Clinical Assessment of Acute Hypovolemia Synopsis-Clinical Assessment of Acute Hypovolemia Synopsis

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The Clinical Practice Guideline on the clinical assessment of acute hypovolemia aims to determine the best non-invasive and objective bedside procedure for identifying acute hypovolemia in adult and pediatric emergency department (ED) patients. The guideline highlights the limitations of standard vital signs such as blood pressure, heart rate, and respiratory rate in accurately reflecting fluid volume and explores alternative indices and technologies that can be easily performed by emergency nurses.<br /><br />The first procedure discussed is Orthostatic Vital Signs (OVS), where vital signs are measured after the patient assumes a standing position. However, OVS lack sensitivity in detecting volume losses of 450 ml or less and there is insufficient evidence regarding the duration of rest in a supine position prior to measurement.<br /><br />Next, Pulse Pressure (PP) is discussed, which is found to correlate with acute blood loss requiring transfusion in trauma patients. However, there is no evidence regarding its utility in children.<br /><br />The guideline also explores the use of Shock Index (SI), where a pre-hospital SI ≥ 0.9 or a SI ≥ 0.8 or ≥ 1.0 in the presence of trauma correlates with acute blood loss requiring transfusion in adults. There is insufficient evidence for the use of Respiratory Rate Adjusted Shock Index (RASI) or Reverse Shock Index (RSI) as indicators of blood loss. In children, a Shock Index > 0.9 correlates with acute blood loss requiring transfusion in those > 1 year old with blunt trauma, and an age-adjusted Shock Index performs better in detecting blood loss in this population.<br /><br />The guideline provides different levels of recommendation based on the quality and consistency of evidence. Level A (High) and Level B (Moderate) recommendations indicate relevance and applicability to emergency nursing practice, while Level C (Weak) recommendations suggest limited or low-quality evidence. Recommendations marked as NR (Not Recommended), IE (Insufficient Evidence), or NE (No Evidence) are indicative of the current lack of evidence to make a recommendation.<br /><br />The full guideline can be accessed at ENA's website through the provided link.

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Keywords

clinical assessment

acute hypovolemia

non-invasive procedure

emergency department patients

orthostatic vital signs

pulse pressure

shock index

blood loss

recommendations

emergency nursing practice