Examine individual changes

[ 0 => '{{Technical|date=June 2009}}', 1 => false, 2 => '{{Infobox medical condition ', 3 => ' | Name = Hypovolemia', 4 => ' | Image = ', 5 => ' | Caption = ', 6 => ' | Field = [[Emergency medicine]]', 7 => ' | DiseasesDB = ', 8 => ' | ICD10 = {{ICD10|E|86||e|70}}, {{ICD10|R|57|1|r|50}}, {{ICD10|T|81|1|t|80}} ', 9 => ' | ICD9 = {{ICD9|276.52}} ', 10 => ' | ICDO = ', 11 => ' | OMIM = ', 12 => ' | MedlinePlus = 000167', 13 => ' | eMedicineSubj = ', 14 => ' | eMedicineTopic = ', 15 => ' | MeshID = D020896 ', 16 => '}}', 17 => false, 18 => ''''Hypovolemia''', or '''oligemia''', (also '''hypovolaemia''' or '''oligaemia''') is a state of decreased [[blood volume]]; more specifically, decrease in volume of [[blood plasma]].<ref>{{cite web|url=http://www.medterms.com/script/main/art.asp?articlekey=3871 |title=Hypovolemia definition - MedicineNet - Health and Medical Information Produced by Doctors |publisher=Medterms.com |date=2012-03-19 |accessdate=2015-11-01}}</ref><ref>{{cite web|url=http://medical-dictionary.thefreedictionary.com/hypovolemia |title=Hypovolemia &#124; definition of hypovolemia by Medical dictionary |publisher=Medical-dictionary.thefreedictionary.com |date= |accessdate=2015-11-01}}</ref> It is thus the intravascular component of [[volume contraction]] (or loss of blood volume due to things such as [[hemorrhaging|bleeding]] or [[dehydration]]), but, as it also is the most essential one, ''hypovolemia'' and '''''volume contraction''''' are sometimes used synonymously.', 19 => false, 20 => 'Hypovolemia is characterized by sodium depletion (salt depletion) and thus differs from [[dehydration]], which is defined as excessive loss of [[body water]].<ref>{{cite web|url=http://www.medterms.com/script/main/art.asp?articlekey=2933 |title=Dehydration definition - MedicineNet - Health and Medical Information Produced by Doctors |publisher=Medterms.com |date=2013-10-30 |accessdate=2015-11-01}}</ref>', 21 => false, 22 => '==Causes==', 23 => 'Common causes of hypovolemia are<ref>Sircar, S. Principles of Medical Physiology. Thieme Medical Pub. {{ISBN|9781588905727}}</ref> ', 24 => '* Loss of blood (external or internal [[bleeding]] or [[blood donation]]<ref>{{cite journal |vauthors=Danic B, Gouézec H, Bigant E, Thomas T |title=[Incidents of blood donation] |language=French |journal=Transfus Clin Biol |volume=12 |issue=2 |pages=153–9 |date=June 2005 |pmid=15894504 |doi=10.1016/j.tracli.2005.04.003 |url=}}</ref>) ', 25 => '* Loss of plasma (severe [[Burn (injury)|burns]]<ref>{{cite web|url=http://www.totalburncare.com/orientation_burn_shock.htm |title=Burn Shock / House Staff Manual |publisher=Total Burn Care |date= |accessdate=2015-11-01}}</ref><ref>{{cite web|url=http://www.patient.info/doctor/Resuscitation-in-Hypovolaemic-Shock.htm |title=Resuscitation in Hypovolaemic Shock. Information page &#124; Patient |publisher=Patient.info |date= |accessdate=2015-11-01}}</ref> and [[lesions]] discharging fluid) ', 26 => '* Loss of body sodium and consequent intravascular water; e.g. diarrhea or vomiting ', 27 => 'Excessive sweating is not a cause of hypovolemia, because the body eliminates significantly more water than sodium.<ref>{{cite web|url=http://highered.mcgraw-hill.com/sites/dl/free/0077262514/621682/Saladin_24_Ext_Outline.doc |title=Saladin 5e Extended Outline : Chapter 24 : Water, Electrolyte, and Acid–Base Balance |publisher=Highered.mcgraw-hill.com |accessdate=2015-11-01}}', 28 => '</ref>', 29 => false, 30 => '==Diagnosis==', 31 => 'Clinical symptoms may not be present until 10–20% of total whole-blood volume is lost.', 32 => false, 33 => 'Hypovolemia can be recognized by [[tachycardia]], diminished blood pressure,<ref>{{cite web|url=http://www.stagesofshock.com/stage3/index.html |title=Stage 3: Compensated Shock|archiveurl=https://web.archive.org/web/20100611035541/http://www.stagesofshock.com/stage3/index.html |archivedate=2010-06-11}}</ref> and the absence of [[perfusion]] as assessed by skin signs (skin turning pale) and/or [[capillary refill]] on [[forehead]], [[lip]]s and [[nail beds]]. The patient may feel dizzy, faint, nauseated, or very thirsty. These signs are also characteristic of most types of [[Shock (circulatory)|shock]].', 34 => false, 35 => 'Note