Hypovolemia in Traffic Accidents

Hypovolemia is a major cause of morbidity and mortality in traffic accidents. It is also called hypovolemic shock and it is an emergency condition secondary to fluid loss and blood loss. The heart is unable to pump enough of the blood around the body. Organs stop working and death ensues.

Hypovolemia sinks in when a person loses about 1/5 of the normal amount of blood in the body. This is about a quart. The blood loss can happen from lacerations that cause blood to leave the body. Blood can be “lost” internally. As long as the blood is not part of the circulation, it is considered “lost”.

Other conditions can also lead to hypovolemia when fluids in the body are lost. This can happen in situations of diarrhea, vomiting, excessive perspiration and burns.

There are many symptoms which result when a person suffers from hypovolemia. The person can be agitated or anxious, confused, have cool, clammy skin, have decreased urine output, be pale, be weak, have rapid breathing, sweating and unconsciousness. The faster and greater the blood loss, the more severe symptoms.

Doctors can identify signs of shock by noting a low body temperature and a low blood pressure. The pulse is often weak and thready, and is usually fast.

Treatment includes keeping the patient warm and raising the feet up about 12 inches to keep blood flowing to the trunk, brain and heart. Giving fluids by mouth is avoided, instead using IV blood and fluids. If the shock is due to an allergic reaction, treat the allergic reaction primarily. Medications used to treat shock include dopamine, epinephrine, dobutamine and norepinephrine, which raise blood pressure and cardiac output, which is the amount of blood pumped out of the heart. The patient may need a Swan Ganz catheter which measures pressures inside the body and heart. A urinary catheter may need to be used to measure how much urine is being produced.

One study looked at 127 patients who died of blunt abdominal injuries because of traffic accidents during the years 1969-1974. The study took place in Vermont. There were medical errors that took place in these deaths, including the failure to recognize or treat the patient’s hypovolemia and failure to understand the need for urgent surgery. Many patients incidentally died on the x-ray table. While x-rays were needed, the hypovolemia was not treated properly before the patient went to the x-ray facility. In fact, 80 percent of deaths with a ruptured spleen died on the x-ray table after being seen in the emergency room after a traffic accident. It turned out that 47 percent of deaths in automobile accidents died of blunt abdominal trauma. Of those patients who arrived at the emergency room alive, a total of 26 percent would have lived if the hypovolemia was detected and treated while the patient was in the emergency room.

Hypovolemia is a serious medical condition with distinct physical findings and a high rate of death, especially when associated with blunt abdominal trauma in a traffic accident.

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