Hemorrhagic Shock

Section 6 - TRAUMA

HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION SECONDARY TO BLOOD LOSS

INITIAL TRAUMA CARE - Provide OXYGEN or assist ventilations as appropriate for patient condition.

• Control any external hemorrhage if present
• For spontaneously breathing patients with a systolic blood pressure less than 100 mm Hg and no known contraindications to the device, apply the ResQGuard impedance threshold device with mask or mouth-piece as indicated (procedure 9.31) if available. Monitor systolic Blood pressure every 2-3 minutes.
• Consider administration of Tranexamic Acid (TXA) if:
  • Sustained Systolic Blood Pressure is less than 90 mmHg AND
  • Sustained heart rate of 110 beats per minute or higher
  • Strongly consider transport of patient to a Trauma Center if TXA administered even if atraumatic hemorrhage.
• Establish 2 large bore IV lines if Systolic BP less than 90 mm Hg. Fluid boluses in increments of 200 - 300 ml, to titrate systolic BP greater than 90 mm Hg. Monitor for signs of fluid overload.
• Limit fluid administration to 2000cc due to possibility of DIC.
• If known hemorrhagic shock infuse fluid rapidly until systolic BP greater than 90 mm Hg. Monitor patient for signs of fluid overload.

ADMINISTRATION OF DOPAMINE TO HYPOVOLEMIC PATIENTS IS CONTRAINDICATED.