Hypovolemic Shock

[csisn08]

I am hoping someone can help me understand why dopamine is administered as part of the treatment for hypovolemic shock. Doesn't systemic vascular constriction occur during hypovolemic shock? I would think that giving a potent vasoconstrictor would further impede blood flow.

Thanks!

[RN1982]

I am hoping someone can help me understand why dopamine is administered as part of the treatment for hypovolemic shock. Doesn't systemic vascular constriction occur during hypovolemic shock? I would think that giving a potent vasoconstrictor would further impede blood flow.

Thanks!

Depends on the dose of dopamine that they are giving. If the dose is 5-10 then it increases the cardiac output and the BP. It has positive inotropic and chronotropic qualities like increaing cardiac muscle contractility, affects the preload and afterload. Patients should have their fluid deficit properly addressed before vasos are used. I've had patients receive about 8-10 liters of fluid.

[pricklypear]

Just realized I said pretty much the same thing as Michigan RN!

[RN1982]

Dopamine isn't really going to help someone who is truly in hypovolemic shock until the hypovolemia is reversed. Most pts in shock already are tachycardic - dopamine will make this worse. Dopamine increases cardiac contractility, and is a vasoconstrictor, but if there is no volume to circulate, it does no good.

In my experience, dopamine is not used in true hypovolemic shock until volume has been replaced and the pt still needs BP support.

That's true. I've never had a patient on Dopamine if they were in hypovolemic shock. It's pointless, replacing the volume lost is what is needed first.

[rjflyn, ASN, RN]

Like MichiganRn said, basically if the tank is empty all the dopamine in the world isn't going to help. Giving dopamine is this instance generally is a last resort hope it works keep the pt from dying kind of thing.

Rj

[Wicked Wahine]

We just learned this in school as, "tank before your crank".

[back2thebooks]

I went into shock after a severe hemorrhage after the birth of my first son. I *believe* it is administered to bring the blood pressure up. They gave me 2 separate blood transfusions so they didn't have to give it to me--I got better from my donor's blood (thank you to those who donate).

[RN1982]

Dopamine or any other pressor is last resort in my opinion. You said you hemorrhaged after giving birth, the only thing that would correct your shock would be blood transfusions.

[bethem]

We would fill first, then use a more alpha-adrenergic pressor like noradrenaline. Dopamine tends to be used as an addit to norad, and only when the norad is maxed out and still ineffective.

The reason you would want vasoconstriction in hypovolemic shock is to ensure that blood is shunted to the vital organs - hang the peripheries, if it's lose a toe or your kidneys I'm going to save your kidneys.

[back2thebooks]

Dopamine or any other pressor is last resort in my opinion. You said you hemorrhaged after giving birth, the only thing that would correct your shock would be blood transfusions.

Yes, and that is exactly what I got---2 of them. But, the hemmorhage/shock did end up causing damage to my pituitary gland in the end.

[blondy2061h, MSN, RN]

We deal with a ton of shock on my unit (mostly septic, some due to straight up dehydration [untreated n/v/d], some due to bleeding out). We bolus the heck out of them with NS, give blood if indicated (generally hgb

Then failing all that we'll start pressors. Dopamine causes a lot of tachycardia which people in shock generally already have. We typically start with vasopressin @ 2, work that up to 4, then add levophed and work upwards on that.

[RN1982]

Yeah, we never use Dopamine for septic shock. It's usually neosynephrine or norepinephrine