About shock

1. HYPOVOLEMIC SHOCK
BY REDEEMER DAMPTEY
5/11/23

2. OUTLINE
 Definition
 Incidence
 Etiology
 Pathophysiology
 Symptom
 Management
 Complicated

3. DEFINITION
 Emergency condition in which severe blood or other fluid loss
makes the unable to pump enough blood to the body.
 A clinical manifestation of cellular function due to inadequate
perfusion and consequent cellular hypoxia.
 Resulting from effective circulatory volume.

4. INCIDENCE
• Approximately 150 per hundred thousand in the USA
• Difficulty to determine in Ghana
• Due to variation in data recording

5. ETIOLOGY
 Acute hemorrhage
Internal:Ruptured spleen, haemothorax
External: Open wound, crush injury
 Loss of Plasma: extensive burns
 Loss of extracellular fluid: diarrhea, intestinal obstruction
RAPTURED SPLEEN

6. PATHOPHYSIOLOGY
 Average adult person has 4-5L
 25%(100ml) must be loss for shock to occur
Reduction in venous return
Activation of compensatory mechanism
 Vasoconstriction
 More forceful contraction
 If reduction continues compensatory mechanism fails.
 Reduction in tissue perfusion
 Worsened hypoxia

7. PATHOPHYSIOLOGY
Cellular dysfunction
Cell death
Release of inflammatory cytokines
Damage of endothelium
Increased capillary permeability
 Plasma exudation
 Coagulopathy
 Leukocyte activation
 Vasodilation

8. PATHOPHYSIOLOGY
 Leukocyte activation
 Vasodilation
 Hypovolemia
 Multiple organ dysfunction

10. SYMPTOM
Tachycardia
Hypotension
Pale mucous membrane
Collapsing veins
Respiratory depression
Confusion
Low urinary output
Cold extremities

11. MANAGEMENT
 History taking
 Physical examination: colour of mucous membrane
mental state: restless, coma or anxiety
hydration: skin moist or dry
State of veins: collapsing or filled
Respiration : Rate and depth
Prescence of bleeding external wound.
 Check vital signs: pulse , temperature, blood pressure

12. MANAGEMENT
 Check vital signs: pulse , temperature, blood pressure
 Oxygen therapy
 Set a line with large bore cannula
 Take blood for grouping and cross matching
 start IV fluids ( Ringers Lactate)
 Manage urine output

13. MANAGEMENT
• FLUID MANAGEMENT
 Acute haemorrhage:
whole blood- 1.5 -2L
IV Fluid: Ringers lactate in first 30-45mins
followed by 5%dextrose in same period.
 Plasma loss: Fresh Frozen Plasma (human albumin solution
dextran ,haemaccel)
 Extracellular fluid: Ringers lactate

14. MANAGEMENT
INVESTIGATION
 LABORATORY – Hemoglobin(reduced)
 Electrolyte-Na+, k+
 PH- Acidosis- Increased H+
 Base deficit: low HCO3-
 hematocrit- low
 IMAGING – x-ray ,CT in acute haemorrhagic shock to check for
internal bleeds.

15. COMPLICATION
Pulmonary insufficiency
Cardiac failure/arrest
Cerebral failure
Renal failure
Metabolic acidosis
Liver failure