Hypovolemic and Distributive Shock

Hypovolemic and Distributive Shock

Definition/Etiology:

• Hypovolemic Shock – condition of inadequate organ perfusion caused by acute loss of intravascular volume
• Distributive Shock – pathological redistribution of intravascular volume.

Pathophysiology:

• Hypovolemic – No volume! Blood loss is the most common cause. No volume = no cardiac preload. HR increases to meet demands, but BP is low because we have no volume
• Usual causes – hemorrhage/trauma/internal bleeding

• Distributive shock – you have the volume, but your vessels are on the fritz. Expand to the point that your regular volume is no longer enough to maintain an adequate pressure. 
• Usual causes – sepsis, anaphylaxis

Clinical Presentation:

Shock presentation:

• High HR
• Low BP 
• Inadequate oxygenation and organ profusion

• Hypovolemic 
• Hemorrhage
• Trauma 

• Distributive 
• Fever
• Low oxygen saturations
• Hives if ampholytic

Collaborative Management:

• Hypovolemic 
• Stop the bleed
• Replace the volume
• CBC
• BMP
• Lactic Acid
• Type & Screen
• Blood transfusion

• Distributive
• CBC
• BMP
• Lactic Acid
• Blood cultures

• Fluids 
• Epinephrine
• Vasoconstrictors
• Antibiotics

Evaluation | Patient Monitoring | Education:

• Hemodynamic monitoring
• Treatment of the cause

Linchpins: (Key Points)

• Hypovolemic = no volume
• Distributive = volume but no vessels
• Treat the cause