Hypovolemic Shock

What Is Hypovolemic Shock?

Hypovolemic shock is a life-threatening circulatory failure caused by a drastic drop in intravascular volume — from massive hemorrhage (hemorrhagic shock) or severe fluid loss (burns, dehydration, vomiting) — resulting in tissue hypoxia and cellular death.

Why Hypovolemic Shock Matters on the Fireground

Uncontrolled bleeding is the leading cause of preventable trauma death. Hypovolemic shock progresses from compensated (tachycardia, narrow pulse pressure) to decompensated (SBP < 90 mmHg, altered mental status), after which survival rates drop precipitously.

Relevant NFPA Standards

• NREMT Standards: National Registry of Emergency Medical Technicians Practice Standards
• NFPA 455: Standard for Emergency Medical Services (EMS)

Field Procedures & Tactical Steps

1. Control external bleeding immediately using direct pressure, high-thigh/high-arm tourniquets, or hemostatic wound packing.
2. Administer high-flow oxygen via non-rebreather mask (15 LPM) to maximize hemoglobin saturation.
3. Establish two large-bore IV lines (14G or 16G) or interosseous (IO) access.
4. Administer 20 mL/kg fluid boluses of warm Normal Saline or Lactated Ringer's (or blood products if available) targeting SBP 80-90 mmHg.
5. Keep patient warm with thermal blankets to prevent the lethal trauma triad (hypothermia, coagulopathy, acidosis).

Common Context & Application

Encountered on severe trauma calls, arterial lacerations, internal abdominal bleeding, pelvic fractures, and major thermal burns.

Frequently Asked Questions about Hypovolemic Shock