Hypovolaemic shock
Shock is characterized by
inadequate systemic perfusion. The most com-mon type, hypovolaemic shock, is
related to abnormally low circulating blood volume.
The causes of hypovolaemia are:
·Trauma.
·GI bleeding.
·Burns.
·Peritonitis.
·Diarrhoea.
·Diabetic ketoacidosis.
Perform a rapid clinical
examination and direct your initial treatment to-ward the patient’s vital
signs.
·Airway,
Breathing, Circulation, Disability (ABCD).
·Blood:
in patients with significant blood
loss, transfusion will be required
(about 2mL/kg to increase haemoglobin concentration by 1g/dL). (Patient may
need O –ve unmatched blood in an emergency). Monitor the response with
laboratory testing.
·Fluid:
acutely, blood pressure and
perfusion need to be restored with
crystalloid infusion. IV bolus of normal saline, 20mL/kg, can be given over
15min and repeated if necessary. If more than 60mL/kg is required consider
endotracheal intubation and ventilatory support. In the patient who is
dehydrated, the water and electrolyte deficit needs to be replaced.
·
Refractory hypotension: intubation and intensive care
monitoring and therapy are required.
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