Question

Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following orders are written for the patient:

Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line

Obtain complete blood count, serum electrolytes

Oxygen at 2 L/min via nasal cannula

Type and cross for 4 units of blood

Flat plate of the abdomen STAT

(Learning Objectives 1, 4, and5)

Describe the pathophysiologic sequence of events seen with hypovolemic shock.

What are the major goals of medical management in this patient?

What is the rationale for placing two large-bore IVs?

What are advantages of using 0.9% NS in this patient?

What is the rationale for placing the patient in a modified Trendelenburg position?

Answer 1

Hypovolemic shock leads to significant and sudden blood or fluid losses within your body. Blood loss of this magnitude can occur because of bleeding from blunt traumatic injuries due to accident.

In addition to actual blood loss, the loss of body fluids can cause a decrease in blood volume.

While bleeding occurs, there is not enough blood in circulation for the heart to be an effective pump. Once body loses these substances faster than it can replace them, organs in your body begin to shut down and the symptoms of shock occur. Blood pressure plummets, which can be life-threatening.

High volume fluid resuscitation may be required for the trauma patient, in which case at least two large bore (14-16 G) IV catheters are usually inserted. All critically ill patients require IV access in anticipation of future potential problems, when fluid and/or medication resuscitation may be necessary.

0.9% Normal Saline is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment, contains no antimicrobial agents. The pH is 5.0 (4.5 to 7.0) It contains 9 g/L Sodium Chloride with an osmolarity of 308 mOsmol/L. •It contains 154 mEq/L Sodium and Chloride.

1. It is indicated as a source of water and electrolytes.

2. In general, intravenous lines should not be started unless the patient currently, or may soon need either fluid replenishment or medication administration.  

3. If used to replenish fluids, a large bore IV (18G or more) should be started, hung with a 1000 mL bag of saline.  

4. If saline is being started for medication administration maintain at TKVO, or consider using a saline lock instead of intravenous line.