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  • Image not available. Plasma does not have to be lost from the body for hypovolemic shock to occur.
  • Image not available. Patients may die of hypovolemic shock despite having normal serum electrolyte concentrations.
  • Image not available. Although the Starling equation of fluid transport is useful for understanding the factors involved in fluid shifting between compartments, it is not a practical tool for use in the clinical setting.
  • Image not available. Patients may have complications and death as a result of reperfusion injury as well as the initial insult.
  • Image not available. The clinical presentation of patients with hypovolemic shock can vary substantially, depending on concomitant disease states, medications, and cause of hypovolemia.
  • Image not available. The initial monitoring of a patient with suspected intravascular depletion always should include vital signs, urine output, mental status, and physical examination.
  • Image not available. The need for intravenous (versus oral) rehydration in children often is overestimated.
  • Image not available. Crystalloid (sodium-containing) solutions should be used for most forms of circulatory insufficiency that are associated with hemodynamic instability.
  • Image not available. Neither crystalloids nor colloids have the oxygen-carrying properties of red blood cells.
  • Image not available. Vasoactive medications should not be considered for hypovolemic shock until fluid resuscitation has been optimized.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe how a patient can have hypovolemic shock in the absence of clinically important bleeding.
  • 2. Discuss the major autoregulatory responses by the body to compensate for reductions in plasma volume.
  • 3. Describe limitations of the use of the Starling equation of fluid transport in the clinical setting.
  • 4. Explain how patients may have complications associated with hypovolemic shock despite adequate initial resuscitation.
  • 5. Describe the primary monitoring parameters used for assessing adequacy of volume expansion in a patient with hypovolemic shock.
  • 6. Compare the efficacy or crystalloid and colloid products for the resuscitation of patients with hypovolemic shock.
  • 7. Describe the appropriate indications for vasoactive medications and blood products in patients with hypovolemic shock.

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This chapter discusses the assessment and management of hypovolemic shock. Neurogenic shock resulting from loss of sympathetic activity and anaphylactic shock resulting from increased vascular permeability often are considered separately from hypovolemic shock because fluid loss from the body is not necessary for their occurrence. Although these forms of shock are not discussed in detail, it is important to note that intravenous fluid administration (in conjunction with vasoactive medications) is a mainstay of therapy because circulating volume is decreased. In this regard, adequate fluid resuscitation to maintain circulating blood volume is a common principle in managing all forms of shock.

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Because shock is not a reportable category by state and federal agencies that track causes of death, the incidence is unknown. Estimates of deaths due to shock are complicated by differences in definitions and classification systems. Part of the problem is defining when progressive circulatory insufficiency results in the loss of normal compensatory responses by the body, which could reverse the processes leading to irreversible organ dysfunction. This loss of appropriate compensation varies from patient to patient and is not always readily ...

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