Severe Hemorrhagic Shock
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Section 6 - TRAUMA
6.13 HEMORRHAGIC SHOCK
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.
