Hypovolemic shock is a loss of blood volume leading to decreased oxygenation of vital organs. The body’s compensatory mechanisms fail and organs begin to shut down.
Any condition causing loss of circulating blood or plasma volume. Hemorrhage from any large source. Traumatic injuries. Burns (plasma loss due to capillary permeability). Prolonged vomiting or diarrhea.
The goal is to restore circulating blood volume, preserve hemodynamics, and prevent any damage to vital organs.
Causes of shock include:
Nurses should assess their patient for the risk of developing hypovolemic shock. The patient may have lost some fluid already, or maybe they’re at risk for bleeding. Either way, the more aware the nurse is of the risk, the more likely it can be prevented or caught early.
Patient may develop tachycardia and tachypnea in the early stages, then hypotension in later stages. It’s important to note these changes in the patient. Monitoring VS could help to prevent hypovolemic shock if caught early, but will also help to determine the patient’s response to treatment.
Level of consciousness should be assessed because it may decrease as the patient loses oxygenation of their brain. Decreasing LOC is a sign of advancing shock.
Notify the provider for:
Hemodynamic measurements will tell us the severity of the shock and how well the patient is responding to treatment.
Arterial lines are placed for invasive hemodynamic monitoring. They can measure MAP, but can also measure other hemodynamic values such as CO/CI, SVR, SV, etc. when using a FloTrac machine.
Central lines are placed for administration of fluids and medications as well as hemodynamic monitoring of CVP, CO/CI, and SVR. Patients who have severe hemorrhages may receive a large bore (12g) central catheter called a Cordis so they can receive large volumes of fluids rapidly.
Patients whose airway has been compromised due to ↓ LOC may need to be intubated to protect their airway, and placed on a ventilator.
Patients may need to be taken to the OR to repair the injury or internal bleeding that caused the hypovolemia in the first place.
**Informed consent MUST be obtained by the provider. You can explain procedures to patients/family, but the provider must give the reason, risks, benefits, etc. and obtain the informed consent.
How fast can 1 L be infused?
12g Cordis – 1:05 min
16g PIV – 2:20 min
18g PIV – 4:23 min
14g CVC – 5:20 min
20g PIV – 6:47 min
PIV = Peripheral IV catheter
CVC = Central Venous Catheter
The patient will need large bore IV access in order to administer fluid resuscitation. This should be done with a pressure bag or rapid infuser.
The highest possible rate on an infusion pump is 999 mL/hr. At this rate, 1 L of fluids takes 1 hour to infuse. Shorter and thicker catheters will provide for faster fluid administration.
Fluids should be given as soon and as fast as possible to restore circulating blood volume.
For patients who have lost significant amounts of blood due to trauma or hemorrhage, they should receive transfusions of blood products.
Be sure that consent is obtained and that the patient is aware of possible reactions. Send a type and crossmatch to determine the patient’s blood type. Verify the blood product with another nurse prior to administering and monitor per facility protocol for transfusion reactions. Usually this is q15min x 2, q30 min x 1, and q1h after that for standard infusions. However, in hypovolemic shock, even blood products are given via rapid infusion.
Packed Red Blood Cells (PRBC’s) do not contain clotting factors, platelets, or plasma – therefore patients may have trouble clotting after receiving multiple units of PRBC’s. During massive transfusion protocol, units of plasma, platelets, and clotting factors are given at certain intervals to prevent this clotting problem.
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