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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the most common etiologies of decreased intravascular volume in hypovolemic shock patients.

  2. Describe the major hemodynamic and metabolic abnormalities that occur in patients with hypovolemic shock.

  3. Describe the clinical presentation including signs, symptoms, and laboratory test measurements for the typical hypovolemic shock patient.

  4. Prepare a treatment plan with clearly defined outcome criteria for a hypovolemic shock patient that includes both fluid management and pharmacologic therapy.

  5. Compare and contrast relative advantages and disadvantages of crystalloids, colloids, and blood products in the treatment of hypovolemic shock.

  6. Formulate a stepwise monitoring strategy for a hypovolemic shock patient.

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KEY CONCEPTS

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  • Image not available. Regardless of etiology, the most distinctive clinical manifestations of hypovolemic shock are arterial hypotension and metabolic acidosis. Metabolic acidosis is a consequence of an accumulation of lactic acid resulting from tissue hypoxia and anaerobic metabolism. If the decrease in arterial blood pressure (BP) is severe and protracted, such hypotension will inevitably lead to severe hypoperfusion and organ dysfunction.

  • Image not available. Hypovolemic shock occurs as a consequence of inadequate intravascular volume to meet the oxygen and metabolic needs of the body.

  • Image not available. Protracted tissue hypoxia sets in motion a downward spiral of events leading to organ dysfunction and eventual failure if untreated.

  • Image not available. The overarching goals in treating hypovolemic shock are to restore effective circulating blood volume, as well as managing its underlying cause, thereby reversing organ dysfunction and returning to homeostasis.

  • Image not available. Three major therapeutic options are available to clinicians for restoring circulating blood volume: crystalloids (electrolyte-based solutions), colloids (large molecular weight solutions), and blood products.

  • Image not available. In the absence of ongoing blood loss, administration of 2,000 to 4,000 mL (approximately 4 to 8 pints) of isotonic crystalloid normally reestablishes baseline vital signs in adult hypovolemic shock patients.

  • Image not available. Colloid solutions administered are primarily confined to the intravascular space, in contrast to isotonic crystalloid solutions that distribute throughout the extracellular fluid space.

  • Image not available. Blood products are indicated in adult hypovolemic shock patients who have sustained blood loss from hemorrhage exceeding 1,500 mL (approximately 3 pints).

  • Image not available. Vasopressors may be warranted as a temporary measure in patients with profound hypotension or evidence of organ dysfunction in the early stages of shock.

  • Image not available. Major treatment goals in hypovolemic shock following fluid resuscitation are as follows: arterial systolic blood pressure (SBP) greater than 90 mm Hg within 1 hour, organ dysfunction reversal, and normalization of laboratory measurements as rapidly as possible (less than 24 hours).

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INTRODUCTION

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The principal function of the circulatory system is to supply oxygen and vital metabolic compounds to cells throughout the body, as well as removal of metabolic waste products. Circulatory shock is a life-threatening condition whereby this principal function is compromised.1 When circulatory shock is caused by a severe loss of blood volume or body water, it is called hypovolemic shock, which is the focus of this chapter. Image not available. Regardless of etiology, the most distinctive ...

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