eMedicine Specialties > Emergency Medicine > Cardiovascular

Shock, Hypovolemic: Follow-up

Author: Paul Kolecki, MD, FACEP, Associate Professor, Department of Emergency Medicine, Thomas Jefferson University Hospital, Director of Undergraduate Emergency Medicine Student Education, Jefferson Medical College, Philadelphia, PA, Consultant, Philadelphia Poison Control Center, Philadelphia, PA
Coauthor(s): Carl R Menckhoff, MD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Medical College of Georgia
Contributor Information and Disclosures

Updated: Sep 14, 2009

Follow-up

Complications

  • Neurologic sequelae
  • Death

Prognosis

  • The prognosis is dependent on the degree of volume loss.

Patient Education

  • For excellent patient education resources, visit eMedicine's Shock Center. Also, see eMedicine's patient education article Shock.

Miscellaneous

Medicolegal Pitfalls

  • A common error in the management of hypovolemic shock is failure to recognize it early.
    • This error leads to delay in diagnosing the cause and in resuscitating the patient.
    • This error often is caused by a reliance on BP or initial hematocrit level, rather than signs of decreased peripheral perfusion, to make the diagnosis.
    • Injuries in patients with trauma can be missed, especially if the examiner focuses on more obvious injuries. This error can be avoided by completing a full physical examination, continuously and closely monitoring the patient's status, and performing serial examinations.
    • Elderly individuals have less tolerance for hypovolemia compared with the rest of the general population. Aggressive therapy should be instituted early to prevent potential complications, such as myocardial infarction and stroke.
    • In patients who require extensive volume resuscitation, care should be taken to prevent hypothermia, because this can contribute to arrhythmia or coagulopathy. Hypothermia can be prevented by warming the intravenous fluids prior to their administration.
    • Patients taking beta-blockers or calcium-channel blockers and those with pacemakers may not have a tachycardic response to hypovolemia; this lack of response may lead to a delay in the diagnosis of shock. To minimize this potential delay, history taking should always include questioning about medications. The examiner should also rely on signs of decreased peripheral perfusion other than tachycardia.
    • Coagulopathies can occur in patients receiving large amounts of volume resuscitation. This is due to dilution of platelets and clotting factors but is rare within the first hour of resuscitation. Baseline coagulation studies should be drawn and should guide the administration of platelets and fresh frozen plasma.
 


More on Shock, Hypovolemic

Overview: Shock, Hypovolemic
Differential Diagnoses & Workup: Shock, Hypovolemic
Treatment & Medication: Shock, Hypovolemic
Follow-up: Shock, Hypovolemic
References
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References

  1. Sarkar D, Philbeck T. The use of multiple intraosseous catheters in combat casualty resuscitation. Mil Med. Feb 2009;174(2):106-8. [Medline].

  2. Ghafari MH, Moosavizadeh SA, Moharari RS, Khashayar P. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock. Middle East J Anesthesiol. Oct 2008;19(6):1337-47. [Medline].

  3. Burns B, Gentilello L, Elliot A, Shafi S. Prehospital hypotension redefined. J Trauma-Injury Infection and Crit Care. Dec 2008;65(6):1217-21. [Medline].

  4. Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma. Jun 2002;52(6):1141-6. [Medline].

  5. Graham CA, Parke TR. Critical care in the emergency department: shock and circulatory support. Emerg Med J. Jan 2005;22(1):17-21. [Medline].

  6. Langley DM, Moran M. Intraosseous needles: they're not just for kids anymore. J Emerg Nurs. Aug 2008;34(4):318-9. [Medline].

  7. Ogino R, Suzuki K, Kohno M, et al. Effects of hypertonic saline and dextran 70 on cardiac contractility after hemorrhagic shock. J Trauma. Jan 1998;44(1):59-69. [Medline].

  8. Silbergleit R, Satz W, McNamara RM, et al. Effect of permissive hypotension in continuous uncontrolled intra-abdominal hemorrhage. Acad Emerg Med. Oct 1996;3(10):922-6. [Medline].

  9. Skagius E, Siegbahn A, Bergqvist D, Henriksson A. Activated coagulation in patients with shock due to ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. Jan 2008;35(1):37-40. [Medline].

  10. Smith K, Deimling DL, Hinckley WR. Transporting the pregnant patient in shock; case report and review. Air Medical J. Jan-Feb 2009;28(1):37-9. [Medline].

  11. Stern SA. Low-volume fluid resuscitation for presumed hemorrhagic shock: helpful or harmful?. Curr Opin Crit Care. Dec 2001;7(6):422-30. [Medline].

  12. Yajima D, Motani H, Hayakawa M, Sato Y, Iwase H. A fatal case of hypovolemic shock after cesarean section. Am J Forensic Med Pathol. Sep 2007;28(3):212-5. [Medline].

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Further Reading

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Keywords

hypovolemic shock, inadequate perfusion, rapid blood loss, acute internal blood loss, hemorrhagic shock, hemorrhage, acute hemorrhage, multiple organ failure, shock, rapid fluid loss, GI bleeding, penetrating trauma

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Contributor Information and Disclosures

Author

Paul Kolecki, MD, FACEP, Associate Professor, Department of Emergency Medicine, Thomas Jefferson University Hospital, Director of Undergraduate Emergency Medicine Student Education, Jefferson Medical College, Philadelphia, PA, Consultant, Philadelphia Poison Control Center, Philadelphia, PA
Paul Kolecki, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Carl R Menckhoff, MD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Medical College of Georgia
Carl R Menckhoff, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston
Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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