Paper on Comprehensive Analysis of Hypovolemic Shock: Pathology, Causes, Symptoms, and Medications

Case 1: Pathology and Medications for Hypovolemic Shock

Pathology is a specialty of medical science tasked with understanding the causes, development mechanisms, natural history, structural or functional alterations, and consequences of a specific disease. In this context, the disease's concept relates to the deviation in standard and observable traits due to the environment or genome, which is evident through various signs and symptoms. Health professionals or pathologists examine surgically removed tissues, organs, bodily fluids, or even under extreme circumstances, the whole body, to identify and understand a specific illness's nature. After an in-depth examination of a particular disease, health professionals are likely to use their expertise to prescribe appropriate medications. In this case, drugs represent one of the critical alternatives for the treatment, cure, and prevention of the medical condition. Therefore, the analysis conducted in this article focuses on discussing the pathology of hypovolemic shock and substance misuse. Also, the review addresses the various existing medications and other available treatment options for the two medical conditions.

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Hypovolemia Shock Disease Process

Hypovolemia shock relates to the decrease in the volume of an individual's blood due to the massive loss of blood, plasma water, or plasma (Mandal, 2016). As a result, it causes severe damage to the intravascular content, which can result in the restriction of the passage of fluids to the organs or tissues. Severe loss of blood and plasma fluids hinders the heart from pumping enough blood to all body parts. The medical condition can result in the failure or damage of critical organs and require urgent and emergency medical attention.

The treatment of the disorder often commences at the point of accident, whether at home, school, or workplace. The health providers' team's immediate patient care at the scene of the accident aims at preventing further injuries. After that, the patient should be transported to a medical facility as rapidly as possible and initiate an appropriate treatment team. The application of direct pressure occurs for patients with external bleeding vessels to prevent further bleeding and blood loss. For a patient with trauma, the management or treatment protocols begin by preventing new injuries such as immobilizing the cervical spine, extricating, and moving to the stretcher.

In the management and care of hypovolemic shock patients, the assessment of history, vital signs, and trauma is critical. Evaluation of patient history assists the physicians in determining the possible causes and workups. Examining the essential symptoms before the arrival at the emergency department of a hospital is critical as it helps in assigning the appropriate medical team to the patient based on the assessed signs and symptoms. Immediate care response also involves determining the mechanism of injury and other information and data that are useful for identifying specific damages. Since hypovolemic shock is a medical emergency, there is a need for immediate first-aid care for patients. Some of the first aid protocols include keeping the patient warm to avoid hypothermia: dropping of body temperatures below 950F. Also, the patient should lie flat and refrain from any form of movement in the case of neck, back, or head injuries.

Etiology or Causes of Hypovolemic Shock

Hypovolemic shock is a medical condition characterized by insufficient organ perfusion due to loss of intravascular volume. However, it is divided into four subtypes: traumatic hemorrhagic, hemorrhagic, traumatic hypovolemic, and hypovolemic shocks (Standl et al., 2018). Hypovolemic shock is the most prevalent type of trauma, and it is mainly experienced among the young and older populations. The condition is most common among children in developing countries as it is caused by diarrheal illness within the regions (Taghavi & Askari, 2019). On the other end, hemorrhagic shock occurs specifically due to blood loss because of bleeding from severe wounds and cuts. Also, this disease is caused by blood loss from surgical interventions or even substantial vaginal hemorrhage. Other causes of this shock include bleeding from the digestive tract, internal bleeding from abdominal organs, and blood from a ruptured ectopic pregnancy.

However, hypovolemic shock etiology is not limited to the loss of blood; it extends to the loss of body fluids. It can occur in various circumstances such as protracted and excessive sweating and vomiting. Hypovolemic shock can also occur due to more renal injuries and salt, such as sodium and water in the kidney than the amount of intake (Taghavi & Askari, 2019). Lastly, hypovolemic shock can occur due to severe burns that interrupt a person’s skin mechanisms to prevent loss of fluids in a hot and dry climate. Blood and body fluids are responsible for the transportation of essential substances such as oxygen to all body organs and tissues. Therefore, excessive bleeding implies that there will be insufficient blood circulation for the heart to pump successfully. When the loss of these substances occurs at a faster rate than replacing them, body organs shut down, and an individual develops and portrays signs and symptoms of shock.

Signs and Symptoms of Hypovolemic Shock

Hypovolemic shock signs and symptoms vary based on the severity of the blood or fluid loss in a person. Also, the disease can show itself depending on various factors such as age, medical or health history, cause or source of the injury, and amount of blood or fluids lost. While external bleeding is easy to detect, symptoms related to internal blood loss are usually undetected until later stages when the shock appears. Some of the mild symptoms in the early stages of the disease include pale skin color, and sudden episodes of anxiety (Lovie, 2018). At this stage, diagnosing the disease can be difficult since the rate of breathing and blood pressure are still reasonable.