that in children compensation can result in an artificially high blood pressure despite hypovolemia. Children will typically compensate (maintain blood pressure despite loss of blood volume) for a longer period than adults, but will deteriorate rapidly and severely once they do begin to decompensate. This is another reason (aside from initial lower blood volume) that even the possibility of [[internal bleeding]] in children should almost always be treated aggressively.', 36 => false, 37 => 'Obvious signs of external bleeding should be noted while remembering that people can bleed to death internally without any external blood loss. ("Blood on the floor, plus 4 more" = intrathoracic, intraperitoneal, retroperitoneal, pelvis/thigh)', 38 => false, 39 => 'There should be considered possible mechanisms of injury that may have caused internal bleeding, such as ruptured or bruised internal organs. If trained to do so and if the situation permits, there should be conducted a [[Advanced Trauma Life Support#Secondary survey|secondary survey]] and checked the chest and abdomen for pain, deformity, guarding, discoloration or swelling. Bleeding into the abdominal cavity can cause the classical bruising patterns of [[Grey Turner's sign]] or [[Cullen's sign]].', 40 => false, 41 => '===Stages of hypovolemic shock===', 42 => '[[File:Shock video.webm|thumb|upright=1.4|Video explanation of shock]]', 43 => 'Usually referred to as a "class" of shock.', 44 => 'Most sources state that there are 4 stages of hypovolemic shock;<ref name="dynamicnursingeducation.com">{{cite web|author=Hudson, Kristi|url=http://dynamicnursingeducation.com/class.php?class_id=47&pid=18|title=Hypovolemic Shock - 1 Nursing CE|archiveurl=https://web.archive.org/web/20090606044910/http://dynamicnursingeducation.com/class.php?class_id=47&pid=18 |archivedate=2009-06-06}}</ref> however, a number of other systems exist with as many as 6 stages.<ref>{{cite web|url=http://www.stagesofshock.com/stage1/index.html|title=Stage 1: Anticipation stage (a new paradigm)|archiveurl=https://web.archive.org/web/20100116055045/http://www.stagesofshock.com/stage1/index.html|archivedate=2010-01-16}}</ref>', 45 => false, 46 => 'The 4 stages are sometimes known as the "Tennis" staging of hypovolemic shock, as the stages of blood loss (under 15% of volume, 15–30% of volume, 30–40% of volume and above 40% of volume) mimic the scores in a game of tennis: 15, 15–30, 30–40 and 40.<ref name=emergencycare>{{cite book|editor1-last=Greaves|editor1-first=Ian|editor2-last=Porter|editor2-first=Keith|editor3-last=Hodgetts|editor3-first=Timothy|display-editors = 3 |editor4-last=Woollard|editor4-first=Malcolm|title=Emergency Care: A Textbook for Paramedics|date=2006|publisher=Elsevier Health Sciences|isbn=9780702025860|page=229}}</ref> It is basically the same as used in classifying [[bleeding]] by blood loss.', 47 => false, 48 => 'The signs and symptoms of the major stages of hypovolemic shock include:<ref name=agabegi2nd>{{cite book |author1=Elizabeth D Agabegi |author2=Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages= |isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}}</ref>', 49 => false, 50 => '{| class="wikitable" style="margin: 1em auto 1em auto;"', 51 => '! scope="col" | ', 52 => '! scope="col" | '''Stage 1'''', 53 => '! scope="col" | '''Stage 2'''', 54 => '! scope="col" | '''Stage 3'''', 55 => '! scope="col" | '''Stage 4'''', 56 => '|-', 57 => '| '''Blood loss''' || Up to 15% (750mL) || 15–30% (750–1500mL) || 30–40% (1500–2000mL) || Over 40% (over 2000mL)', 58 => '|-', 59 => '|| '''Blood pressure''' || Normal (Maintained<br/>by [[vasoconstriction]]) || Increased [[diastolic blood pressure|diastolic BP]] || [[Systolic blood pressure|Systolic BP]] < 100 || Systolic BP < 70', 60 => '|-', 61 => '|| '''Heart rate''' || Normal || Slight [[tachycardia]] (> 100bpm) || Tachycardia (> 120bpm) || Extreme tachycardia (> 140bpm) with weak pulse', 62 => '|-', 63 => '|| '''Respiratory rate''' || Normal || Increased (> 20) || [[Tachypnea|Tachypneic]] (> 30) || Extreme [[tachypnea]]', 64 => '|-', 65 => '| '''Mental status''' || Normal || Slight anxiety, restless || [[Altered mental status|Altered]], confused || Decreased [[level of consciousness|LOC]], [[lethargy]], [[coma]]', 66 => '|-', 67 => '| '''Skin''' || [[Pallor]] || Pale, cool, clammy || Increased [[diaphoresis]] || Extreme [[diaphoresis]]; [[mottling]] possible', 68 => '|-', 69 => '| '''[[Capillary refill]]''' || Normal || Delayed || Delayed || Absent', 70 => '|-', 71 => '| '''Urine output''' || Normal || 20–30mL/hr || 20ml/hr || Negligible', 72 => '|}', 73 => false, 74 => '==Treatment==', 75 => false, 76 => '===Field care===', 77 => 'Emergency oxygen should be immediately employed to increase the efficiency of the patient's remaining blood supply. This intervention can be life-saving.