How to Overcome Hypovolemic Shock

dr. Satriyo Dwi Suryantoro

Asclepio Edukasi Medika ©2020

 DEFINITION
• Imbalance between oxygen demand and oxygen supply
• A state of acute circulatory failure leading to decreased
organ perfusion, with inadequate delivery of oxygenated
blood to tissues and resulting end-organ dysfunction

Oxygen
supply
Oxygen
demand

Deutsches Ärzteblatt International | Dtsch Arztebl Int 2018; 115: 757–68

 CLASSIFICATION
Systemic Central Pulmonary
Cardiac
Vascular Venous Capillary Wedge
Output
Resistance Pressure Pressure
(CO)
(SVR) (CVP) (PCWP)
Distributive
• Septic ↑ ↓ ↓ ↓
• Anaphylactic ↑ ↓ ↓ ↓
• Neurogenic ↓ ↓ ↓ ↓
Cardiogenic ↓ ↑ ↑ ↑
Obstructive ↓ ↑ ↑ ↑↓
Hypovolemic ↓ ↑ ↓ ↓
Deutsches Ärzteblatt International | Dtsch Arztebl Int 2018; 115: 757–68
 PATHOPHYSIOLOGY
↓ tissue perfusion ↓ oxygen supply

Anaerob
metabolism

↓ ATP ↑ Lactate

↓ Na+-K+ pump Metabolic Acidosis

↑ intracellular Na+
↑ intracellular water

Cellular edema

Release of lysosomal
enzyme Cell damage
PRACTICAL APPROACH

Deutsches Ärzteblatt International | Dtsch Arztebl Int 2018; 115: 757–68

 HYPOVOLEMIC SHOCK
• Condition of inadequate organ perfusion caused by loss of intravascular
volume
• Reduced cardiac preload to a critical level and reduced macro- and
microcirculation à anaerob tissue metabolism and triggering of an
inflammatory reaction
HYPOVOLEMIC SHOCK
Sooner we know, better

Suresh et al, 2018

PRACTICAL APPROACH

Deutsches Ärzteblatt International | Dtsch Arztebl Int 2018; 115: 757–68

Fluid therapy
Fluid therapy
TAKE HOME MESSAGE

Raghunatan et al, 2013

TERIMA KASIH