Shock

Inclusion Criteria: Any patient experiencing signs and symptoms consistent with shock. Refer also to Trauma, specific arrhythmia, and Allergic Reaction guidelines.

          Basic Level

1. Assess and support ABCs.
   
   
2. Initiate spinal movement restrictions, if needed. Place patient supine and elevate legs, unless contraindicated.
   
   
3. Control any obvious external bleeding.
   
   
4. Cover the patient to avoid heat loss. Do not over bundle.
   
   
5. Administer oxygen via non-rebreather mask at 10-15 lpm or via BVM.
   
   
6. Begin transport at the earliest possible moment.
   
   
   Advanced Level
   
   
7. Apply ECG, SpO2 and EtCO2 monitors.
   
   
8. Establish one large bore IV and infuse normal saline with the following guidelines
   
   Hypovolemic Shock

   Adult Administer 250 ml boluses as needed to maintain radial pulses (do not exceed systolic BP of 90 mmHg) Examine area of controlled hemorrhage frequently to determine that bleeding remains controlled.

   Pediatric Administer 20 ml/kg bolus Repeat once if systolic pressure not above 70 mmHg If the patient is unconscious, consider the use of an IO infusion early.

   
   
   Cardiogenic Shock - Assure heart rate and rhythm are adequate, then:

   Adult Infuse a single 250 ml bolus unless pulmonary edema is present. Contact BioTel for vasopressor

   Pediatric Run fluid at TKO rate. Contact BioTel for vasopressor

   
   
   All Other Forms of Shock

   Adult Infuse 250 ml boluses as needed titrating to a systolic B/P of 90 mmHg Do not exceed 1,000 ml under standing orders

   Pediatric Infuse bolus of 20 ml/kg. Repeat once if systolic pressure not above 70 mm Hg. If the patient is unconscious, consider the use of an IO infusion early.

   
   
9. Monitor vital signs and neurological status during transport.
   
   
10. For additional patient care considerations not covered under standing orders, consult BioTel.

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