Hypovolemic Shock Workup

  • Author: Paul Kolecki, MD, FACEP; Chief Editor: David FM Brown, MD   more...
 
Updated: Mar 21, 2012
 

Laboratory Studies

  • After the history is taken and the physical examination is performed, further workup depends on the probable cause of the hypovolemia, as well as on the stability of the patient's condition.
  • Initial laboratory studies should include analysis of the CBC, electrolyte levels (eg, Na, K, Cl, HCO3, BUN, creatinine, glucose levels), prothrombin time, activated partial thromboplastin time, ABGs, urinalysis (in patients with trauma), and a urine pregnancy test. Blood should be typed and cross-matched.
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Imaging Studies

  • Patients with marked hypotension and/or unstable conditions must first be resuscitated adequately. This treatment takes precedence over imaging studies and may include immediate interventions and immediately taking the patient to the operating room.
  • The workup for the patient with trauma and signs and symptoms of hypovolemia is directed toward finding the source of blood loss.
  • The atraumatic patient with hypovolemic shock requires ultrasonographic examination in the ED if an abdominal aortic aneurysm is suspected. If GI bleeding is suspected, a nasogastric tube should be placed, and gastric lavage should be performed. An upright chest radiograph should be obtained if a perforated ulcer or Boerhaave syndrome is a possibility. Endoscopy can be performed (usually after the patient has been admitted) to further delineate the source of bleeding.
  • A pregnancy test should be performed in all female patients of childbearing age. If the patient is pregnant and in shock, surgical consultation and the consideration of bedside pelvic ultrasonography should be immediately performed in the ED. Hypovolemic shock secondary to an ectopic pregnancy is common. Hypovolemic shock secondary to an ectopic pregnancy in a patient with a negative pregnancy test, although rare, has been reported.
  • If thoracic dissection is suspected because of the mechanism and initial chest radiographic findings, the workup may include transesophageal echocardiography, aortography, or CT scanning of the chest.
  • If a traumatic abdominal injury is suspected, a focused abdominal sonography for trauma (FAST) ultrasonography examination may be performed in the stable or unstable patient. Computed tomography (CT) scanning typically is performed in the stable patient.
  • If long-bone fractures are suspected, radiographs should be obtained.
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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  Associate Professor, Department of Emergency Medicine, Medical College of Georgia; Medical Director and Chairman, Medical Center of Lewisville; Regional Ultrasound Director, Questcare Partners

Carl R Menckhoff, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD, FACEP, FAAP, FAAEM  Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

A Antoine Kazzi  MD, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

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  Associate 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.

References

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