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

  1. Describe how a patient can have hypovolemic shock in the absence of clinically important bleeding.

  2. Explain how dehydration differs from hypovolemia.

  3. Explain the physiologic derangements from blood losses that comprise the lethal triad.

  4. Discuss the major autoregulatory responses by the body to compensate for reductions in plasma volume.

  5. Describe the order of activation of compensatory mechanisms associated with hypovolemic shock.

  6. Describe limitations of the use of the Starling's equation of fluid transport in the clinical setting.

  7. Describe the general diagnostic criteria of the acute respiratory distress syndrome.

  8. Describe the typical clinical presentation of a patient with hypovolemic shock.

  9. Explain how patients may have complications associated with hypovolemic shock despite adequate initial resuscitation.

  10. Describe the primary monitoring parameters used for assessing adequacy of volume expansion in a patient with hypovolemic shock.

  11. Discuss the general principles of appropriate oral rehydration therapy for patients with dehydration.

  12. Compare the efficacy of crystalloid and colloid products for the resuscitation of patients with hypovolemic shock.

  13. Compare the safety of crystalloid and colloid products for the resuscitation of patients with hypovolemic shock.

  14. Discuss the controversies surrounding more invasive techniques such as right heart catheterization for monitoring interventions for hypovolemic shock.

  15. Describe the appropriate indications for vasoactive medications and blood products in patients with hypovolemic shock.

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 IV 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.

Because shock is not ...

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