Ganesh is a 22 year old medical student who was in a car accident. He was found to be agitated and complaining of abdominal pain. At the scene, his vital signs showed elevated breathing and heart rate with low blood pressure. Upon arrival at the emergency room, his vital signs and physical exam showed signs of shock including a distended abdomen, cold hands and feet, and dark urine. His hemoglobin was low at 7, indicating blood loss and hypovolemic shock.

1. Ganesh is a 22 years old medical student was driving his car and
accident. He was found to be agitated and complaining of
abdominal pain. His airway was patent. At the scene, her
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.Upon arrival
his vital signs were the same, with temp. of 36 degree celsius C.
His abdomen was markedly distended. His hands and feet were
cold. A urinary catheter revealed dark yellow urine. His Hb is 7.

2. HYPOVOLEMIC SHOCK AND
ITS MANAGEMENT
Presented by
Karan choudhary
CON AIIMS JODHPUR

3. INTRODUCTION
•Shock is a serious, life-threatening medical emergency
and one of the most common causes of death for
critically ill people.
•Shock leads to insufficient blood flow which reaches
the body tissues. As the blood carries oxygen and
nutrients around the body
•The process of blood entering the tissues is called
perfusion, so when perfusion is not occurring properly
this is called a hypo perfusion.

4. DEFINITION OF SHOCK
A physiological state characterized by a significant, systemic
reduction in tissue perfusion, resulting in decreased tissue
oxygen delivery and insufficient removal of cellular
metabolic products, resulting in tissue injury.

5. Stage of shock
1) INITIAL STAGE
2) COMPENSATORY (Compensating) STAGE
3) PROGRESSIVE (Decompensating) STAGE
4) REFRACTORY (Irreversible) STAGE

6. INITIAL STAGE
During this stage………. The hypoperfusional state
Mitochondria being unable to
produce ATP.
Which results in systemic
metabolic acidosis.
These compounds getting
removed by the liver requires
oxygen, which is absent.
Cellular Hypoxia,
Lack of oxygen and atp
The cells perform anaerobic
respiration.
This causes a build-up of lactic
and pyruvic acid

7. INTERMEDIATE STAGE
•This stage is characterised by the body employing physiological
mechanisms, including neural, hormonal and bio-chemical
mechanisms in an attempt to reverse the condition.
The Baroreceptors in
the arteries detect
the resulting
hypotension,
As a result of the
acidosis,
The release of
adrenaline and
noradrenaline.
AND
Renin-angiotensin
axis is activated
Causes
predominately
vasoconstriction with
a mild increase in
heart rate,
AND
vasopressin is
released to conserve
fluid via the kidneys.
The
combined
effect results
in an
increase in
blood
pressure.
The person will begin to
hyperventilate in order
to rid the body of
carbon dioxide (CO2).
attempt to raise the pH
of the blood.

8. Progressive stage
•When the cause of the crisis not successfully treated,
the shock will proceed to the progressive stage and
the compensatory mechanism begin to fail.
•The prolonged Vasoconstriction will also cause the
vital organs to be compromised due to Reduced
perfusion.

9. Refractory (irreversible) stage
Brain damage
and cell death
have occurred.
Death will
occur
immediately.
At this stage,
the vital
organs have
failed
the shock can
no longer be
reversed.

10. Types of shock
• In 1972 Hinshaw and Cox suggested the following classification which is still used today.
1. Hypovolemic Shock
a) hemorrhagic shock
b) Traumatic shock
c) Surgical shock
d) Dehydration shock
2. Cardiogenic Shock
3. Distributive Shock /warm shock/vasogenic shock
a) Septic Shock,
b) Anaphylactic Shock
c) Neurogenic Shock
4. Obstructive Shock
5. Endocrine Shock

11. DEFINITION OF HYPOVOLEMIC SHOCK
DEFINATION-
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
•Hypovolemic shock is most common type of shock.
•Also called as cold shock.

12. CAUSE/RISK FACTOR
External: Fluid Losses
•Trauma
•Surgery
•Severe Vomiting
•Diarrhea
•Diuresis
•Diabetes insipidus
Renal losses (polyuric phase of acute renal failure)
Gastrointestinal Losses
Skin Losses

13. Internal: Fluid Shifts
•Hemorrhage (hemothorax, hemoperitoneum ,etc.)
•Burns
•Ascites
•Peritonitis
•Dehydration

14. PATHOPHYSIOLOGY

15. CLINICAL MENIFESTATION
•Tachypnea(early sign)
•Cold and clammy skin
•Rapid and thready pulse
•Decrease cardiac output
•Hypotension
•Oliguria
•Tachycardia
•Intense thirst
•The skin is pale and moist.

