- Past medical history
- Estimated downtime
- Weak, rapid pulse
- Pale, cool, clammy skin
- Delayed capillary refill
- Altered mental status
- Ectopic pregnancy
- Pulmonary embolus
- Tension pneumothorax
- Medication effect/overdose
- Physiologic (pregnancy)
- Consider Spinal Immobilization
- Initiate IV/IO; place 2nd IV/IO when feasible
Adult with severe external bleeding ?
- Once bleeding is controlled administer Normal Saline IV/IO to achieve a B/P >90; max 2,000 mL
Pediatric with severe external bleeding ?
- Once bleeding is controlled, administer Normal Saline 20 mL/kg IV/IO; max 60 mL/kg or 1,000 mL
Suspected internal bleeding with signs and symptoms of shock ?
- Just enough Normal Saline to maintain a radial pulse (MAP of 60)
- Notify receiving facility or contact Medical Control
- Notify trauma center of the START triage category as soon as possible. When en-route notify trauma center of GCS, major area of injury or mechanism of hypovolemia, and anticipated ETA
- Aggressive steps should be taken to prevent hypothermia; remove wet clothing, cover with blankets, and utilize heat packs if indicated.