Hypovolemic Shock

 

History:

 

  • Past medical history
  • Medications
  • Estimated downtime

 

Significant Findings:

 

  • Restlessness/confusion
  • Weakness/dizziness
  • Weak, rapid pulse
  • Pale, cool, clammy skin
  • Delayed capillary refill
  • Altered mental status

 

Differential:

 

  • Shock
  • Hypovolemic
  • Cardiogenic
  • Septic
  • Neurogenic
  • Anaphylactic
  • Ectopic pregnancy
  • Dysrhythmias
  • Pulmonary embolus
  • Tension pneumothorax
  • Medication effect/overdose
  • Vasovagal
  • Physiologic (pregnancy)

 

Treatment:

 

  • Rapid Transport

 

 

 

  • Oxygen
  • 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

 

PEARLS:

 

  • 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.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic