3. Hypovolemic Shock
• most common
• reduced circulating volume
Hemorrhagic shock
External or Internal
Non Hemorragic hypovolemic shock
Vomiting Diuresis
Diarrhoea Burns
4. Pathophysiology of Hypovolemic shock
Hypovolemia
Multiorgan failure
↓Venous
Return
↓Preload
CO = SV x HR
↓Cardiac output
BP = CO x TPR
Hypotension
Perfusion failure &
Tissue hypoxia
Organ dysfunction
5. Bodily responses
Physiologic responsessympathetic activity – tachycardia and SVR
Hyperventilation
collapse of venous capacitance vessels
stress hormones
Attempt to replace intravascular volume loss
The body will prioritize – Brain and heart
Severity ~ magnitude and the rate of fluid loss
9. Treatment principles:
Hypovolemic Shock
• control ongoing loss
• rapid reexpansion of the circulating
intravascular blood volume
• GOAL: restore blood volume and improve
tissue perfusion and oxygenation
10. Control bleeding
•
•
•
•
•
Direct pressure on the site of wound, Gauze
Elevation
Pressure points Tourniquets Surgical Methods
•
•
•
•
Artery forceps (Spencer Well’s forceps)
Ligation
Cauterisation
Splenectomy – splenic rupture, Hysterectomy for post
partum bleeding
11. Treatment contd.
• ABC …
– Supplemental Oxygen
– Endotracheal intubation
• Secure a large bore IV line for fluid
resuscitation
– Median cubital vein, saphenous vein and
sometimes the internal jugular and subclavian
veins
– In pediatric patient - intraosseus line
12. Re-expansion of Intravascular volume
Fluid Therapy
Crystalloid solutions –
0.9% saline
Ringer Lactate
Colloid solutions – 5% albumin, gelatins, hetastarch
20 ml/kg in 5 – 15 minutes – repeat upto 60 ml/kg
Blood transfusion – 1 unit of blood in 20 minutes
>40% of blood loss (class IV)
If the patient is anemic ( Hg < 8g/dl)
We may need to supplement fresh frozen plasma and platelates
15. Septic Shock
Sepsis
• Septicemia - Presence of microbes or their toxins
Sepsis and organ
in blood
dysfunction, hypoperfusion,
Severe Sepsis
or hypotension
• Sepsis – Systemic inflammatory response
syndrome (SIRS) that has a proven or suspected
microbial etiology
Septic
Sepsis-induced
hypotension
• Severe sepsis – Hypoperfusion with signs of organ
shock
dysfunction – Lactic acidosis, oliguria etc.
• Septic shock - Sepsis + hypotension (ABP<90
mmHg systolic, or MODS
40 mmHg less than patient's
normal BP) for at least 1 hr despite adequate fluid
resuscitation;
Death
16. Septic, contd.
• Importance??
– The most common of the distributive types,
– The leading cause of Deaths in ICU in the US.
– Increasing in occurrence
• Increased life support for high risk patients
• Increase in invasive procedures
• Growing number of the immunocompromised
– HIV
– Chemotherapy
23. Principles of treatment:
Septic shock
• Ventilatory support
• IV fluids – crystalloids or colloids - Fill the tank
• Vasoactive agents – Norepinephrine,
Dopamine etc.
• Draw blood for culture – before Antibiotics
• Remove septic focus – Resect a gangrenous
bowel, Drain an abscess
• Early empirical antibiotic therapy
24. Neurogenic Shock
• Cause – high spinal cord injury, spinal
anaesthesia
• Pathophysiology - Interruption of
sympathetic vasomotor input
• extremities are warm
• Rx – IV fluids
• norepinephrine or a pure -adrenergic agent
(phenylephrine)
31. References
• Harrison’s principles of internal medicine18th edition
• ACS surgery: principles & practice
• Mannipal manual of surgery
• Robbin’s basic pathology
• Shwartz principles of surgery
• Davidson’s principles and practice of medicine
• World Wide Web