Cause Of Hypovolemic Shock Research Articles

Hypovolemic shock Hypovolemic Shock: How Does Lactic Acid Affect the Heart?

Hypovolemic shock is due to a critical loss in the effective circulating blood volume with systemic hypoperfusion. If left untreated, hypovolemic shock can lead to ischemic injury of vital organs, leading to multi-system organ failure and death. Hypovolemic shock is a potentially life-threatening condition (1,2). There are five causes of hypovolemic shock: hemorrhage, trauma, surgical intervention, burns, and fluid loss caused by vomiting or diarrhea. This woman was involved in a motor vehicle accident, which resulted in a traumatic crash (2,3). This was caused by blood loss to the abdomen, as the physical examination suggested (3). Early recognition and appropriate management are essential. Hypovolemic shock results from depletion of intravascular volume, whether by extracellular fluid loss or blood loss (1,2). The pre-shock stage is characterized by compensatory mechanisms with increased sympathetic tone resulting in increased heart rate, increased cardiac contractility, and peripheral vasoconstriction (2,3).

Traumatic brain injury of childhood

Traumatic brain injury of childhood

The Role of Passive legs Raising Position in Hypovolemic Shock: A Case Report and Review of the Literature

Background: Hypovolemic shock can be catastrophic rapidly unless recognized and treated promptly. Although gastrointestinal loses might be the cause of hypovolemic shock in the elderly, it rarely causes a change in the blood gas analysis results.Purpose: This study aimed to report a case of a 75-year-old male with signs of hypovolemic shock caused by gastrointestinal loses and discuss the effect of passive leg raising procedure as an early nursing intervention in patients presenting with shock.Methods: The method used in this paper is a case study. The subject in this study is a 75-year-old male presenting to our Emergency Room with signs of shock which was caused by gastrointestinal problems. Passive leg raising or also known as modified Trendelenburg Position was performed as the patient presenting with low blood pressure. The results of physical dan laboratory investigation, as well as the nursing and medical therapies were presented, analyzed and discussed based on the recent literature.Results: There was an increase in the Mean Arterial Pressure (MAP) after the intervention was given for five minutes followed by fluid resuscitation with 1000 ml of warm Normal Saline. The patient responded well to the intervention given in the ED and was sent to the Intermediate Ward for further treatments.Conclusion: Passive leg raising might be beneficial to be performed in patients with hypovolemic shock as it increases the venous blood return the heart.

Weird and wonderful ICU cases: Unusual causes of shock

During their practice, intensivists are ought to face challenging cases that are rare. Intensivists need to be aware of the rare causes of shock beyond common presentations. In each category of shock, there are rare causes that require prompt identification and management. Certain clues in the patient's presentation might point to those rare causes.Classically shock is classified into: distributive, hypovolemic, cardiogenic, and obstructive. In this era of bedside point-of-care ultrasound, intensivists are able to promptly identify the cause of shock and institute a resuscitation plan. However, there are cases when the diagnosis is still obscure and the cause of shock is not easily identified. For example, in a study of patients admitted with presumed septic shock, 7.4% had no identified cause of shock and 11% had sepsis mimickers.1 Hypovolemic shock occurs secondary to a reduction in the effective circulating volume secondary to fluid loss or third spacing. A rare cause of hypovolemic shock is idiopathic capillary leak syndrome (Clarkson Syndrome).2 The syndrome is characterized by recurrent episodes of rapidly progressive generalized edema, shock, renal failure and high hematocrit. The episode usually resolves in 3-7 days where the capillary leak resolves and a phase of pulmonary edema occurs. Several treatment options such as intravenous immunoglobulin (IVIG) and aminophylline were used in case reports.3 Vasodilatory shock occurs secondary to peripheral vasodilation and decrease in blood flow. It occurs as part of the systemic inflammatory response syndrome for which sepsis, acute pancreatitis, acute liver failure, and major trauma are common causes. Rare causes that need to be considered include: hemophagocytic lymphohistiocytosis (HLH), systemic mastocytosis, and toxic shock syndrome.Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome characterized by macrophage activation and engulfment of hemopoetic cells which leads to pancytopenia. It is also characterized by cytokines storm that lead to a vasodilatory shock, multi-organ failure, and acute respiratory distress syndrome (ARDS). The most common triggers are infection, malignancy, and autoimmune diseases. Pointers to this diagnosis in the intensive care unit include: pancytopenias, hypofibrinogenemia, high triglycerides, and high ferritin. Treatment necessitates treating the underlying cause as well as using immune modifying therapies.4 Systemic mastocytosis is a rare cause of recurrent anaphylaxis shock. It results from the accumulation of mast cells in tissues and can present with anaphylaxis and vascular collapse. An important clue to the diagnosis is the presence of urticarial pigmentosa and the absence of an allergen history.5 Toxic shock syndrome is a unique cause of sepsis. It is caused by a pre-formed toxin produced by Staphylococcus aureus and Streptococcus pyrogenes. The clue to the diagnosis include the rapid onset after the precipitating factor, erythroderma, and skin desquamation. Treatment includes IVIG and Clindamycin.6

