Hypovolemic shock: the resuscitation

Once hypovolemic shock is recognized the volume is replaced with the fluid that matches what was lost — warmed isotonic crystalloid for water and salt, and blood early rather than late for blood, with crystalloid kept limited in hemorrhage and the pressure allowed to sit below normal until the bleeding is controlled, because a circulation forced back to a normal pressure with clear fluid dilutes the clotting factors, cools the patient and lifts the clot off the bleed — and the resuscitation is judged by the perfusion that returns rather than by the blood pressure alone: mental state, skin, pulse and pulse pressure, urine output, and a lactate that is clearing, read against a hemoglobin that lags the loss and is not reassuring on the first sample; a vasopressor is never a substitute for the missing volume, colloid earns no place ahead of crystalloid, and the patient is watched as closely for what the resuscitation costs — the coagulopathy, hypothermia and acidosis that feed each other, and the fluid overload and pulmonary edema in a heart or kidney that cannot take the volume — as for the shock it was given for.