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squigglywindy · 1 year

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So…I’ve gotten a few requests for my infamous Hypovolemia Infodump, so it’s under the cut!

Disclaimer: This is not medical advice, this is Turture Blorbo Advice. But, I mean, if someone’s bleeding out and you remember something from this…I guess that’s a positive?

Most of my experience is purely hypothetical, I have a lot of textbook knowledge, but my actual hands-on shock experience is pretty small. So, take that as you will. Shock is one of my favorite subjects to study, which you can probably tell :D

Enjoy!

Hypovolemic shock is the shock that happens when too much of your blood falls out :)

So first! There’s three stages depending on how much blood you’ve lost:

1: About 15% (You’re probably feeling pretty okay)

2: 15-30% (The symptoms are setting in and you’re pretty out of it)

3: 30% and up (Oh no the shock is real)(but over 40% and you’re almost definitely toast. Gotta do something before you get to this point. That’s about a half gallon or two liters. Lotta blood)

The symptoms for each of the stages are going to be very similar, but they’ll get more and more intense as the blood loss increases (makes sense, right? No blood = bad)

Classic hypovolemia symptoms:

Tachycardia! Heart rate’s gonna speed up. It’s trying to compensate for the lack of blood, but there’s not blood, so if you feel the pulse it’s going to be really fast, but very weak. Thready, if you will.

Hyperventilation! Respiration rate is going to go up. This is because of distress, but also because of metabolic acidosis (which is a fancy way of saying your systemic pH is low, and your body compensates for this by blowing off CO2 by hyperventilating. That’s not really important, just know that you’ll breathe real fast)

Hypotension. Blood pressure drops. Makes sense - you’ve got less blood going through your blood vessels, so it can’t exert enough pressure. This is the big deal with shock - it’s like ‘the shock Thing’. The thing that needs treatment ASAP. With other types of shock, such as anaphylaxis (serious allergic reaction), this is done by injecting epinephrine, which causes blood pressure to spike, and all is well. That’s a story for another day, but consider: medicines that raise blood pressure will do absolutely nothing if there’s no blood to pressurize. So hypovolemic shock works a little different.

Pallor. Pale skin. Part of the pigmentation of skin can be attributed to the blood that lives underneath it, and when your blood falls out, so does your color. Whatever your natural skin tone is, it’ll go down a few notches.

Diaphoresis (I’m making you learn words, sorry). That’s a fancy way of saying sweat. This happens because your body’s releasing epinephrine in an effort to raise your blood pressure. It won’t work, but it’s trying, and epinephrine is the fight-or-flight hormone, which leads to…

Anxiety! This one’s fancy because yeah, it’s caused by the release of epinephrine, but also if you’re going into hypovolemic shock you’ve definitely been injured and are losing an obscene amount of blood, so who needs fancy hormones to feel anxiety?

Weakness. No blood, no strength - it’s pretty straightforward

Dizziness. Not enough blood to the brain = unsteady, the world will spin. Maybe they’ll fall; be ready to catch them. Actually, go ahead and set them down. You see blood, get them on the ground

Nausea, from all the crazy reactions from your body trying to keep you alive

Cold. Less blood means less warmth

And my personal favorite: CNS effects, such as confusion and agitation. If you don’t have enough blood, not enough blood can get to your brain. This results in brain malperfusion (not enough blood-flow) so it can’t work right and doesn’t know what’s going on. What’s more fun than helping someone who’s bleeding? Helping someone who’s bleeding and has no idea what’s going on!

In early stages, blood pressure may be normal and the symptoms mild; but as blood continues to drain, blood pressure drops, and symptoms increase. It’s a highly individualized experience.

So what do you do about it? Your friend’s laying there, they’ve been stabbed or sliced or fell off a building, and they’re bleeding. Maybe they have been; the shock’s already started. What now?

First and foremost! Stop the bleeding. Treating the symptoms of shock means nothing if the blood’s still falling out: they’re only going to get worse.

So, how to stop the bleeding.

For a smaller-scale injury, pressure. Pressure forever it is lovely. Noninvasive, doesn’t create secondary fallout, mash that injury into next Tuesday it’s gonna hurt but it’s worth it. Smoosh it. Mash it together and hold on tight.

So the pressure hasn’t worked. It’s too big, it’s bleeding too much, oh no. Perfect world? Stitches would be nice. But, depending on where it is and how it’s injured, they may or may not work. Whole artery got severed? Closing up the hole in the flesh isn’t gonna help a whole lot (hematoma, anyone? Bleeding under the skin) but it’s better than nothing until you can get to help.

Oh no, all else has failed? It’s tourniquet time. (Special side note that shouldn’t need to be said, but you never know. If you are bleeding from a head injury [and head injuries bleed a lot] then you’re just gonna have to suffer because you can’t tourniquet a neck. The ABCs are always priority. Airway, Breathing, Circulation. So yes, circulation is one of them and stopping the bleeding is number one, but you can’t sacrifice another ABC to save it. In this case, breathing). Tourniquets are fun because the angst potential is unreal. They can be made out of anything, which is where I get a lot of jollies. Very few people have a tourniquet laying around (I have one in my bag, but I never pretended to be normal), so they’re going to have to find something else. Any stray bit of cloth will do. A scarf. A really strong plant. Anything you can tie and make a loop out of. Wherever the wound is, put the tourniquet closer to the body. Slide something in the loop (stick, coathanger, a shoe, just not a body part) and twist that bad boy until it’s tight. Tighter than you think. Twist until you think “ah that’s too tight” and then twist a little bit more. And hold it. Actual tourniquets have a stick-holder, but if you makeshift it, you are the stick-holder. Now you need to write down what time it is, because when you get to help they’re going to want to know how long that tourniquet’s been tourniqueting.

The bleeding’s stopped, for better or worse. What else? (These can be done while stopping the bleeding, but remember: blood loss is priority)

Put the person in “the shock position”. Laying on their back, feet raised above their heart to help the remaining blood get to the parts that really matter (heart and brain, not legs)

If, and only if, you know that there’s not damage to their spinal cord, turn their head to the side (in case they throw up, this eliminates the risk for aspiration [fancy word for choking on inhaled fluids])

Put a blanket over them, if there is one. Helps keep them warm and conserve energy otherwise wasted by shivering

And of course, in any scenario where it’s remotely possible, the real priority is to call emergency responders and get help. Ideally, this can be done with one hand while controlling bleeding with the other. But if there’s no help to be had, do what you can

Always for any of the above, DO NOT MOVE THEM if you’re unsure if there’s spinal cord damage. Leave them still unless you know

So you held them together and now professional help has arrived. What’s next?

If the bleeding isn’t actually stopped, usually because a vessel’s been wrecked, they’re probably headed to surgery to get it sewed back up right

Tourniqueted limbs are usually sacrificed for the greater good and may get removed

But above all else, blood replacement. Transfusion is inevitable if you’ve lost enough blood to experience shock of any degree

Hydrate - you’ve lost a lot of fluid and hydration is never bad

That’s about it for hypovolemia. Enjoy harming the blorbos and making them bleed <3

#squiggles rambles #squiggles writes #squiggles says something educational #hypovolemia #hypovolemic shock #blood #obviously

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