Hypovolemic Shock




  • 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




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




  • 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




  • 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.