A rare cause of hypovolemic shock after cesarean delivery; Rectus sheath hematoma

A rare cause of hypovolemic shock after cesarean delivery; Rectus sheath hematoma

Massive Bleeding From Inferior Mesenteric Vein With Hypovolemic Shock: A Rare Complication of Acute Pancreatitis

BackgroundAcute pancreatitis may cause massive intra-abdominal bleeding as vascular complications caused by the erosion of a major pancreatic or peripancreatic vessel. In terms of treatment, the differentiation between arterial bleeding and venous bleeding using abdominal computed tomography (CT) angiography is important. In addition, hypovolemic shock caused by bleeding from the inferior mesenteric vein (IMV) in acute pancreatitis has not been reported. Case ReportA 58-year-old man presented to our emergency department with complaints of abdominal pain of 10 hours’ duration. The pain had an abrupt onset and started with alcohol consumption. After performing initial laboratory tests and an abdominal CT scan, he was diagnosed with acute pancreatitis. However, he complained of severe abdominal pain and was drowsy 2 h later. Follow-up CT angiography revealed acute necrotizing pancreatitis with massive hemoperitoneum and hypovolemic shock. We also found active bleeding from the IMV. We did not consider emergency catheter angiography with embolization; instead, exploratory laparotomy and hematoma evacuation with IMV ligation was performed. He was discharged without complications 14 days later. Why Should an Emergency Physician Be Aware of This?Massive bleeding from the IMV accompanied by shock bowel syndrome is a rare complication of acute pancreatitis that can be confused with arterial bleeding. Emergency physicians should consider this diagnosis in acute pancreatitis as a possible cause of hypovolemic shock and anatomic course of the IMV and prevent fulminant shock by administering appropriate treatment.

Spleen rupture during labor

Background: A ruptured splenic artery aneurysm is rare but potentially fatal and has a greater chance of occurring during pregnancy. Case: A 38-year-old pregnant woman was admitted to hospital in labor and presented with dyspnea and hypovolemic shock during the expulsion stage. After delivery, a bedside ultrasound was performed and showed a large amount of free fluid in the abdominal cavity. The patient was submitted to an exploratory laparotomy, which found a ruptured splenic hilum, and anatomopathological examination confirmed a ruptured splenic artery aneurysm. Both mother and baby survived without sequelae. Conclusion: Ruptured aneurysm must be considered among the causes of hypovolemic shock in pregnancy, and early detection can reduce the morbidity and mortality of this event.

Virtopsija klinikinėje praktikoje

Article presents meta-analysis of previous studies; experience at Klaipeda University hospital is outlined. The case of polytrauma with letal outcome is being described. The patient was diagnosed with multiple vertebral and limb fractures, suspected pulmonary contussion, alleged cause of death – hypovolemia due to suspected internal hemorrhage. The direct mechanism of death was not completelly understood, therefore, in view of academic interest, the desicion was to perform virtopsy DSKT?, at which bilateral pleural effussions of up to 2000 ml of intensive fluid was discovered, together with multiple bone fractures. Forensic investigation later confirmed multiple fractures of thoracic vertebrae, limb fractures, massive bilateral hemothorax. The proposed hypothesis of acute hemothorax as a cause of hypovolemic shock with adverse outcome has been confirmed. doi:10.5200/sm-hs.2013.080

Intragastric rupture of splenic artery aneurysms:Three case reports and literature review

Rupture of splenic artery aneurysm remains an uncommon cause of hypovolemic shock although it is the third most common intra-abdominal aneurysms. It is difficult to diagnosis timely and entails a significant morbidity and mortality. We present three uncommon cases of bleeding from upper gastrointestinal tract as a result of rupture of splenic artery aneurysm to stomach in patients with liver cirrhosis or infectious endocarditis. We also reviewed the literature and these case reports highlighted that rapid resuscitation, diagnostic imaging, surgical consultation, and alternatively transarterial embolization were the priorities in the management. Early diagnosis and intervention for ruptured splenic artery aneurysm are crucial for patient's survival; therefore, it must be kept in mind as feasible etiology of life-threatening gastrointestinal bleeding, especially in patients with underlying liver cirrhosis or infective endocarditis.

Intra‐leiomyoma massive hemorrhage after delivery

Massive bleeding into a uterine leiomyoma is an extremely rare cause of hypovolemic shock. Only one case of this life-threatening condition has been reported. Our patient was a 39-year-old woman who had a gradual growth of a subserous myoma throughout pregnancy and sudden rapid growth after cesarean section at 35 weeks of gestation. The rapid growth was due to intra-tumor massive bleeding and was associated with hypovolemic shock without evidence of external or intra-abdominal hemorrhage. We hypothesize that a rapid decrease in size of the uterus after delivery might have compressed the venous drainages, which were more vulnerable to occlusion than arterial blood flows, resulting in blood sequestration into the tumor leading to hypovolemia.

