Hypovolemic shock

What do we know as shock?

The term shock is used to describe a medical situation in which the organs and tissues of the body do not receive a sufficient contribution of oxygen and nutrientsThis leads to a progressive death of cells and a failure in the function of the different organs that can lead to death.

This lack of contribution occurs basically because the amount of blood reaching the tissues is insufficient due to a malfunction of the heart (cardiogenic shock), due to a loss of body fluids (hypovolemic shock) or due to a serious infection ().

How does hypovolemic shock occur?

Vollemia is the percentage of total blood in an individual. In turn, the blood is made up of a liquid portion called plasma (55%) and another made up of cells (mainly red blood cells). The highest percentage of blood volume is represented by Water.

Before small decreases in blood volume (<15%) the body has compensation mechanisms (increased blood pressure and heart rate) that allow the heart to continue pumping blood normally and ensuring adequate nutrients. When there are more important losses (such as heavy bleeding) and especially if they occur quickly, the body loses this compensation capacity or it is not enough, entering a situation of shock.

The Causes major hypovolemic shock include:

• Significant blood loss (hemorrhagic shock). External bleeding (for example, due to trauma) or internal bleeding (such as gastric bleeding from a stomach ulcer).
• Loss of water and electrolytes (sodium and potassium): severe vomiting and diarrhea.
• Loss of plasma: Burns.

Symptoms of hypovolemic shock

Dehydration caused by the loss of fluids from the body is reflected in a number of symptom:

• Fast breathing
• Palpitations due to increased heart rate
• Confusion and dizziness due to altered level of consciousness
• Cold and pale skin
• Dry mucous membranes (dry tongue and eyes)
• Generalized weakness and malaise from low blood pressure
• Decreased diuresis
• Diagnosis

Diagnosis

The diagnosis is based on the medical history and signs that the patient presents and that include:

• High heart rate: tachycardia
• High respiratory rate: tachypnea
• Arterial hypotension
• Oliguria: decreased volume of urine emitted

The physical examination allows to detect these alterations and to find out the possible causes of shock. Other explorations useful complementary are:

• Analytics (and biochemistry) that allows to determine the loss of blood, plasma and electrolytes (sodium and potassium).
• Imaging tests such as ultrasound, (computerized axial tomography) and (magnetic resonance imaging). Especially useful in those cases in which there are internal bleeding or organ damage.

Out-of-hospital measures

• It is an urgent situation therefore immediate medical help must be requested.
• The patient should be kept comfortable and clothed
• Lay him down by raising his feet about 30º to facilitate blood supply to the brain and upper body.

Hospital measures

• Once in the hospital, because the fundamental problem is the loss of fluids, the treatment is based on the blood and fluid intake that the patient has lost.
• Volume replacement by administering blood and / or fluids by intravenously. Liquid solutions such as crystalloids or colloids can be administered.
• Sometimes the fluid intake is not enough to maintain sufficient blood pressure to allow blood to reach the tissues and it is also necessary to use other drugs intravenously. The most used are the dopamine and norepinephrine.

Specific treatment of the cause that causes it

• Wounds, trauma, organ rupture, burns, etc., thus, surgical treatment and antibiotics, among others, may be required.

Other measures called support are aimed at maintaining the patient's vital signs:

• Oxygen administration
• : blood pressure, heart rate, respiratory rate and oxygen saturation. For this, specific devices called monitors are used.
• Control of diuresis. One of the indicators that the patient is recovering and the fluid intake is adequate is the recovery of urine output. Requires the placement of a urinary catheter.

Is there any way to avoid it?

In all those situations in which there may be a significant loss of blood volume: dehydration due to intense heat, diarrhea, vomiting, etc. It is important ensure a supply of fluids suitable.

It must be taken into account that it is a medical situation that sets in quickly and that it can have very serious consequences, therefore it is always a medical emergency that requires urgent attention.

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