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There are multiple types of shock such as Cardiogenic (due to heart problems), Anaphylactic (allergenic reaction), Septic (due to infections), Neurogenic (caused by damage to the nervous system), however, we will talk about Hypovolemic shock as well as its definition. Hypovolemic shock is defined as a life-threatening, emergency condition and it occurs when one’s body severely loses too much fluid or blood to sufficiently perfuse the cells. This type of shock can cause many organs to stop working. Hypovolemic shock generally occurs after the body has lost approximately one-fifth (1/5) of its volume of blood (Kolecki, 2014).
Hypovolemic shock can also be known as hemorrhagic shock (Nail, 2016) and due to some type of bleeding, being the normal cause for volume depletion.
The hemorrhages are either internal or external. The more obvious hemorrhage is the external hemorrhage. Most of the external hemorrhages come from some type of penetrating trauma, a GI bleed, or significant vaginal bleeding (Borke, 2015). The hardest to identify and diagnose are internal and the causes could greatly vary from a blunt force trauma that causes the internal bleeding such as bursting blood vessels, internal bleeding from abdominal organs or a ruptured ectopic pregnancy (Nail, 2016).
In addition to normal bleeding causes, hypovolemic shock can also originate from severe burns, excessive diarrhea, vomiting, or sweating; all of which can cause significant fluid volume loss (Nail, 2016).
Hypovolemic shock in patients will usually present with similar symptoms, and those symptoms could be mild or severe. The mild symptoms can range from headaches, fatigue, nausea, sweating and dizziness (Nail, 2016).
As a patient’s condition continues to deteriorate, symptoms will progress to cold, clammy, pale skin with rapid shallow breathing, a rapid heart rate (tachycardia), signs of confusion (altered mental status), weakness, cyanosis (bluing of the lips and nail beds), and have an altered levels of consciousness (Nail, 2016). Although external hemorrhages can be blatantly obvious; internal hemorrhages, conversely, are usually not. Their symptoms can vary from abdominal pain, blood in the stool, black tarry stools, blood in the urine, blood present in vomitus, chest pain and abdominal swelling (Nail, 2016).
A patient’s odds of a quick recovery from hypovolemic shock start with early detection. Completing a physical examination in a thorough and detailed mannor, some cues to the immediate problems will present themselves including low blood pressure (less than 90 systolic), lower body temperatures and a rapid weak pulse (Borke, 2015). Further testing can be done in a hospital setting to include various blood tests, CT or X-ray of suspected areas, endoscopy or colonoscopy, or urinary cauterization to measure output (Borke, 2015).
Treatment of hypovolemic shock starts with controlling bleeding if possible, keeping the patient warm with the use of blankets and placing in a position of comfort. These methods will act to prevent hypothermia which can further complicate the situation. Have the patient lay flat (supine) with their feet elevated approximately 12 inches upwards, which is known as the Trendelenburg position, to increase blood circulation (Borke, 2015). You may also place the patient on oxygen by nonrebreather or nasal cannula if O2 stats are low. Further prehospital treatment may include rapid patient packaging and transport, and calling for ALS intercept for IV fluids and or drug therapy by the Advanced Life Support methods to help maintain a perfusing blood pressure (Borke, 2015). Overall prognosis for the patient will depend on how severe the symptoms became and how long they symptoms carried on before corrective action was taken.
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