Question about hypovolemic shock treatment

Question

The treatment of hypovolemic shock is usually directed at maintaining the circulatory volume through fluid resuscitation, rather than maintaining blood pressure through the use of vasoactive medications. Explain.

Answer 1

Hello Alesha:

By definition alone, hypovolemia or even hypovolemic shock occurs when either there is not enough volume or when there is not enough perceived volume. Hypovolemia occurs when a person loses too much volume such as blood or other bodily fluids. Good examples would be someone who has diarrhea or vomiting. The person loses fluid volume very fast. In this case, the best treatment would be to replace the volume loss, and this is best accomplished via fluids such as normal saline. Adequately replacing the volume typically solves the problem. By doing this, blood pressure, heart rate, and other bodily functions returns to normal fairly quickly.

However, if volume depletion alone is not the issue, vasoactive substances which stimulate the sympathetic nervous system may be required. Earlier, I mentioned "perceived" volume loss. Let's use the example of a massive heart attack. Physically, the person may have enough volume ( blood, etc.), but the heart may not be able to pump the volume, as in the case of a massive heart attack.

So, in this situation, there is no volume depletion or hypovolemia present--instead there is a pump problem to get the fluid/blood pumped through the circulatory system. So, if you give just fluids alone, this may not solve the problem of a broken pump. Vasoactive medicines such as Dopamine and Levophed may be given to actually stimulate the nervous system to function.

I hope this helps you to understand the concept you mentioned.

Page High, MSN-FNP-C