If hypovolemic shock is already at a late stage, the patient will experience the following symptoms:
- Bradycardia or tachycardia.
- The pulse will be weak.
- The limbs will be cold.
- There may be hypothermia, i.e., hypothermia of the body.
- The amount of urine will be significantly less (oliguria).
- A person will feel general weakness.
- Depression or stupor may also occur.
There are three main stages of hypovolemic shock:
First one. Shock develops due to blood loss of not more than 25% of the total volume (maximum 1300 ml). Here it must be sa >
Mild manifestations of hypovolemia can be eliminated by the use of slightly salted water (it should be drunk slowly, in small sips). With severe diarrhea, vomiting or high temperature, causing profuse sweating, the patient should drink as much tea, fruit drinks, juices, decoctions or saline solutions (Ringer, Regidron, etc.) as possible. Immediate medical attention for such hypovolemic reactions is also mandatory.
If more severe signs of shock are detected – a significant decrease in pressure, weakening and increased heart rate, pallor and cooling of the skin – it is necessary to call an ambulance and begin to provide first-aid emergency care:
- Lay the victim on a flat surface, raising his legs by about 30 cm. Provide him with peace and immobility. If the victim is in an unconscious state, then to prevent choking of vomit, the head must be turned to one side.
- If you suspect a back or head injury, refrain from moving the patient or perform these actions with extreme care and accuracy.
- In case of external bleeding, stop it: immobilization of the limb, pressure bandage or application of a tourniquet (be sure to indicate the time of application). With internal bleeding, apply an ice bubble to the area of its source.
- With open wounds, clean them of visible impurities, treat with an antiseptic solution and apply a bandage from a sterile bandage.
- Ensure optimal temperature conditions. The victim must be warm.
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What not to do
- Offer the patient water, tea or other liquids, because their ingestion in the respiratory tract can cause choking.
- Raise the head, because such an action will cause an even greater outflow of blood from the brain.
- Remove items stuck in the wound (knife, rod, glass, etc.), because such an action can increase bleeding.
After the arrival of the ambulance, the implementation of infusion therapy aimed at replenishing the lost blood begins. For this, the patient’s vein is punctured and injected with saline, 5% glucose, Albumin or Reopoliglukin. In addition, cardiac glycosides that support cardiac activity, and other means for symptomatic therapy, are introduced.
During transportation of the patient to the hospital, doctors conduct constant monitoring of blood pressure and heart rate. Their measurement is carried out every 30 minutes.
Depending on the preliminary diagnosis of a patient with hypovolemic shock, they are hospitalized in the intensive care unit of a medical institution with a surgical profile or in the intensive care unit of the infectious department. After the diagnosis, the volume of which is determined by the clinical case, a decision is made about the need for surgical treatment or a conservative therapy plan is drawn up.
The goals of treatment for hypovolemic shock are aimed at:
- restoration of the volume of circulating blood;
- normalization of blood circulation of the brain, lungs, heart and the elimination of hypoxia;
- stabilization of acid-base and electrolyte balance;
- normalization of blood supply to the kidneys and restoration of their functions;
- support for brain and heart activity.
The need for surgery arises when it is impossible to eliminate the cause of blood loss in other ways. The method and timing of the intervention in such cases is determined by the clinical case.
After admission to the hospital and a preliminary diagnosis is made to restore the lost blood from the patient’s vein, blood sampling is performed to determine the group and the Rh factor. While this indicator is unknown, a catheter is inserted into the subclavian vein or 2-3 veins are punctured to infuse large volumes of fluid and blood. A catheter is inserted into the bladder to control the volume of urine output and the effectiveness of correcting the shock state.
To replenish the blood volume can be used:
- blood substitutes (solutions of Polyglukin, Reopoliglukin, Albumin, Protein);
- blood plasma;
- single-group blood.
The volume of injected fluids is determined individually for each patient.
To eliminate ischemia, leading to oxygen starvation of tissues and organs, oxygen therapy is performed to the patient. Nasal catheters or an oxygen mask can be used to inject the gas mixture. In some cases, mechanical ventilation is recommended.
To eliminate the effects of hypovolemic shock, the following medications may be indicated:
- glucocorticoids – are used in large doses to eliminate spasm of peripheral vessels;
- sodium bicarbonate solution – to eliminate acidosis;
- Panangin – to eliminate the deficiency of potassium and magnesium.
If hemodynamic parameters do not stabilize, blood pressure remains low and less than 50-60 ml of urine is released through the urinary catheter in 1 hour, then the introduction of Mannitol is recommended to stimulate diuresis. And to maintain the activity of the heart, solutions of Dobutamine, Dopamine, Adrenaline and / or Norepinephrine are administered.
The following indicators indicate the elimination of hypovolemic shock:
- stabilization of blood pressure and heart rate;
- excretion of urine at 50-60 ml per hour;
- increase in central venous pressure to a mark of 120 mm of water. Art.
After stabilization of the patient’s condition, treatment is prescribed aimed at eliminating the disease that caused hypovolemic shock. His plan is determined by the data of diagnostic studies and is compiled individually for each patient.
Hypovolemic shock occurs with a critical decrease in the volume of circulating blood. This condition is accompanied by a decrease in stroke volume of the heart and a decrease in the filling of its ventricles. As a result, blood supply to tissues and organs becomes insufficient and hypoxia and metabolic acidosis develop. This condition of the patient always requires immediate medical attention, which may consist in performing a surgical operation to stop bleeding and conservative therapy aimed at eliminating the causes and consequences of shock.
The state of shock is dangerous for the body. Indeed, in this case, a cascade of the most important changes occurs, which can very negatively affect the patient’s condition. In this article I want to talk more about what hypovolemic shock is.
If a person has hypovolemic shock, emergency care is what matters. So, it is worth remembering that the victim needs to provide the range of services that will not worsen the patient’s condition.
- At the very beginning, the cause of the shock must be completely eliminated. So, you have to stop the bleeding, extinguish burning clothes or body tissues, release the pinched limb.
- Next, you need to carefully check the nose and mouth of the victim. If necessary, remove all unnecessary items from there.
- It is also necessary to check for a pulse, listen for breathing. At this stage, you may need an indirect heart massage or artificial respiration.
- Be sure to make sure that the victim is lying correctly. So, his head should be inclined to one side. In this case, the tongue will not fall and the patient will not be able to choke on his own vomit.
- If the victim is conscious, he can be given an anesthetic. If there is no abdominal injury, you can also offer the patient hot tea.
- The victim’s body should not be constrained, all clothing should be loosened. Especially the chest, neck, and lower back should not be squeezed.
- Be sure to ensure that the victim does not overheat or overcool.
- You also need to remember that the victim should not be left alone. In this condition, it is strictly forbidden to smoke. You can not apply a heating pad to the affected areas.
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