Hypovolemic Shock Block 3.2 Collage of Medicine, King Faisal University Al-Ahsa, Saudi Arabia

1. Hypovolemic
Shock
Abdullatiff Sami AL-Rashed
Block 3.2
Collage of Medicine, KFU
Al-Ahsa, Saudi Arabia

2. Presentation Outline

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.
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
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.
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.

6. The Questions

7. IInnttrroodduuccttiioonn

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.

9. Causes of Hypovolemic Shock

10. Causes of Hypovolemic Shock

11. Causes of Hypovolemic Shock

12. Classification

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.

25. Hypovolemic Shock