Principles of treatment of Hypovolemic Shock

The essential principles in management of hypovolemic shock are:-

  1. Resuscitation
  2. Diagnosis &
  3. Treatment of underlying cause

Resuscitation: The mainstays of early treatment– infusion of fluid and O2 administration with the aim of improving cardiac output and oxygen transport. ABC protocol needs to be followed. The indices of tissue perfusion( a lucid patient with rapid capillary refill, warm dry skin, & a good urine output) are most useful in the early management of hypovolemia.

  • Fluid administration (initial bolus10 ml/kg body weight crystalloid if normotensive, 20 ml/kg body weight if hypotensive), colloid & blood transfusion can be added depending on the underlying cause e.g. hemorrhage & the response of the treatment.
  • Oxygen- initially to be given in high concentration (12–15 l/min) until blood gas analysis or saturation measurements available.
  • Monitoring & Instrumentation- IV access/venous cut-down, bladder catheterisation, ECG, Pulse Oximeter, CVP line.

Diagnosis: by history, clinical & radiological examinations & investigations of the underlying cause {Hemorrhagic-trauma, GI bleeding, ruptured aneurysm or hematoma, fistula, post-partum hemorrhage; Non-hemorrhagic– gastrointestinal fluid losses, skin losses (e.g., burns or Stevens-Johnson syndrome), renal losses, 3rd space losses}.

Treatment of underlying cause: A successful treatment depends largely on detection and elimination of the underlying cause, e.g., major haemorrhage with exsanguinating patients need immediate definitive
treatment like surgical intervention.

Assessment of Response– is one of the most important measures. During resuscitation & thereafter every 30 minutes or so, reassessment of patient’s progress needs to be done. In case of no improvement, a change in plan of action may be required. It will detect temporary responders & those cases which were initially misjudged.