomen was markedly
distended. His hands and feet were cold, his legs
mottled.
A NG tube revealed green liquid. A urinary catheter
revealed dark yellow urine. His Hb is 7. His FAST
examination is positive in Morrison’s Pouch.
A NG tube revealed green liquid. A urinary catheter
revealed dark yellow urine. His Hb is 7. His FAST
examination is positive in Morrison’s Pouch.
The Questions
Introduction
Introduction
Hypovolemic Shock
• Hypovolemic shock is an emergency condition in
which severe blood and fluid loss make the heart
unable to pump enough blood to the body due to
decreased preload.
• The diminished preload decreases the CO and the
SVR increases in an effort to compensate for the
diminished CO and maintain perfusion to the vital
organs.
• It leads to multiple organs failure.
Causes of Hypovolemic Shock
Causes of Hypovolemic Shock
Causes of Hypovolemic Shock
Classification
3/ What acid/base category
would be expected.
The Answer
• The effect of fluid loss on acid-base balance is
variable.
• Although many patients maintain a normal
extracellular pH, either metabolic acidosis or
metabolic alkalosis can occur.
• Lactate acidosis is common in cases of
hypovolemic shock.
The Answer
• Lactic acidosis , considered a type of metabolic acidosis, is
a physiological condition characterized by low pH in body
tissues and blood (acidosis) accompanied by the buildup of
lactate.
• Lactic acidosis is characterized by lactate levels >5 mmol/L
and serum pH <7.35.
• Type A lactic acidosis is the most common type of lactic
acidosis in hypovolemic shock
4/ What is the effect of this
kind of shock on kidneys,
heart, lungs, brain, and
intestines.
Kidneys
• The urine output will decrease do to renal
hypoperfusion.
Blood loss 750-
1500ml
Blood loss 1500-
2000
Blood loss >2000
Urinary output mildly
affected
Urinary output
mildly/severely
affected.
Severe oliguria or
anuria
Heart
• Cardiovascular signs are due to
adrenergic response to blood loss.
(Shock class I) (Shock class II) (Shock class III) (Shock class IIII)
NONE Tachycardia due to
catecholamine
release.
Weak pulse or
absent pulses (they
are more significant
than weak pulses).
Skin: pale, moist
and cool.
Tachycardia
Hypotension
Tachycardia, very
weak pulse.
Capillary refill is
undetectable.
The skin is pale
and moist.
Blood pressure
very low or
undetectable.
Lungs
• Tachypnoea due to central nervous
system chemoreceptor stimulation by a
decreased pH and hypoxia.
Brain
• Symptoms are duo to cerebral
hypoperfusion and acidosis.
(Shock class I) (Shock class II) (Shock class III) (Shock class IIII)
None or
orthostatic
dizziness.
Restlessness,
anxiety,
agitation.
Anxiety,
confusion.
Confusion,
drowsiness,
and coma
Intestine
• Decreased intestinal motility due to intestinal
hypoperfusion.
• This leads to bilious aspirate “Green liquid in
Nasogastric tube aspirate”
5/ What would be the cardiac
output.
The Answer
• Hypovolemic shock is characterized by a loss in
intravascular volume that results in decreased preload.
• Since preload is one of the determinants of stroke
volume, cardiac output falls.
The Answer
• The initial hemodynamic abnormality of fluid loss
activates the compensatory mechanisms under
neuroendocrine control, which maintain adequate central
perfusion despite the fall in cardiac output.
• However, systemic vasoconstriction may lead to tissue
ischemia, hypoxia, and eventually to altered cellular
function and global organ dysfunction.
