Hypovolemic Shock

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Hypovolemic shock is the most common type in trauma patients.
Signs and symptoms

  • Decreased peripheral or central pulses; peripheral vasoconstriction is an early compensatory mechanism for shock.
  • Pale and/or cool, clammy extremities; a tachycardic patient who has cool, clammy skin is in hypovolemic shock until proven otherwise.
  • Heart rate >120 to 130 beats/min in adult trauma patients should be assumed to be caused by shock.
  • Altered level of consciousness may indicate a brain injury, hypovolemic shock, or both; the key to preventing secondary brain injury is to prevent (or treat, if present) hypoxia and hypotension.
  • Relying on systolic blood pressure measurements alone may be misleading, up to 33 % of blood volume can be lost before a patient becomes manifest  hypotension.
  • Pulse pressures may decrease with loss of as little as 15% of blood volume.
  • Urine output, although useful to judge resuscitation, is not used during the primary survey.

Shock resuscitation

  •  Initial bolus of 2 L of crystalloid that can be repeated once if vital signs are not restored to normal
  • Patients who respond well to fluid resuscitation likely had a 10% to 20% blood volume deficit; patients who do not respond have a higher volume deficit.
  • As the second bolus is being given, blood should be obtained.

Initial radiographic evaluation

  • Views include a chest radiograph, lateral view of the cervical spine, and AP view of the pelvis.
  •  The AP pelvis and chest radiographs can identify potential bleeding sources.
  • Focused Assessment for the Sonographic Evaluation of the Trauma Patient (FAST) may be needed
    for patients with persistent hypotension; like adiographic evaluation, FAST is quickly obtained
    and can be performed in the trauma bay.
  • FAST is accurate for detecting free intraperitoneal fluid and looking for blood in the pericardial sacand dependent regions of the abdomen, including
    the right and left upper quadrants and pelvis, but it cannot detect isolated bowel injuries and does not reliably detect retroperitoneal injuries.
  • Patient may require diagnostic peritoneal lavage.

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