Treatment for hypovolemic shock

[csisn08]

Why is dopamine 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.

[surferbettycrocker]

look at dopamine at different concentrations. for example, dopamine at lower doses actually improves renal blood flow. interesting isn't it, since the word dopamine conjures up images of constricted vessels, but what about the inotropic activity of dopamine related to its MOA?

look at the MOA of dopamine, what class of drug is it? is it a catecholamine--if so, what kind of effect do circulating catecholamines have on the heart? pump harder, maybe faster in order to try and circulate any existing volume?

you get that heart to chemically pump a little bit harder and the compensatory mechanisms tend to let up a little, like SVR. of course many drugs in the same class will have different outcome on SVR.

also for hypovolemic shock I would imagine another fluid component would be added to increase circulating volume rather than dopamine alone.

just my two cents hope it helps. maybe some unit nurses could expand.

[EricJRN, MSN, RN]

Usually you don't look at dopamine until after you've addressed the fluid deficit.

[csisn08]

Thank you, these responses have been helpful.

[rkitty198, BSN, RN]

Treatment for hypovolemic shock in its early phase would be to give fluid resuscitation, as this is the potentiating factor. In the later phases when the blood pressure is low, and the patient has been adequately hydrated as noted by the PAWP, small doses of dopamine are given- increase cardiac output to increase blood flow to other organs- due to its alpha and beta effects. Always like Eric said, the patient needs to have hydration given first.

[cessamei]

hi there, can I also ask a question? it's related to hypovolemic shock.. could it be possible to use hypertonic solution for hypovolemic shock since it is a volume expander instead of isotonic normal saline? I'm quite curious of this because I've read articles that say it could be helpful while some say, it's not. Take a look on this:

Intravenous saline solutions are typically given as first-line therapy for shock patients to compensate for acute blood loss before transfusions can be safely administered. On the basis of preclinical testing and other evidence, the rationale for use of hypertonic saline instead of normal saline is that it is thought to more effectively compensate for blood loss through volume expansion, to reduce excessive inflammation, and to help prevent brain edema....

"Several prior studies suggested the potential for improved outcome for patients with shock treated with hypertonic saline," Eileen M. Bulger, MD, FACS, associate professor of surgery at the University of Washington in Seattle, and coprincipal investigator of the hypertonic saline studies for the Resuscitation Outcomes Consortium (ROC), told Medscape Emergency Medicine. "Hypertonic saline solutions had been shown to improve tissue perfusion and reduce the excessive inflammatory response early after injury which results in organ damage. These fluids may be particularly beneficial for patients with traumatic brain injury, as they maintain cerebral perfusion while reducing intracranial swelling."[unquote]

Source- http://www.medscape.com/viewarticle/590647

Can I have your ideas about this? Can anyone help me for my evidence-based nursing too? Anything easy about hypovolemic shock? Because it's quite hard for me to find one.. thank you and God bless. :)

[cessamei]

if hypertonic solution and LRS normal saline can be used in hypovolemic shock, which is more effective in an 'emergency resuscitation'?