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Hypovolaemic shock (Classification (Haemorrhagic) (Class 2 Blood loss…
Hypovolaemic shock
Classification
(Haemorrhagic)
Class 2
Blood loss 750-1500mL (15-30%)
Tachycardia, tachypnoea, anxious
Class 3
Blood loss 1500-2000mL (30-40%)
Tachycardia, tachypnoea, hypotension,
reduced UO, confused
Class 1
Blood loss <750mL (<15%)
Asymptomatic
Class 4
Blood loss >2000mL (>40%)
Tachycardia, tachypnoea, hypotension,
anuric, confused/coma
Clinical
presentation
Palpitations
Confusion/coma
SOB
Loss of conciousness
Pathophysiology
Haemorrhage
Trauma (internal/external)
GI bleed, AAA, ectopic preg
Na and water loss
Diarrhoea
Vomiting
Burns
Polyuria (DI/DM)
Third space loss
Pancreatitis
Ascites
Diagnosis
Examination
General: pale, cold, signs of trauma
Cardio: high HR, low BP, pale, cold
Resp: may have high RR
Abdo: pulsating mass (AAA), bruising (pancreatitis),
distension, shifting dullness (ascites)
Neuro: reduced GCS
Investigations
Bedside
Obs: high HR, low BP
ECG: sinus tachy, arrhythmia
BM: may be hypo
Bloods
Major haemorrhage protocol
Group+save, crossmatch
ABG, FBC (anemia), U+E (dehydration), LFTs,
clotting, glucose (DM), amylase (pancreatitis)
Imaging
CXR - haemothorax
AXR/pelvic XR - pelvic fracture
FAST scan - abdominal fluid, AAA
CT abdo/pelvis - pancreatitis, AAA
Microbiology
Stool - MCS, C diff toxin, norovirus PCR
History
PC/HPC: trauma, D+V, burns
PMH: DM,, pancreatitis, AAA
DH: meds, allergies
SH: alcohol, drugs, smoking
Management
Initial ABCDE
Particularly fluid resus
Definitive
Conservative
Monitoring (obs)
Identify cause
ITU/HDU referral if refractory to fluids
Medical
RBC replacement
Indication: haemorrhage
E.g. packed red cells plus FFP (1:1)
MOA: replace lost RBCs and clotting factors
Fluids
E.g. IV 0.9% saline
MOA: intravascular vol replacement
Definition
Systemic shock due to reduced
circulating blood volume