TREATMENT
■ Ensure adequate oxygenation and ventilation.
■ Volume resuscitation
■ NS or Ringer’s lactateboluses through large peripheral intravenous
lines, central lines, or intraosseous lines.
■ 1–2 L in adults
■ 10–20 cc/kg in neonates, infants, and young children
■ Blood productsif no response to two fluid boluses, ongoing hemor-
rhage, or if impending cardiovascular collapse
■ When time is critical, the use of O-negative blood is standard
(O-positive in men is also acceptable).
■ Two units PRBC in adults
■ 10–15 mL/kg PRBC in neonates, infants, and young children
■ Hemorrhage control
■ Control source of bleeding.
■ Fix hereditary or acquired bleeding diatheses:
■ Platelets when platelet count is <50,000/μL
■ Fresh frozen plasma (FFP), prothrombin complex concentrate,
or recombinant factor VIIa for patients on warfarin with an ele-
vated INR
■ FFP and/or cryoprecipitate and specific factors for hemophiliacs
NONHEMORRHAGICHYPOVOLEMICSHOCK
Nonhemorrhagic hypovolemic shock arises when volume intake is insufficient
to make up for volume losses.Laboratory analyses are almost always abnormal
in these cases since they generally occur over a period of time.
CAUSES
Causes include:
■ Inadequate intake
■ Excessive output: Respiratory, renal diuresis, GI losses, skin losses
■ Metabolic derangement (inborn error of metabolism)
DIAGNOSIS
■ Hematocrit and hemoglobin levels are high due to hemoconcentration.
■ BUN rises in relation to creatinine secondary to decreased tubular flow.
■ Sodium is usually elevated secondary to free water loss.
■ In DKA and hyperosmolar states, sodium may be factitiously low.
TREATMENT
■ Ensure adequate ventilation and oxygenation.
■ Immediate isotonic intravascular volume resuscitation
■ NS or Ringer’s lactate boluses
■ 1–2 L in adults
■ 20 cc/kg over 5–20 minutes in neonates and pediatrics
■ Restore total body water and sodium.
■ Adults: 0.45 NS with or without 5% dextrose at a rate of 100–200 cc/hr
■ Pediatrics
■ Deficit fluids: Percent fluid loss x weight (kg) = L deficit. (ie, 10%
loss in 20 kg child = 2 L fluid deficit). Replace one-half the deficit
over first 8 hours and remainder over next 16 hours.
RESUSCITATIONIndications for PRBC
tranfusion in hemorrhagic
shock:
No response to two fluid
boluses
Ongoing hemorrhage
Impending CV collapse