Hypovolemic shock is an emergency condition caused by the loss of blood and body fluids in large quantities, so that the heart cannot pump enough blood throughout the body. Hypovolemic shock must be urgent handled to prevent organ and tissue damage.
Hypovolemic shock is often the result of severe bleeding and dehydration. Hypovolemic shock is characterized by a drop in blood pressure, a drop in body temperature, and a fast but weak pulse.
Causes of Hypovolemic Shock
Hypovolemic shock occurs when the body loses a lot of blood or fluids. Apart from bleeding, the amount of blood circulating in the body can also decrease when a person loses too much body fluids.
Some conditions that can cause bleeding and trigger hypovolemic shock, namely:
- Extensive laceration
- Fracture
- Tearing or rupture of an aortic aneurysm
- Rupture or rupture of an ectopic pregnancy
- Placental abruption
- Injuries that damage organs, such as the liver, spleen, or kidneys
- Gastrointestinal bleeding
In addition to bleeding, hypovolemic shock can also occur due to severe dehydration which is prone to occur in the following conditions:
- Continuous diarrhea
- Constant vomiting
- Extensive burns
- Excessive sweating
Risk factors for hypovolemic shock
Hypovolemic shock is at risk in someone who has a disease that increases the risk of bleeding. Some diseases and conditions that can increase this risk are heart and blood vessel diseases, such as aortic aneurysms and disorders of the digestive tract, such as stomach ulcers and duodenal ulcers.
In addition, injuries experienced by a person, such as when experiencing a car or motorcycle accident, falling from a height, being stabbed by a sharp object, are also at risk of causing bleeding that can trigger hypovolemic shock.
Symptoms of Hypovolemic Shock
During hypovolemic shock, the heart is unable to pump sufficient blood throughout the body. As a result, the following complaints and symptoms will appear:
- Weak
- Decreased blood pressure (hypotension)
- Akral (finger tips or soles of the feet) cold
- The pulse is fast but feels weak
- Quick breath
- Heart pounding
- Infrequent urination or no urination at all
- Drop in body temperature
- Pale
- Anxious, confused, or restless
- Loss of consciousness to fainting
The appearance of signs and symptoms of hypovolemic shock will usually depend on the amount of blood or fluid lost, medical history, and previous drug use.
Hypovolemic shock that is not treated promptly can worsen rapidly. Hypovolemic shock caused by bleeding is also known as hemorrhagic shock. Based on the amount of blood lost, hemorrhagic shock can be divided into 4 stages, namely:
Bleeding grade 1
In this condition, bleeding causes blood loss up to 15% of the total body blood volume. In this condition, there are usually no symptoms that need to be watched out for. However, one of the signs that can be found at this stage is a faster pulse.
Bleeding grade 2
In this condition, bleeding causes blood loss of about 15–30% of the total blood volume in the body. At this stage, signs and symptoms will begin to appear, such as a rapid pulse rate, cold body, anxiety, rapid breathing, and a drop in blood pressure.
Bleeding grade 3
The volume of blood lost at this stage is about 30–40% of the total blood volume in the body. When experiencing grade 3 bleeding, the patient will experience a rapid pulse, drop in blood pressure, confusion, restlessness, reduced frequency of urination, and rapid breathing.
Bleeding grade 4
Grade 4 hemorrhage occurs when the amount of blood lost is more than 40% of the total blood volume in the body. This condition will be characterized by a rapid pulse but feels weaker, lower blood pressure, loss of consciousness, paleness, colder body, and no urine output.
Grade 4 hemorrhage is a dangerous and life-threatening condition.
When to go to the doctor
Go to the ER immediately if you have an injury that causes bleeding or another condition that can lead to hypovolemic shock, such as persistent diarrhea and vomiting. If you are around someone who is injured or bleeding profusely, call an ambulance immediately or take him to the ER.
Diagnosis of hypovolemic shock
Symptoms of hypovolemic shock can vary. If the patient comes with a decreased level of consciousness or loses consciousness, an examination will be carried out which includes the presence or absence of obstructions in the respiratory tract, respiratory rate, blood pressure, pulse, and body temperature.
While doing the examination, the doctor will provide initial treatment to stabilize the patient's condition. The doctor will also conduct a question and answer session with the person who brought the patient to the hospital. After that, the doctor will perform additional tests to determine the cause of hypovolemic shock. Some of the types of tests that will be performed are:
- Complete blood test, to confirm the reduced blood count
- Blood chemistry tests, to check kidney and heart muscle function
- Endoscopy, to examine the digestive tract and ensure there is bleeding from the digestive tract
- Scanning with X-rays, ultrasound, or CT scans, to confirm if there is bleeding in the suspected area
Hypovolemic shock can be caused by internal bleeding. In addition to injury or gastrointestinal bleeding, rupture or rupture of an ectopic pregnancy (pregnancy outside the womb) can also cause bleeding. In these patients, a pregnancy test will usually be done to confirm it.
Treatment of Hypovolemic Shock
Hypovolemic shock is an emergency condition. One of the causes of hypovolemic shock is bleeding due to injury. If you find or are in the vicinity of a person who is bleeding from an injury, immediately call an ambulance or ask someone nearby to contact the nearest health facility.
While waiting there are several things you can do, namely:
First aid
While waiting for the ambulance or before bringing the patient to the ER, first aid that needs to be done includes:
- Position the patient's body on a flat surface. If possible, raise your legs about 30 cm so that your head is lower than your feet.
- Do not change the patient's position if there is an injury to the head, neck, back, or legs, unless the patient is in danger, for example near an explosive object.
- Do not put any liquid into the patient's mouth and do not remove anything stuck in the patient's body, such as a knife or broken glass.
- Press the bleeding point with a cloth or towel to minimize the volume of wasted blood. If necessary, tie a cloth or towel tightly to the area.
- Keep the patient's body temperature warm to prevent hypothermia, for example by covering him.
- Stabilize the neck before transferring the patient into an ambulance or other means of transportation, if there is an injury to the neck or head.
Advanced help
After the patient is in the ER, medical staff will provide further assistance which includes:
- Supplemental oxygen administration or installation of breathing apparatus, to treat respiratory disorders in patients
- Rapid administration of intravenous fluids or blood transfusions, to return the patient's fluid and blood volume to normal levels
- Surgery, to stop bleeding that occurs outside or inside the body.
- Giving drugs in the form of dobutamine, dopamine, epinephrine, or norepinephrine, to increase the heart's ability to pump blood.
Complications of Hypovolemic Shock
Lack of blood and fluids in the body due to hypovolemic shock can lead to the following complications:
- Damage to organs, such as the kidneys or brain
- Gangrene of arms and legs
- Heart attack
If left untreated, hypovolemic shock can lead to death.
Prevention of Hypovolemic Shock
Hypovolemic shock can be prevented if things that cause severe bleeding or drastic loss of body fluids are treated immediately. Here are some things you can do to prevent hypovolemic shock:
- Use a helmet, seat belt or other safety equipment when driving or doing activities that pose a risk of injury.
- Immediately take the injured victim to the ER.
- Check with your doctor if you have problems with the digestive system, such as diarrhea, stomach ulcers, or bloody stools.
- Keep your heart and blood vessels healthy. If you have heart disease, have regular check-ups with your doctor.
- Sufficient body fluids to prevent dehydration due to vomiting and diarrhea.