Mr. Raj Kumar is an 84-year-old man with carcinoma of the stomach, who returned to the ward an hour ago following surgery for a total gastrectomy. He has a Robinson’s drain in situ that is draining small amounts of blood-stained fluid, a urinary catheter on hourly measurements of urine output, and intravenous infusion of normal saline in progress. He is currently on half-hourly observations of his vital signs and has been stable since his return from theatre.

Forty-five minutes later, Mrs. Kumar asks you to check on her husband as she is worried about him. On examination his pulse is rapid, weak and thready, and he is breathless and hypotensive. His wound is oozing slightly, the Robinson’s drain is now full of blood-stained fluid and there is approximately 5ml of dark colored urine in the urometer.
What type of shock is Mr. Kumar likely to be experiencing?
Discuss the signs and symptoms that Mr. Kumar is experiencing.
Discuss the role of fluid therapy in managing Mr. Kumar’s condition.
Outline the immediate care that Mr. Kumar will require to prevent deterioration.

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