Hypovolemic Shock & Hemorrhagic Shock

By Author: Michael Morales
Total Articles: 2
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Treatment for hemorrhagic shock focuses on identifying the cause and reversing it. If it is simply a lack of water volume, intravenous fluid administration can reverse the effects of fluid loss. If there is an underlying condition causing fluid to be excessively excreted from the body, then that is also corrected. Treatment of hemorrhagic shock centers on controlling the source of bleeding and, if necessary, blood transfusions can replenish the body of the red blood cells it lost. With chronic blood loss, the body learns to compensate and can perfuse the smaller capillary beds, but often the patient will have a reduced exercise tolerance or ability to exercise or even sometimes perform activities of daily living well without becoming symptomatic (Wedro, 2007).

In hypovolemic shock, intravenous infusions of fluid are administered to replace fluid/electrolyte losses. Sodium helps to keep the fluid in the intravascular space (Wikipedia, 2008). Giving too much "free water" or solutions without electrolytes in them will cause brain swelling as the excess fluid is shunted to the brain. Brain swelling causes increased cranial ...
... pressure and can lead to cell death. Blood loss of more than 20% must have blood replacement, while smaller losses of blood can simply be replaced with isotonic fluid replacement (Wikipedia, 2008). Hemorrhagic shock unresponsive to 2 L for adults (smaller amounts for children based on size) of crystalloid are often treated with blood infusion.

Vasopressor agents are not indicated for treatment of hemorrhagic shock unless other forms of shock are present such as cardiogenic, obstructive, or distributive shock (Weil, 2007). Replacement of proteins in the blood via the administration of albumin may also be helpful to increase blood pressure due to protein loss through membrane permeability. When metabolic acidosis is present, it is treated by reversing the source of lactic acid or pyruvic acid production by increasing perfusion and oxygen/glucose to the cells (Wikipedia, 2008).
Michael Morales is an EMT - Paramedic and the program director for Vital Ethics Inc., which provides basic and advanced life support training and certification programs to health care professionals.