HYPOVOLEMIC SHOCK

is an urgent medical condition in which a rapid decrease of the volume of the intravascular fluid (water, plasma or whole blood due to fluid loss) results in inadequate perfusion of the peripheral tissues and, eventually, in multiple organ failure

most common type of shock

(diarrhea in children, severe bleeding in adults) http://www.ehealthstar.com

occurs when there is reduction in blood volume by 15%- 25%.

CAUSES:

Loss of body fluids other than blood

STAGES OF HYPOVOLEMIC SHOCK:

Stage 1

Stage 2

Stage 3

Stage 4

Blood volume loss

<15% (< 750 mL)

>40% 15-30% 30-40% (>2,000 mL) (750-1,500 (1,500(immediately mL) 2,000 mL) life threatening)

Major GOALS in the treatment of Hypovolemic Shock are to: Restore Intravascular volume Redistribute Fluid Volume Correct Underlying Cause of Fluid Loss as quickly as possible
LIFE THRETHENING:

Chest
Abdomen Thighs

External Bleeding
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CASE:

A 25 y/o male client arrives at ER at around 7:30pm dated November 12, 2013 accompanied by friends due to a motorcycle accident at Bimmaley, Pangasinan

COMPLAINTS:
SUBJECTIVE OBJECTIVE

Abdominal pain with severe affection on Left flank area to Left shoulder (Kehr sign)

Anxious +Alcohol breath Abdominal guarding Pale in appearance Bruising on flank area(turners sign) and in Left extremities Hematemesis Abdominal tenderness HR= 115 RR= 29 Temp.= 36 degrees BP= 90/60mmhg
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PHYSICAL EXAM

PAS T M E D I C AL H I S TO RY:

+smoking +drinking

-drugs
BP- ranging from 110/80- 130/80

Appendectomydone when he was 18y/o

FA M I LY H I S T O R Y

+ hypertention

-DM
+stroke

MEDICAL AND NURSING INTERVENTIONS

O2 inhalation at 4LPM CBC with PC Blood typing H and H Serum electrolytes ECG CT scan of abdomen X Ray = cranial, chest, abdominal, IFC NGT ex lap
Raise side rails Modified trendelenburg position

LAB AND IMAGING RESULTS

CBC RBC= 4 million/cu mm WBC= 5551/cu mm PC185,000/mm3 blood typing- B+ HemoglobinHematocrit11.5 gm/dl 39% (13-18 gm/dl) (42-52 %) low low (4.6-6.2 million/cu mm) (4500-11000/cu mm) (150000-450000/mm3) low normal normal

Serum electrolytesSodium155meqs/L (135-144meqs/L) high Potassium3.2mg/100ml (3-4.5 mg/100ml) normal Calcium9.2mg/dl (8.5-10.2 mg/dl) normal Cholesterol289mg/dl (150-200mg/dl) high

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CT scan result - Intra-parenchymal blush on spleen, spleenic injury Grade 3

X- Ray- chest cranial abdomen

calcified splenic

left lower rib fracture Normal peripherally calcified mass in the left upper quadrant under the diaphragm. The mass represents a hematoma.

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Exploratory laparotomy celiotomy for hemoperitoneum splenorrhaphy

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PATHOPHYSIOLOGY:
Vehicular Accident (blunt injury)
Abdominal pain, Kehr sign, Hematemesis

Intra-parenchymal blush on spleen, spleenic injury Grade 4, decreased H&H

Lab and imaging tests

Spleen rupture

HYPOVOLE MIA
(DECREASED BLOOD VOLUME)

Intra abdominal hemorrhage turners sign

Decreased venous return Decreased stroke volume (Preload, afterload, contractility)

Decreased cardiac output

Decreased tissue perfusion Altered LOC Hypotension, tachycardia, tachypnea

SHOCK

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