Shock
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Section 5 -MEDICAL
5.13 SHOCK
HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION SECONDARY TO FLUID LOSS
INITIAL MEDICAL CARE - Provide OXYGEN or assist ventilations as appropriate for patient condition.
- Place patient in Trendelenburg
- 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.
- Establish 2 large bore IV lines. 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.
- In non-hemorrhagic shock, if condition worsens despite fluid therapy, administer DOPAMINE 5 - 20 mcg/kg/minute titrated to systolic BP greater than 90 mm Hg.
ADMINISTRATION OF DOPAMINE TO HYPOVOLEMIC PATIENTS IS CONTRAINDICATED.