<ref>Takasu A, Prueckner S, Tisherman SA, Stezoski SW, Stezoski J, Safar P. (2000), ''Effects of increased oxygen breathing in a volume controlled hemorrhagic shock outcome model in rats.'', {{PMID|10959021}}</ref>', 78 => false, 79 => 'The use of [[intravenous drip|intravenous fluids]] (IVs) may help compensate for lost fluid volume, but IV fluids cannot carry oxygen in the way that blood can; however, [[blood substitutes]] are being developed which can. Infusion of [[colloid fluids|colloid]] or [[crystalloid fluid|crystalloid]] IV fluids will also dilute [[clotting factor]]s within the blood, increasing the risk of bleeding. It is current best practice to allow [[permissive hypotension]] in patients suffering from hypovolemic shock,<ref>{{cite web|url=http://www.trauma.org/archive/resus/permissivehypotension.html |title=Permissive Hypotension |publisher=Trauma.Org |date=1997-08-31 |accessdate=2015-11-01}}</ref> both to ensure clotting factors are not overly diluted and also to stop blood pressure being artificially raised to a point where it "blows off" clots that have formed.', 80 => false, 81 => '===Hospital treatment===', 82 => '[[Fluid replacement]] is beneficial in hypovolemia of stage 2, and is necessary in stage 3 and 4.<ref name=agabegi2nd /> See also the discussion of [[Shock (circulatory)|shock]] and the importance of treating reversible shock while it can still be countered.', 83 => false, 84 => 'For a patient presenting with hypovolemic shock in hospital the following investigations would be carried out:', 85 => '* Blood tests: [[Basic metabolic panel|U+Es/Chem7]], full blood count, glucose, blood type and screen', 86 => '* [[Central venous catheter]] or blood pressure', 87 => '* [[Arterial line]] or [[arterial blood gas]]es', 88 => '* Urine output measurements (via [[urinary catheterization|urinary catheter]])', 89 => '* Blood pressure', 90 => '* SpO2 Oxygen saturations', 91 => false, 92 => 'The following interventions would be carried out:', 93 => '* IV access', 94 => '* Oxygen as required', 95 => '* Surgical repair at sites of hemorrhage', 96 => '* [[Inotrope]] therapy ([[Dopamine]], [[Norepinephrine (drug)|Noradrenaline]]) which increase the [[contractility]] of the heart muscle', 97 => '* Fresh frozen plasma or whole blood', 98 => false, 99 => '==History==', 100 => 'In cases in which loss of blood volume is clearly attributable to bleeding (as opposed to, ''e.g.'', dehydration), most medical practitioners of today prefer the term ''[[exsanguination]]'' for its greater specificity and descriptiveness, with the effect that the latter term is now more common in the relevant context.<ref>{{cite journal |author1=L. Geeraedts Jr. |author2=H. Kaasjager |author3=A. van Vugt |author4=J. Frölke | year = | title = Exsanguination in trauma: A review of diagnostics and treatment options | url = | journal = Injury | volume = 40 | issue = 1| pages = 11–20 | doi=10.1016/j.injury.2008.10.007}}</ref>', 101 => false, 102 => '==See also==', 103 => '* [[Exsanguination]]', 104 => '* [[Hypervolemia]]', 105 => '* [[Non-pneumatic anti-shock garment]]', 106 => '* [[Polycythemia]], an increase of the hematocrit level, with the "relative polycythemia" being a decrease in the volume of plasma', 107 => '* [[Volume status]]', 108 => false, 109 => '==References==', 110 => '{{Reflist|colwidth=30em}}', 111 => false, 112 => '==External links==', 113 => '* {{CrispThesaurus|00004050}}', 114 => '* {{DiseasesDB|29217}}', 115 => false, 116 => '{{Water-electrolyte imbalance and acid-base imbalance}}', 117 => '{{Cardiovascular system symptoms and signs}}', 118 => false, 119 => '[[Category:Blood]]', 120 => '[[Category:Medical emergencies]]' ]