However, in the next step, according to Lovie (2018), a patient is likely to experience increased heart rates, rapid and shallow breathing, sweating, and a feeling of restlessness. Also, the early stages of hypovolemic shock are characterized by generalized weakness or a sense of tiredness, nausea and vomiting, dizziness, and headache.

Patients often complain of chest and abdominal pains due to coronary and mesenteric ischemia (Taghavi & Askari, 2019). Also, a severe shock is noticeable through lethargy, confusion, wooziness, and agitation, mainly arising from brain malperfusion. Besides, hypovolemic trauma caused by fluid losses leads to volume depletion. As a result, it makes patients complain of muscle cramps, orthostatic hypotension, and frequent thirst. Hypotension or low systolic blood pressure is witnessed along with little or no urine output among shock patients in severe stages. Patients of hypovolemic shock also seem to have clammy, cold, or cool on touch, and cyanotic skin, which is bluish discoloration on the skin surface, lips, and fingernails. Another sign and symptom of this disease relates to a lack of responsiveness or drifting in and out of consciousness.

Medication for Hypovolemic Shock

First-Line Treatment

First-line treatment for a disease is often part of a standard set of medications administered as the first option for reversing the condition. In most cases, first-line therapy acts as the best treatment alternative. However, health providers recommend other medications if first-line treatment does not cure the disease or causes devastating side effects. For this case involving hypovolemic shock, treatment efforts focus on controlling the source of loss of fluid and blood. Therefore, the first-line therapy for severe cases of the disease is fluid resuscitation or fluid replacement. It is a medical practice that aims at replenishing bodily fluids that have been lost through bleeding or sweating. The therapy involves the infusion of crystalloid colloid solutions and oxygen-carrying blood substitutes. The solutions aim to replace what has been lost, improve blood and oxygen circulation, and stabilize the damage caused by the disease.

Early fluid resuscitation to hypovolemic shock patients restores blood circulation and enables body organs to maintain perfusion. However, the strategy can dislodge soft clots and result in dilutional coagulopathy (Ramesh et al., 2019). In doing so, this treatment technique can lead to increased bleeding and mortality. Also, large amounts of crystalloids can cause resuscitation injuries, cardiac or gastrointestinal complications, electrolyte imbalance, and coagulation disturbances. On the other end, despite maintaining low tissue perfusion, the use of small-volume fluid resuscitation during permissive hypotension only lasts for a short period.

Second-Line Treatment

Second-line treatment applies when the initial therapy has failed or presents severe side effects on the patient. For hypovolemic shock, the initial treatment of fluid resuscitation can cause an increase in blood pressure or even disrupt the clot. In doing so, the treatment strategy is likely to increase the bleeding rates. Also, the administration of fluids leads to hemodilution, which subsequently dilutes the coagulation factors and weakens the clot formation, thus increasing bleeding. Therefore, the second alternative for the treatment of hypovolemic shock involves the use of vasopressors. The main aim of the procedure is to improve arterial pressure, which increases the heart’s pumping strength, improves circulation, and gets blood where it’s needed (Pollard et al., 2015). The most commonly used vasopressor agents are dopamine and norepinephrine. They both stimulate beta- and alpha-adrenergic receptors, which improves the heart rate and vasoconstriction. However, clinicians prefer dopamine since it facilitates further stimulation of dopaminergic receptors, increasing renal perfusion.

Other alternative therapies for hypovolemic shock include the use of inotropic drugs, specifically dobutamine. In this procedure, dobutamine is mainly administered to improve cardiac output and oxygen support (Dubin et al., 2017). However, experimental studies associate the use of dobutamine with several side effects, such as increased blood pressure. The severe headache, vomiting, and increased nervousness constitute the common side effects of dobutamine. In some circumstances, the administration of dobutamine causes swelling at the sites of injection.

Hypovolemic shock is a disorder related to the depletion in the volume of blood as a result of blood loss, water, and plasma fluids. The disease's causes include diarrheal illness among children and bleeding from severe wounds, in the vagina, and digestive tract. Also, hypovolemic shock occurs from the loss of body fluids through excessive sweating and vomiting. Signs and symptoms of the disorder in the early stages include pale skin color, unpredictable episodes of anxiety, feelings of tiredness, nausea, and vomiting. In the severe stages, patients are likely to experience chest pains, agitation, rapid breathing, increased heart rates, and frequent thirst. The first-line treatment for hypovolemic shock is fluid resuscitation, which aims to replenish bodily fluids that have been lost. However, if the technique fails, the second-line therapy involves vasopressors such as dopamine and norepinephrine to increase the heart's pumping strength.