Hypovolemic Shock

Choc Hypovolémique

Hypovolemic ShockBY HEMORRHAGIA:


* pallor , sweat , cold extremity, mottling of the knees .

* disturbance of consciousness: agitation or prostration, incoherent remarks, obnubilation.

* pulse rate : frequency> 120 / min and weak pulse.

– attention: sometimes paradoxical bradycardia by vasovagal reflex.

– absent tachycardia if associated negative chronotropic treatment.

* polypnea , cyanosis.

* drop in blood pressure (<80 mmHg), pinch differential.

* increase in the coloring time> 3 seconds, discolored conjunctiva.

* Collabated veins, oligo-anuria, thirst.

* risk of vital distress: coma, respiratory distress, cardiorespiratory arrest.


* cardiogenic shock.

* anaphylactic shock.

* septic shock.


* post-traumatic hemorrhage, external or internal (make rectal examination, vaginal examination, gastric tube): hemothorax, tamponade, rupture of aneurysm of the aorta, rupture of spleen or liver, pelvic fracture, fracture of the femur.

* gastrointestinal haemorrhage, acute pancreatitis.

* gyneco-obstetric bleeding: GEU.

bleeding with anticoagulants: retroperitoneal hematoma or right

* burns.


* scope, SpO²: unreliable if persistent shock.

* ECG.

* groupage, RAI.

* NFS: normal hemoglobin and hematocrit at the beginning to repeat regularly if diagnostic doubt, sometimes early leukocytosis.

* hemostasis.

* chest X-ray after clinical stabilization.


* gestures of hemostasis : compressive dressing, surgery, Blackemore probe, gynecological tamponade, …

* Trendelenburg position or raised legs.

* warming up the patient.

* set up two G14-G16 venous lines, bulbous tubules.

* oxygen therapy mask: 8 to 10 l / min.

* filling thanks to the device of Jouvelet:

– crystalloid if hypovolemia not important: NaCl 0.9%, Ringer-Lactate.

– colloids if greater shock or if TA <80 mmHg:

 Plasmion (20 ml / kg in 15 minutes in children) or Elohès.

– if doubtful diagnostic, make a filling test in 10-15 minutes:

Either with 50-200 ml of colloids or with 200-600 ml of crystalloids.

* hospitalization.

* treatment of the cause: surgery.

* transfusion to maintain hematocrit at 20-25% after ABO grouping:

– if hemoglobin <7 g / 100 ml

– if hemoglobin <10 g / 100 ml in subjects with cardiopathy, angina, stroke, respiratory disease or if taking beta-blockers or ACE inhibitors.

The unit of globular concentrate raises the hemoglobin by 1 g / 100 ml.

* if failure:

– Dobutrex or Dopamine with the electric syringe.

– Adrenaline, 0.25 μg / kg / min by electric syringe or more.

* if severe sub-diaphragmatic hemorrhage:

– shockproof trousers at 30 mmHg (then 60) for the abdomen and 50 mmHg (then 80) for the lower limbs.

* if vital distress: intubation and assisted ventilation after anesthesia (Hypnovel + Fentanyl)



* those of dehydration:

– thirst , dryness of the mucous membranes (on the lower side of the tongue), skin fold.

 frequent fever , weight loss .

– arterial hypotension .

– confusion, disturbances of consciousness.


* fever, vomiting, diarrhea especially in the old man.

* diuretics, IEC.

* adrenal insufficiency.

* intestinal obstruction .


* scope, SpO².

* urine strips, capillary blood glucose.

* standard assessment, blood ionogram, urinary ionogram, serum calcium, ECBU.


* venous route, oxygen therapy mask.

* Sodium chloride 0.9% immediately if moderate hypovolemia otherwise filling with Elohès or Plasmion if persistent shock.

* hospitalization.