Physiology of shock and volume resuscitation

Haemorrhagic and severe hypovolaemic shock can be rapidly fatal unless identified and resuscitated quickly. Monitoring of haemodynamic and cellular end points is crucial in guiding treatment and improving outcomes. This article therefore focuses on the pathophysiology of hypovolaemic shock, volume resuscitation, haemostasis and approaches to management. Fluid resuscitation saves lives but debate remains regarding the ideal fluid type and strategy to use. Blood transfusion is also a critical therapy in the shocked, bleeding patient – strategies vary depending on the clinical situation. Coagulopathy can accompany haemorrhage, particularly in trauma, and administration of coagulation products should be guided by testing. The aim is to stabilize the patient until definitive control of haemorrhage can be achieved by intervention.