What are the recommended fluid resuscitation protocols for managing hypovolemic shock in adults?

Recommended fluid resuscitation protocols for managing hypovolemic shock in adult patients:

• Initial assessment should identify hypovolemia using clinical indicators such as systolic blood pressure less than 100 mmHg, heart rate over 90 bpm, capillary refill time over 2 seconds or cold peripheries, respiratory rate over 20 breaths per minute, and a National Early Warning Score (NEWS) of 5 or more. Passive leg raising can be used to assess fluid responsiveness at the bedside ³.
• For fluid resuscitation, intravenous (IV) fluids should be administered promptly to patients who cannot meet their fluid needs orally or enterally, with continuous reassessment and monitoring ³.
• In cases of hypovolemic shock due to active bleeding (haemorrhagic shock), hospital protocols recommend avoiding crystalloids and instead using blood components with a ratio of 1 unit plasma to 1 unit red blood cells for adults ².
• In pre-hospital settings, crystalloids may be used to replace fluid volume if blood components are unavailable, but in hospital settings, blood components are preferred for active bleeding ².
• For non-bleeding hypovolemic shock, follow the NICE guideline on intravenous fluid therapy in adults, which includes using isotonic crystalloid solutions for initial resuscitation, titrated to clinical response and ongoing monitoring ³.
• Continuous monitoring during resuscitation should include ABCDE assessment, respiratory rate, pulse, blood pressure, perfusion, venous lactate, arterial pH, and base excess as per advanced life support guidance ³.
• Fluid prescriptions must specify type, rate, and volume, and patients should have an IV fluid management plan with daily expert review initially ³.