2 Hypovolemic Shock
Learn what causes hypovolemic shock, how to recognize worsening poor perfusion, and which immediate and clinical responses address the fluid loss and its cause.
Causes and circulation
occurs when severe loss of blood or other body fluid critically reduces circulating volume. This lowers , , and , making the condition a medical emergency.
Causes include , such as trauma or gastrointestinal bleeding, and nonhemorrhagic losses such as severe vomiting, diarrhea, extensive burns, excessive sweating, or renal fluid loss.
Recognizing poor perfusion
Suspect early when there are signs of poor perfusion, even if blood pressure is not yet low. The body may compensate, and a near-normal blood pressure does not rule out shock.
Possible warning signs include:
Rapid, weak pulse
Cool, clammy, or pale skin
Delayed
Rapid breathing
Restlessness or confusion
Worsening mental status, hypotension, and reduced urine output are also concerning. Reassess repeatedly: no single finding, including blood pressure, reliably rules shock in or out on its own.
Immediate response to bleeding
For severe external bleeding, activate emergency medical services or the facility emergency response and control the bleeding immediately with firm direct pressure. Use wound packing or a tourniquet when indicated and within your training.
Keep the person warm, monitor breathing and responsiveness, and arrange urgent transport. Do not give food or drink to someone who may be in shock.
Clinical treatment and volume replacement
Clinical priorities include assessing airway and breathing, obtaining rapid vascular access, and providing blood-product resuscitation when indicated. Clinicians must also definitively control the bleeding source.
When prolonged vomiting or diarrhea has caused , emergency clinicians assess and treat the cause and replace circulating volume, commonly with intravenous isotonic crystalloid, while monitoring the patient’s response. When the cause is bleeding, controlling the and providing appropriate blood products are essential; fluids alone do not stop blood loss.