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Shock, Hypovolemic 1449

Shock, Hypovolemic
VetBooks.ir

Metabolic shock: Failure of nutrient
Cardiogenic shock:
Suspect shock:
delivery, as in profound hypoglycemia life-threatening inability to supply tissues Failure of cardiac pump function
with oxygen and nutrients and remove
waste products
(Mal)distributive shock: Obstructive shock:
Perturbed blood distribution despite Obstruction of flow reducing
adequate intravascular volume cardiac preload

Hypoxic shock: Hypovolemic shock: Anaphylactic shock:
Severe hypoxemia and/or anemia Decreased intravascular volume, as from Type I hypersensitivity
preventing tissue oxygenation hemorrhage, severe dehydration, or severe ↓COP

Large-bore catheter for rapid administration of crystalloid If hemorrhage is ongoing, attempt to staunch simultaneously
fluid (LRS, Normosol-R, Plasma-LyteA, 0.9% saline) with addressing shock
• Initial bolus of 15–25 (dog) or 10–20 (cat) mL/kg quickly • Depending on reason for and site of hemorrhage, may not
• Reassess HR, CRT, membrane color, pulse quality, mentation, be possible
and blood pressure (goal: normalize HR, CRT, color, pulse, • Assess PCV/TS, although reduction in PCV is not immediate
improved mentation, MAP >65 mm Hg) • Assess blood pressure
• Transfuse if drop in PCV ≥ 10%, PCV ≤ 20%, or blood loss
>1% body weight

Inadequate response:
• Goals not met If severe↓ albumin/COP, administer colloidal solution (use caution
• Repeat fluid bolus to maximum of 80 (dog) or 50 (cat) mL/kg or avoid with trauma)
• If response still inadequate, reassess need for blood/colloid • Canine or human albumin
• Synthetic colloids (e.g., hetastarch or VetStarch)

Inadequate response: Consider use of hypertonic saline
• Goals not met despite adequate crystalloid volume/blood • Avoid if hypernatremicor markedly dehydrated
/colloid support • If head trauma, initial 2–4 mL/kg of 7.5% (hypertonic) saline bolus over
• Add vasopressors as constant rate infusion 15 minutes preferred over repeated bolus of isotonic crystalloid
• Dopamine 5–12 mcg/kg/min • Up to 8 mL/kg total bolus of 7.5% hypertonic saline acceptable
• Dobutamine 5–15 (dog) or 3–7 (cat; seizure risk) mcg/kg/min
• Norepinephrine 0.05–1 mcg/kg/min (some sources use up to
2 mcg/kg)
• Vasopressin 0.5–4 mU/kg/min

COP, Colloid oncotic pressure; CRT, capillary refill time; HR, heart rate; LRS, lactated Ringer’s solution; MAP, mean arterial pressure; PCV,
packed cell volume; TS, total solids.

Clinical Algorithms

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