Bleeding & Volume Loss: Hypovolemic Shock

• With hemorrhage, control the source immediately by pressure, tourniquet, surgery or interventional radiology while resuscitation proceeds.
• For major traumatic hemorrhage, activate the local major-hemorrhage protocol, minimize crystalloids and use its balanced blood-component strategy until laboratory or viscoelastic results guide treatment.
• For nonhemorrhagic volume loss, give isotonic crystalloid in reassessed aliquots appropriate to the cause; use dedicated burn and DKA pathways rather than one fixed volume prescription.
• Track response with mentation, peripheral perfusion, urine output, blood pressure and lactate trend. Before hemorrhage control, permissive hypotension may be appropriate unless traumatic brain injury is present.
• For significant traumatic bleeding or risk, give TXA 1 g IV over 10 minutes within 3 hours of injury, followed by 1 g IV over 8 hours; do not start it after 3 hours.

First tests: Full blood count, Blood group and crossmatch, PT/INR, aPTT and fibrinogen, Blood lactate, Sodium, potassium, bicarbonate, urea and creatinine, Ionized calcium.

Only if indicated: Focused ultrasound / source-directed CT, Viscoelastic coagulation testing.

Repeat monitoring: Full blood count, PT/INR, aPTT and fibrinogen.

• Managing Hypovolemic Shock