What Are the Symptoms of Hypovolemic Shock?

1.Exogenous loss of circulation capacity is lost directly to the body, such as trauma, burns, blood loss during major surgical operations, gastrointestinal ulcers, esophageal varices rupture, and ectopic pregnancy rupture. It can also be caused by vomiting, diarrhea, dehydration, polyuria, etc. To.
2. Endogenous volume loss The loss of circulatory volume outside the circulatory system is mainly due to increased vascular permeability caused by allergies, hypoalbuminemia, and endocrine dysfunction, which leads to extravasation of circulatory volume to the interstitial space or thoracic and abdominal cavity. A "third interstitial liquid" is formed.

Basic Information

Causes of hypovolemic shock

Clinical manifestations of hypovolemic shock

Patients with hypovolemic shock may experience clinical symptoms such as palpitations, dizziness, fatigue, sweating, syncope, oliguria, rapid breathing, cold and pale skin, and altered mental status (apathetic drowsiness or restlessness). Special attention should be paid to the early symptoms of internal bleeding such as sweating, palpitations, fatigue, and light-headedness. Patients can also develop symptoms related to the cause, such as bloody stools, blood in the stool, blood in the urine, diarrhea, vomiting, polyuria, and bleeding from the skin and mucous membranes. Patients with trauma should ask about chest pain, abdominal pain, low back and limb pain, and ask about injury mechanisms, such as high fall injuries, traffic injuries being thrown out of the car, being crushed, etc. Early blood pressure may not drop or slightly increase, and later manifested as blood pressure decline.

Hypovolemic shock test

1. Low oxygen saturation in central venous blood gas The hypovolemic shock compensatory period can be completely normal or manifested as a decrease in oxygen saturation in central venous blood gas.
2. Metabolic acidosis can be manifested as metabolic acidosis during decompensation.
3. If hemoglobin is mainly caused by blood loss, it may be manifested as a progressive decrease in hemoglobin; if hemoglobin is mainly caused by hemorrhage, hemoglobin may not decrease or even increase due to the effect of concentration.
4. The pH of other blood decreased, the residual alkali (BE) decreased, and the lactic acid increased.

Diagnosis of hypovolemic shock

Hypovolemic shock should be considered in one or more of the following situations.
1. There are trauma, burns, gastrointestinal bleeding, diarrhea, intestinal fistula and other causes of blood volume reduction, that is, acute massive blood loss or body fluid loss secondary to inside and outside the body, or a history of severe inadequate fluid (water) intake.
2. The systolic blood pressure is lower than 90 80mmHg, or the blood pressure of the patients with hypertension is reduced by more than 20%, the capillary filling time is prolonged, and it cannot be corrected after the initial fluid resuscitation.
3. Patients have thirst, excitement, irritability, and then appear indifferent, blurred or even coma, skin cold and cold, decreased urine output (urinary volume <30 ml / h), low perfusion such as increased heart rate, and superficial vein atrophy Clinical manifestations of depression, pale to cyanosis, shallow breathing, fine pulse, and decreased body temperature.
4. Increased plasma lactic acid concentration, decreased hemoglobin or hematocrit, increased urine specific gravity or urine osmotic pressure, central venous pressure (CVP) <5 mmHg and pulmonary capillary wedge pressure (PCWP) <8 mmHg, decreased cardiac output .

Hypovolemic shock treatment

1. Actively correcting the cause of low-volume shock is a basic measure of treatment. For patients with shock with a clear bleeding site and active blood loss, surgery or intervention to stop bleeding should be performed as soon as possible. For patients with unclear bleeding sites and active blood loss, various necessary means including ultrasound and CT should be quickly used to find the cause.
2. To ensure tissue oxygen supply, transfusion should be considered when hemoglobin is reduced to 70g / L.
3 Patients with hypovolemic shock generally do not first use vasoconstrictors. Studies have confirmed that these drugs can further exacerbate organ hypoperfusion and hypoxia.