SYMPTOMS/EXAM
■ Vary somewhat with underlying etiology (eg, fever with sepsis, elevated
JVP with cardiogenic shock)
■ Ill appearance, mottling of skin, pallor
■ Abnormal VS: Classically, hypotension, HR > 100, and RR > 22
■ Changes in mental status
■ Decreased urine output: < 0.5–1 mL/kg/hrDIAGNOSIS
■ Based on presence of inadequate tissue oxygenation
■ Suspected based on clinical findings (above) and confirmed by laboratory
studies
■ Base deficit
■ The amount of strong base needed to normalize pH of 1 L of blood
■ Indirectly calculated from arterial pH and
■ Abnormal if more negative than −5mEq/L
■ Lactic acidosis: Serum lactate > 4 mmol/L
■ Multiorgan dysfunction
■ Elevated renal or hepatic function tests
■ Respiratory failure
■ Stress hormone release →
■ Mild hyperglycemia
■ Mild hypokalemiaTREATMENT
■ Ensure adequate ventilation and oxygenation.
■ Improve work of breathing.
■ Intubation or noninvasive ventilation as needed
■ Maximize intravascular volume: Fluids, blood, pressors
■ Treat underlying cause.Hypovolemic ShockHypovolemic shock occurs when one of either intravascular or total body vol-
ume is depleted. The former is seen with acute hemorrhage (hemorrhagic
shock) while the latter is seen in cases where there is an imbalance between
intake and output (nonhemorrhagic hypovolemic shock).HEMORRHAGICSHOCKCAUSES
Causes include:
■ External bleeding, usually due to trauma
■ Internal bleeding including AAA, GI sources, blunt trauma, fractures, arterial
or venous injury, ectopic pregnancyDIAGNOSIS
■ Diagnosis is mostly clinical.
■ Labs may be normal at presentation.
■ With time and volume resuscitation hemoglobin and hematocrit will fall.RESUSCITATION
A “normal” blood pressure
does not exclude the
diagnosis of shock.Laboratory evidence for
inadequate tissue
oxygenation:
Base deficit more negative
than –5mEq/L.
Serum lactate > 4 mmol/L.
Multiorgan dysfunction.In acute hemorrhagic shock,
the initial hemoglobin may be
deceptively normal.