16. •Decrease CVP
•Decreased intestinal motility due to intestinal
hypoperfusion
•systemic vasoconstriction may lead to tissue ischemia,
hypoxia, and eventually to altered cellular function and
global organ dysfunction.
•Collapsed peripheral veins
•Delayed return of color to the nail buds
•Confusion,
•Drowsiness
•Coma

17. DIAGNOSIS EVALVATION-
•History and physical examination - A history of
trauma, overt bleeding, or recent surgery is present for
patients with hemorrhagic shock.
•For the non-hemorrhagic hypovolemic shock due to
fluid losses, history and physical should attempt to
identify possible GI, renal, open wounds, skin, or third-
spacing as a cause of extracellular fluid loss.

18. •Blood pressure
•Blood test are done to find out if any damage has occur
in the kidney or liver.
•CBC
•SERUM ELECTROLYTE
•ABG to determine blood amount of oxygen in blood.
•ECG
•CT Scan

19. MEDICAL MANAGEMENT
Major goals in treating hypovolemic shock are to -
•Restore intravascular volume to reverse the sequence
of events leading to inadequate tissue perfusion
•Redistribute fluid volume
•Correct the underlying cause of the fluid loss as
quickly as possible.

20. TREATMENT OF THE UNDERLYING
•If the patient is hemorrhaging, efforts are made to stop the
bleeding. This may involve applying pressure to the bleeding
site or surgery to stop internal bleeding.
•Anti-fibrinolytic administration to patients with severe
bleeding within 3 hours of traumatic injury appears to
decrease death from major bleeding
•If the cause of the hypovolemia is diarrhea or vomiting,
medications to treat diarrhea and vomiting are administered as
efforts are made simultaneously to identify and treat the cause.
•In the elderly patient, dehydration may be the cause of
hypovolemic shock.

21. FLUID AND BLOOD REPLACEMENT
•At least two large-gauge intravenous lines are inserted
to establish access for fluid administration. Two
intravenous lines allow simultaneous administration of
fluid, medications, and blood component therapy if
required.
•Redistribution of fluid provide the position to the
patient.

22. PHARMACOLOGIC THERAPY
•If the underlying cause of the hypovolemia is dehydration,
medications are also administered to reverse the cause of
the de-hydration. For example, insulin is administered if
dehydration is secondary to hyperglycemia;
•Desmopressin (DDAVP) is administered for diabetes
insipidus, antidiarrheal agents for diarrhea, and antiemetic
medications for vomiting.

23. Nursing Management
•Hypovolemic shock can be prevented in some instances by
closely monitoring patients who are at risk for fluid deficits and
assisting with fluid replacement before intravascular volume is
depleted.
•In other circumstances, hypovolemic shock cannot be pre-
vented, and nursing care focuses on assisting with treatment
targeted at treating its cause and restoring intravascular volume.
•General nursing measures include ensuring safe administration
of prescribed fluids and medications and documenting their
administration and effects.

24. •Administering blood transfusions safely is a vital nursing
role.
•In emergency situations, it is important to obtain blood
specimens quickly to obtain a baseline complete blood count
and to type and cross-match the blood in anticipation of blood
transfusions.
•The patient who receives a transfusion of blood products
must be monitored closely for adverse effects
•Fluid replacement complications can occur, often when large
volumes are administered rapidly. Therefore, the nurse
monitors the patient closely for cardiovascular overload and
pulmonary edema.

25. •Hemodynamic pressure, vital signs, arterial blood
gases, hemoglobin and hematocrit levels, and fluid
intake and output are among the parameters monitored.
•The patient's temperature should also be monitored
closely to ensure that rapid fluid resuscitation does not
precipitate hypothermia.
•The nurse needs to monitor cardiac and respiratory
status closely and report changes in blood pressure,
pulse pressure, heart rate,

26. SUMMARY-
•Today we have discussed introduction, definition of
hypovolemic shock , their causes /risk factors.
Classification of shock its pathophysiology, clinical
manifestations, assessment and diagnostic findings,
medical and nursing management.

27. CONCLUSION
•Hypovolemic shock is an emergency condition in
which severe blood and fluid loss make the heart
unable to pump enough blood to the body this type of
shock can cause may organ to stop working.

Survival
and outcomes improve with early perfusion, adequate
oxvgenation and identification with appropriate
treatment of the cause of shock

28. References:
•Brunner and Suddarth; Textbook of Medical Surgical Nursing 13th Edition
Volume II. New Delhi; Wolters Kluwer Publication, 2015.
•Petrica A. Potter; Fundamentals of Nursing South Asian Edition Volume I.
New Delhi; Elsevier Publications 2013.
•BD Chaurasia; Human Anatomy 6th Edition Volume II. New Delhi; Jaypee
Publications, 2014.
•Harding, Kwong, Roberts, Hagler, Reinisch; Lewis’s Medical Surgical
Nursing 11th Edition Volume II. Philadelphia; Elsevier Publications 2015.
•Chintamani, Mrinalini Mani. Lewis’s Medical Surgical Nursing:
Assessment and Management of Clinical Problems, 2nd edition: Reed
Elsevier India Private Limited, 2014.
•https://www.ncbi.nlm.nih.gov/books/NBK513297/
•https://www.slideshare.net/Zellanienhd/4hypovolemicshockppt