Bleed caused by varicose veins rupture in a rare site in portal hypertension. Differential diagnosis with causes of acute hypovolemic shock in emergency.

Portal hypertension is the increase in the pressure of the venous portal system, which receives around 1,500 mL/m of blood from the intestinum tenue, colon, spleen, and pancreas. A blocking of the flux or an increase in the resistance at any level of the portal tree results in an increase in the pressure in the system and the appearance of lateral circles between the portal vein and the inferior and superior, thus allowing for varicose veins to spread in the whole system. The present paper reports the case of a woman with liver cirrhosis, great ascites and bleeding out of varicose veins’ rupture at the spleen axis level, which presented the problem of differential diagnosis with other causes of hypovolemic shock. This cases resulted in the patient’s exitus.

Use Of Non-invasive Markers For Early And Accurate Detection Of Traumatic Hemorrhage

Acute hemorrhage and subsequent circulatory collapse (shock) account for approximately 50% of the deaths on the battlefield and the forward operating table, a statistic that has remained relatively unchanged since World War I. Hemorrhage is defined as the escape of blood from a vessel and is the most common cause of hypovolemic shock. Current and classic techniques available to battlefield medics for triage and are focused on the traditional vital sign markers. Similarly, monitoring shock in the civilian trauma patient has also focused on the clinical "gold standard" assessments of Blood Pressure (BP), arterial O2 saturation or simple pulse palpation. However, these standard vital sign measurements fail to predict death or identify reductions in central blood volume until cardiovascular collapse has already occurred. About 10 percent of the total blood volume can be removed with almost no effect on either arterial pressure or cardiac output. PURPOSE: To develop and demonstrate a system that rapidly and non-invasively tracks vital sign markers throughout the progression of hemorrhage. METHODS: Orbital Research Inc (ORI) and Kent State University (KSU) used an incremental lower body negative pressure (LBNP) routine to safely educe physiologic changes like those typical to hemorrhage. Six research subjects have completed the study. An instrumented glove (developed by Orbital Research) collected vital signs intermittently and non-invasively during the experiment. Standards measure of metabolism; ECG and cardiac output were collected continuously. RESULTS: Using the instrumented glove to collect cardiovascular metrics, differences in R-R interval variability and Lf/Hf ratio are were detected during the LBNP sequence. Cardiac output, stroke volume and blood pressure data verified the physiologic compensations in response to the LBNP. CONCLUSIONS: Heart Rate Variability (HRV) has also shown promise and correlation to early reductions in central blood volume when blood pressures and SpO2 have not yet changed. This project demonstrated feasibility of using instrumented to glove to rapidly collect cardiovascular markers indicative of the onset of hemorrhage.

Systemic capillary leak syndrome presenting as recurrent shock

To report a case of systemic capillary leak syndrome (SCLS) in a child. Case report. Pediatric intensive care unit. A 6-yr-old girl was admitted twice to the pediatric intensive care unit, at a 10-month interval, in severe shock with important edema. The patient presented with acute symptoms of abdominal pain, vomiting, and syncope in the hour preceding the shock. During both episodes necessary management included aggressive intravenous fluid rehydration, mechanical ventilation, and use of inotropes/vasopressors. Suspicion of a lower limb fasciitis necessitated surgical exploration, but pathology reports were negative on both occasions revealing only subcutaneous tissue edema. The patient recovered within 24 hrs on both episodes. Investigation ruled out cardiogenic shock and septic shock due to bacterial etiology. On the first episode, a nasopharyngeal aspirate was positive for influenza A (H3N2) by both viral immunofluorescence and culture. The presumed diagnosis was toxic shock syndrome associated with influenza virus. On the second episode, all bacterial and virology cultures remained negative. Hypovolemic shock was suspected, but there was no history of dehydration, bleeding, or gastrointestinal losses (persistent vomiting or diarrhea). Noninfectious causes of hypovolemic shock with edema were ruled out, leading us to believe that she suffered from SCLS. Although well described in the adult literature, there have been few reports of SCLS in pediatric patients. SCLS should be considered in the differential diagnosis of recurrent hypovolemic shock without identifiable cause. The only therapeutic intervention is to obtain vascular access when initial manifestations occur and give aggressive fluid reanimation.

An unusual cause of hypovolemic shock in the postpartum period

An unusual cause of hypovolemic shock in the postpartum period

Sequential Retroperitoneal Venous Hemorrhage and Embolism of an Angio-Seal Puncture Closure Device Complicating Iliac Artery Angioplasty

Purpose: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. Methods and Results: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. Conclusions: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.