Hypovolemia can be recognized by a fast heart rate, low blood pressure, and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill on forehead, lips and nail beds. The patient may feel dizzy, faint, nauseated, or very thirsty. These signs are also characteristic of most types of shock. In children, compensation can result in an artificially high blood pressure despite hypovolemia (a decrease in blood volume). Children typically are able to compensate (maintain blood pressure despite hypovolemia) for a longer period than adults, but deteriorate rapidly and severely once they are unable to compensate (decompensate). Consequently, any possibility of internal bleeding in children should be treated aggressively. Signs of external bleeding should be assessed, noting that individuals can bleed internally without external blood loss or otherwise apparent signs. 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 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 (bruising along the sides) or Cullen's sign (around the navel). Investigation In a hospital, physicians respond to a case of hypovolemic shock by conducting these investigations: * Blood tests: U+Es/Chem7, full blood count, glucose, blood type and screen * Central venous catheter * Arterial line * Urine output measurements (via urinary catheter) * Blood pressure * SpO2 oxygen saturation monitoring Stages Untreated hypovolemia can lead to shock (see also: hypovolemic shock). Most sources state that there are 4 stages of hypovolemia and subsequent shock; however, a number of other systems exist with as many as 6 stages. 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. It is basically the same as used in classifying bleeding by blood loss. The signs and symptoms of the major stages of hypovolemic shock include: Stage 1 Stage 2 Stage 3 Stage 4 Blood loss Up to 15% (750 mL) 15–30% (750–1500 mL) 30–40% (1500–2000 mL) Over 40% (over 2000 mL) Blood pressure Normal (Maintainedby vasoconstriction) Increased diastolic BP Systolic BP 100 bpm) Tachycardia (> 120 bpm) Extreme tachycardia (> 140 bpm) with weak pulse Respiratory rate Normal Increased (> 20) Tachypneic (> 30) Extreme tachypnea Mental status Normal Slight anxiety, restless Altered, confused Decreased LOC, lethargy, coma Skin Pale Pale, cool, clammy Increased diaphoresis Extreme diaphoresis; mottling possible Capillary refill Normal Delayed Delayed Absent Urine output Normal 20–30 mL/h 20 mL/h Negligible
symptom of Placental abruption
symptom of Postpartum infections
symptom of Mastitis
symptom of Obstetric fistula
symptom of Postpartum bleeding
symptom of Stillbirth
symptom of Eclampsia
symptom of Ectopic pregnancy