Hypovolemic Shock
case2-141123132324-conversion-gate02.pdf

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case2-141123132324-conversion-gate02.pdf

  • 1. Hypovolemic Shock Abdullatiff Sami AL-Rashed Block 3.2 Collage of Medicine, KFU Al-Ahsa, Saudi Arabia
  • 3. The Case Mustafa a 22 years old Saudi medical student was driving his car at a speed of 145 Km/Hour without fastened his seatbelt when he was involved in a single- vehicle automobile accident. Mustafa a 22 years old Saudi medical student was driving his car at a speed of 145 Km/Hour without fastened his seatbelt when he was involved in a single- vehicle automobile accident. When attended to by Red Crescent emergency team personnel, no information was available about the time of the accident When attended to by Red Crescent emergency team personnel, no information was available about the time of the accident
  • 4. The Case He was found to be agitated and complaining of abdominal pain. His airway was patent He was found to be agitated and complaining of abdominal pain. His airway was patent At the scene, he was breathing at 32 breaths/ min with BP of 90/60 mmHg and a pulse of 130 Bpm. At the scene, he was breathing at 32 breaths/ min with BP of 90/60 mmHg and a pulse of 130 Bpm. He was placed in a hard cervical collar on a back board and transported to the emergency room He was placed in a hard cervical collar on a back board and transported to the emergency room
  • 5. The Case Upon arrival his vital signs were the same, with temp. of 36 C. His abdomen was markedly distended. His hands and feet were cold, his legs mottled. Upon arrival his vital signs were the same, with temp. of 36 C. His abdomen was markedly distended. His hands and feet were cold, his legs mottled. A NG tube revealed green liquid. A urinary catheter revealed dark yellow urine. His Hb is 7. His FAST examination is positive in Morrison’s Pouch. A NG tube revealed green liquid. A urinary catheter revealed dark yellow urine. His Hb is 7. His FAST examination is positive in Morrison’s Pouch.
  • 8. Hypovolemic Shock • Hypovolemic shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body due to decreased preload. • The diminished preload decreases the CO and the SVR increases in an effort to compensate for the diminished CO and maintain perfusion to the vital organs. • It leads to multiple organs failure.
  • 13. 3/ What acid/base category would be expected.
  • 14. The Answer • The effect of fluid loss on acid-base balance is variable. • Although many patients maintain a normal extracellular pH, either metabolic acidosis or metabolic alkalosis can occur. • Lactate acidosis is common in cases of hypovolemic shock.
  • 15. The Answer • Lactic acidosis , considered a type of metabolic acidosis, is a physiological condition characterized by low pH in body tissues and blood (acidosis) accompanied by the buildup of lactate. • Lactic acidosis is characterized by lactate levels >5 mmol/L and serum pH <7.35. • Type A lactic acidosis is the most common type of lactic acidosis in hypovolemic shock
  • 16. 4/ What is the effect of this kind of shock on kidneys, heart, lungs, brain, and intestines.
  • 17. Kidneys • The urine output will decrease do to renal hypoperfusion. Blood loss 750- 1500ml Blood loss 1500- 2000 Blood loss >2000 Urinary output mildly affected Urinary output mildly/severely affected. Severe oliguria or anuria
  • 18. Heart • Cardiovascular signs are due to adrenergic response to blood loss. (Shock class I) (Shock class II) (Shock class III) (Shock class IIII) NONE Tachycardia due to catecholamine release. Weak pulse or absent pulses (they are more significant than weak pulses). Skin: pale, moist and cool. Tachycardia Hypotension Tachycardia, very weak pulse. Capillary refill is undetectable. The skin is pale and moist. Blood pressure very low or undetectable.
  • 19. Lungs • Tachypnoea due to central nervous system chemoreceptor stimulation by a decreased pH and hypoxia.
  • 20. Brain • Symptoms are duo to cerebral hypoperfusion and acidosis. (Shock class I) (Shock class II) (Shock class III) (Shock class IIII) None or orthostatic dizziness. Restlessness, anxiety, agitation. Anxiety, confusion. Confusion, drowsiness, and coma
  • 21. Intestine • Decreased intestinal motility due to intestinal hypoperfusion. • This leads to bilious aspirate “Green liquid in Nasogastric tube aspirate”
  • 22. 5/ What would be the cardiac output.
  • 23. The Answer • Hypovolemic shock is characterized by a loss in intravascular volume that results in decreased preload. • Since preload is one of the determinants of stroke volume, cardiac output falls.
  • 24. The Answer • The initial hemodynamic abnormality of fluid loss activates the compensatory mechanisms under neuroendocrine control, which maintain adequate central perfusion despite the fall in cardiac output. • However, systemic vasoconstriction may lead to tissue ischemia, hypoxia, and eventually to altered cellular function and global organ dysfunction.