Hypovolemic Shock Workup

Updated: Oct 13, 2016
  • Author: Paul Kolecki, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
  • Print
Workup

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), lactate, prothrombin time, activated partial thromboplastin time, ABGs, urinalysis (in patients with trauma), and a urine pregnancy test. Blood should be typed and cross-matched.

Next:

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.

Previous