Hypovolaemia (Adult)
 
Status
Evidence of Hypovolaemia
   
Stop
Identify and manage:
- Haemorrhage, Fractures, Pain, Tension pneumothorax, Hypoxia
   
Assess

• HR / BP
• Consider modifying factors:
  - SCI, chest injury, penetrating trunk injury, AAA, uncontrolled external haemorrhage
               
HR & BP NAD   Isolated Tachycardia   Hypotension
HR < 100 and BP > 100   • HR >100 and BP>100   • BP<100 (regardless of HR)
Fluid not required unless signs of significant dehydration   Normal Saline 20ml/kg IV   Normal Saline 20ml/kg IV
                       
If significantly dehydrated                    
Normal Saline up to 20ml/kg IV over 30 minutes                    
                     
Reassess   Reassess
                     
HR>100 and/or BP<100   HR<100 and BP>100   HR<100 and BP>100   HR>100 and/or BP<100
Repeat Normal Saline 20ml/kg IV   No further fluid required   No further fluid required   • Insert second IV
• Repeat Normal Saline 20ml/kg IV
                     
Assess BP               Assess BP
Is BP <100?   Yes      
Yes
   Is BP <100?
  No               No  
BP>100     BP remains <100     BP>100
No further fluid required     After Normal Saline IV 40ml/kg (e.g. 20ml/kg x 2)     No further fluid required
    • Consult with MTS
• If consult unavailable, repeat:
Normal Saline 20ml/kg IV		    
           
   
Modifying Factors
Complete spinal cord transection Mx as per Cord Injury
  - Pt with isolated neurogenic shock can be given up to 500ml Normal Saline bolus to correct hypotension.
  - No further fluid should be given if SCI is the sole injury.
Chest injury
  - Consider tension pneumothorax Mx Chest Injury
Penetrating Trunk Injury, aortic aneurysm or uncontrolled haemorrhage.
  - Accept palpable carotid pulse and transport immediately
GI bleeding
  – consider lesser volumes of fluid and accepting a blood pressure of 80 to 100mmHg systolic
 
Special Notes
Modifying factors must be considered and managed prior to aggressive fluid therapy.
• Titrate fluid administration to Pt response
• Aim for HR < 100, BP > 100 if VSS altered
• Consider establishing IV en route. Do not delay transport for IV therapy.
• Always consider tension pneumothorax, particularly in the Pt with a chest injury, not responding to fluid therapy and persistently hypotensive
• Excessive fluid should not be given if spinal cord injury is an isolated injury

• Clinical signs of significant dehydration include:
  - Postural perfusion changes including tachycardia, hypotension or dizziness  
  - Decreased sweating and urination
  - Poor skin turgor, dry mouth, dry tongue
  - Fatigue and altered consciousness
  - Evidence of poor fluid intake compared to fluid loss
• Dehydration in the hyperglycaemic patient should be managed under this guideline
 
General Care
• Haemorrhage from Blunt trauma is not considered as 'uncontrolled' in the context of this guideline and should be managed as defined within
• GI bleeding has potential to be 'uncontrolled' in the context of this guideline and should be considered as a modifying factor