Hypovolemic Shock Overview
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Hypovolemic Shock Overview

Hypovolemic shock is a serious emergency condition that results when there is an underlying medical condition or injuries that lead to severe blood loss hence decreasing the cardiac output or total amount of blood in the circulation. The management of this shock is geared towards identifying and correcting the disorder or the problem that caused the shock.

Hypovolemic shock occurs as a result of severe blood loss/hemorrhage, fluid loss or due to other medical conditions that lead to internal fluid shifting such as severe edema or ascites. These events lead to decreased intravascular volume (blood volume within the blood vessels) and hence decreasing the venous return (blood returning to the heart).  With reduced venous return, there is a reduction in ventricular filling which decreases the total amount of blood ejected from the heart to the body system (the cardiac output).  At this stage, the heart cannot be able to supply the rest parts of the body with adequate amount of blood which eventually lead to inadequate tissue perfusion.

Clinical Manifestations

In most cases, any type of shock progresses through various stages, though the medical status of the patient may hasten/slow the progression process. An anemic patient who experiences severe blood loss may show progression faster than a normal health person who has lost the same amount of blood. The symptoms manifested by each individual patient depends on the severity of the shock or stage of progression and other underlying medical conditions of the patient.

Initially, the patient is able to maintain a desired blood pressure (BP) with a slight increase in respiratory and heart rate as a body compensatory process. The patient may also manifest slight anxiety. At this stage, the body is working hard to try and maintain adequate perfusion in vital organs like brain and heart by reducing the amount of blood going to other organ like skin. The skin of the patient may feel cool and clammy due to decreased perfusion. The urine output slightly decreases ranging from 20-30ml/hour. At this stage, the prognosis is good if treatment is initiated immediately.

In the next stage of progression, the patient experience further reduction in BP which may fall below 90mmHg for a systolic and 50mmHg for a diastolic. This is an indication that the mechanism that is responsible of maintaining a normal BP is not working well. The heart is not able to pump enough blood into the circulation. The patient heart rate and respiratory rates increases further. The heart rate can be up to 120bpm. The patient becomes confused, disoriented and may experience a marked anxiety. There is presence of poor capillary refill with urine decreasing further in amount. Other body organs such as renal, hepatic are also affected at this stage.  This is a critical stage and the patient survival rate will depends on his health status before the shock and how fast the intervention is done.

The final stage is fatal  and occurs when the patient is unable to respond to any form of treatment.  The body organs may severely get damaged and despite all the medical and conservative intervention given, the BP (systolic) remains below 70mmHg. The heart rate further increased to 140bpm or even higher (extreme tachycardia) and you can hardly feel the patient pulse (weak). No capillary refill and urine output is very little. With the brain been significantly involved, the patient becomes lethargy, stuporous and eventually may go to a coma. Even if the patient is put on mechanical ventilator, there is still inadequate ventilation due respiratory failure. At this stage, the shock is non-reversible due to multiple organ failure which faster progresses to total organ failure and eventually to death.

Management

The management of hypovolemic shock is geared towards the following;

  • Treatment of the underlying condition that lead to blood loss or hemorrhage.
  • Restoring of the right amount of blood volume.
  • Reversing the consequence of the events that caused the decrease in perfusion.
  • Treatment of other past medical conditions if any.

The type of treatment given to each individual shock patient depends on the stage of progression and how well the patient is responding to the given regimen. Each stage of progression brings about different challenges and the most important goal of shock management is to prevent the progression of shock from one stage to another and working towards correcting the underlying cause.

In any case, the most important thing that everyone should understand is that hypovolemic shock is a serious emergency medical condition and prompt seeking of medical care services is required to prevent the progression of the shock to an irreversible stage.

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Comments (6)

Excellent overview of this medical condition.

Well done research.

I am actually not familiar with this. Thanks for sharing..

Thank you everyone for your comments.

Great to know this Timm, well done.

This information is good to know.  Thanks.

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