Uganda guidelines for the treatment of Hypovolaemic Shock
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Class 1 — Mild (Blood loss <15% / <0.75 L)
Pulse normal. Systolic BP normal. Urine output >30 ml/h. Mental state: alert.
Class 2 — Progressing (Blood loss 15–30% / 0.75–1.5 L)
Pulse >100. Systolic BP normal. Urine output 20–30 ml/h. Mental state: anxious.
Class 3 — Severe (Blood loss 30–40% / 1.5–2 L)
Pulse >120. Systolic BP decreased. Urine output 5–20 ml/h. Mental state: confused.
Class 4 — End Stage (Blood loss >40% / >2 L)
Pulse >140. Systolic BP markedly reduced. Urine output <5 ml/h. Mental state: confused/unconscious.
Treatment
General Measures (All Classes)
Control obvious bleeding with pressure. Keep patient lying down with raised legs. Do not use glucose solution or plain water as replacement fluids.
Class 2 and Above
Set 2 large bore IV lines. Give IV Ringer's Lactate (or Normal Saline 0.9%) 20–30 ml/kg over 60 minutes. Warm fluid if possible. Start rapidly, monitor BP. Assess response: BP, HR, RR, capillary refill, consciousness, urine output.
If Internal or External Haemorrhage
Consider blood transfusion (see section 11.2).
Rapid Improvement and Stable (blood loss <20%, not progressing)
Slow IV fluids to maintenance levels. No immediate transfusion but cross-match blood. Regular reassessment. Detailed examination and definitive treatment of cause.
Transient Improvement (blood loss 20–40% or ongoing bleeding)
Rapid IV fluid administration. Initiate blood transfusion. Regular reassessment. Detailed examination and early surgery.
No Improvement
Vigorous fluid administration. Urgent blood transfusion. Immediate surgery.
General Pediatric
Treatment
General Principles
Principles are similar to adults. Vital signs may change little even when up to 25% of blood volume is lost (Class 1 and 2). Tachycardia is often the first response but may also reflect fear or pain.
Class 2 or Greater
Give initial fluid challenge of 20–30 ml/kg Normal Saline 0.9% (or Ringer's Lactate) over 60 minutes. Start rapidly, monitor BP, reduce rate depending on BP response.
Repeat Boluses
Repeat bolus up to 3 times if necessary (max 60 ml/kg total).
No Response to Fluid
Transfuse 20 ml/kg of whole blood OR 10 ml/kg of packed red cells (for severe anaemia only). Continue IV fluids alongside transfusion.
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