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

• Activate Trauma Alert

• Initiate IV/IO; place 2nd IV/IO when feasible

 

Adult with severe external bleeding ?

 

• • See Extremity Trauma/Amputation Protocol

 

• • Once bleeding is controlled administer Normal Saline IV/IO to achieve a B/P >90; max 2,000 mL

 

Pediatric with severe external bleeding ?

 

• • See Extremity Trauma/Amputation Protocol

 

• • 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)

 

• • Consider pleural decompression

 

• • 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