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.

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

7. CLASSIFICATION
Hypovolemic
DistributiveCardiogenic
Obstructive

8. CHARACTERISTICS OF SHOCK
 Hypotension
 Altered mental status
 Oliguria
 Tachypnea
 Cool clammy skin
 Delayed capillary refill
 Metabolic acidosis

9. HIPOVOLEMIC SHOCK

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

16. Hemorrhagic
Vascular
Aneurysm
Aorto=enteric fistula
AV malformations

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