On the Diagnosis of Hemorrhage in Man

Shenkin, Henry A.; Cheney, Robert; Govons, S.R.; Hardy, Judy; Fletcher, Austin; Starr, Issac

doi:10.1097/00000441-194410000-00001

Cited by 59 publications

(4 citation statements)

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“…The first documented observations are from World War II in air raid casualties with hypovolaemic shock (Grant and Reeve 1941; McMichael 1944), in volunteers bleeding large amounts (Shenkin et al 1944), and in patients with serious haemorrhagic shock where the finding of a low f c was unexpected (Van Lieshout and Secher 1999; Kinsella and Tuckey 2001). …”

Section: Haemorrhagementioning

confidence: 99%

A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

2010

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The Frank–Starling mechanism describes the relationship between stroke volume and preload to the heart, or the volume of blood that is available to the heart—the central blood volume. Understanding the role of the central blood volume for cardiovascular control has been complicated by the fact that a given central blood volume may be associated with markedly different central vascular pressures. The central blood volume varies with posture and, consequently, stroke volume and cardiac output () are affected, but with the increased central blood volume during head-down tilt, stroke volume and do not increase further indicating that in the supine resting position the heart operates on the plateau of the Frank–Starling curve which, therefore, may be taken as a functional definition of normovolaemia. Since the capacity of the vascular system surpasses the blood volume, orthostatic and environmental stress including bed rest/microgravity, exercise and training, thermal loading, illness, and trauma/haemorrhage is likely to restrict venous return and . Consequently the cardiovascular responses are determined primarily by their effect on the central blood volume. Thus during environmental stress, flow redistribution becomes dependent on sympathetic activation affecting not only skin and splanchnic blood flow, but also flow to skeletal muscles and the brain. This review addresses the hypothesis that deviations from normovolaemia significantly influence these cardiovascular responses.

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Section: Haemorrhagementioning

confidence: 99%

A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

2010

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“…In contrast, bradycardia occurs frequently after significant blood loss, often immediately preceding the decrease in systemic vascular resistance and thefaintingthat mayoccur. 11,[27][28][29][30][31][32]39,[79][80][81] One study 80 showed a strong correlation between the decrease in heart rate after blood loss and the maximal decrease in BP (r, 0.79), and, in hypotensive patients receiving fluid resuscitation, the pulse may paradoxically rise initially. 81 Inpatientswithsuspectedbloodloss,supinehypotension(systolicBPϽ95mmHg) is a specific finding of hypovolemia (97% specificity),althoughitisinsensitivetoboth moderatebloodlossof450to630mL(13% sensitivity) and more significant loss of 630 to 1150 mL (33% sensitivity).…”

Section: Precision Of Physical Signsmentioning

confidence: 99%

Is This Patient Hypovolemic?

McGee

Abernethy²,

Simel

1999

JAMA

516

177

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In each of the following clinical scenarios, clinicians need to identify which physical signs reliably and accurately indicate volume depletion or dehydration. Case 1A 54-year-old man, taking ibuprofen for knee arthritis, presents with a 1-day history of melena. Physical examination reveals a pulse of 80/min and blood pressure (BP) of 140/82 mm Hg when supine, and 115 and 132/86 mm Hg when standing. There ismildepigastrictendernessandhemoccultpositive stool. The hematocrit is 0.39. Case 2A 62-year-old woman has 6 months of episodic vertigo and unilateral hearing loss, attributed to Ménière disease. She begins treatment with hydrochlorothiazide, but during a follow-up visit 3 weeks later, she reports her dizziness is slightly worse since starting the medication. Her heart rate is 80/min and BP is 160/84 mm Hg when supine, 88 and 134/72 mm Hg when standing. She experiences slight dizziness when standing. Case 3An 82-year-old nursing home resident presents to the emergency department with a 1-day history of nausea and vomiting. Her underlying medical problems include dementia, coronary artery disease, atrial fibrillation, emphysema, and hypertension. She has been treated with aspirin, isosorbide dinitrate, furosemide, bagonist inhalers, and lisinopril. The clinician diagnoses viral gastroenteritis or food poisoning because other members of the nursing home have an identical illness. On examination, the patient is afebrile, alert, and demonstrates normal speech and strength. Her mental status is no different from her baseline. The pulse is 75/min and the BP is 154/90 mm Hg supine, and 90 and 130/76 mm Hg when upright. The tongue, mucous membranes, and axillae are moist. Results of an examination of the heart, lungs, and abdomen and an electrocardiogram are normal. WHY IS CLINICAL EXAMINATION IMPORTANT?The term volume depletion describes the loss of sodium from the extracellular space (intravascular and interstitial fluid) that occurs after gastrointestinal hemorrhage, vomiting, diarrhea, and diuresis.

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“…Hypovolemia can be subdivided into three main categories: mild, moderate, and severe (Shenkin et al 1944).…”

Section: Discussionmentioning

confidence: 99%

“…Severe hypovolemia (>1000 ml) is characterized by tachycardia, failure to maintain microvascular blood flow, and cardiovascular collapse (Cooke et al 2004). In the setting of cardiovascular collapse, arterial pressure and pulse rate rapidly decline, and symptoms indicative of severe hypovolemic shock occurs (Shenkin et al 1944).…”

Section: Discussionmentioning

confidence: 99%

Using the ear photoplethysmographic waveform as an early indicator of central hypovolemia in healthy volunteers utilizing LBNP induced hypovolemia model

Eid

Elgamal²,

Fiol

et al. 2023

Physiol. Meas.

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Objective: To study the photoplethysmographic (PPG) waveforms of different locations (ear and finger) during lower body negative pressure (LBNP) induced hypovolemia. Then, to determine whether the PPG waveform can be used to detect hypovolemia during the early stage of LBNP.Approach: 36 healthy volunteers were recruited for progressive LBNP induced hypovolemia, with an endpoint of -60 mmHg or development of hypoperfusion symptoms, whichever comes first. Subjects tolerating the entire protocol without symptoms were designated as high tolerance (HT), while symptomatic subjects were designated as low tolerance (LT). Subjects were monitored with an electrocardiogram, continuous noninvasive blood pressure monitor (CNAP), and two pulse oximetry probes, one on the ear (Xhale) and one the finger (Nellcor). Stroke volume (SV) was measured non-invasively utilizing NICOM (Cheetah Medical). The waveform morphology was analyzed using novel PPG waveforms indices, including phase hemodynamic index (PHI) and amplitude hemodyamaic index (AHI) and were evaluated from the ear PPG and finger PPG at different LBNP stages.Main Results: The PHI, particularly the phase relationship between the second harmonic and the fundamental component of the ear PPG denoted as 〖∇φ〗_2, during the early stage of LBNP (-15 mmHg) in the HT and LT groups is statistically significantly different (p value=0.0033) with the area under curve 0.81 (CI: 0.616-0.926). The other indices are not significantly different. The 5 fold cross validation shows that 〖∇φ〗_2 during the early stage of LBNP (-15 mmHg) as the single index could predict the tolerance of the subject with the sensitivity, specificity, accuracy and F1 as 0.771±0.192, 0.71±0.107, 0.7±0.1 and 0.771±0.192 respectively.Significance: The ear’s PPG PHI which compares the phases of the fundamental and second harmonic has the potential to be used as an early predictor of central hypovolemia. 

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On the Diagnosis of Hemorrhage in Man

Cited by 59 publications

References 0 publications

A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

Is This Patient Hypovolemic?

Using the ear photoplethysmographic waveform as an early indicator of central hypovolemia in healthy volunteers utilizing LBNP induced hypovolemia model

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