Non-Hemorrhagic Shock

Section 5 -MEDICAL

HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION SECONDARY TO FLUID LOSS

INITIAL MEDICAL CARE - Provide OXYGEN or assist ventilations as appropriate for patient condition.

• Place patient in Trendelenburg
• Control any external hemorrhage if present
• For spontaneously breathing patients with a systolic blood pressure less than 100 mm Hg and no known contraindications to the device, apply the ResQGuard impedance threshold device with mask or mouth-piece as indicated (procedure 9.31) if available. Monitor systolic Blood pressure every 2-3 minutes.
• Consider administration of Tranexamic Acid (TXA) if:
  • Sustained Systolic Blood Pressure is less than 90 mmHg AND
  • Sustained heart rate of 110 beats per minute or higher
• Establish 2 large bore IV lines. Fluid boluses in increments of 200 - 300 ml, to titrate systolic BP greater than 90 mm Hg. Monitor for signs of fluid overload.
• Limit fluid administration to 2000cc due to possibility of DIC.
• If known hemorrhagic shock infuse fluid rapidly until systolic BP greater than 90 mm Hg. Monitor patient for signs of fluid overload.
• In non-hemorrhagic shock, if condition worsens despite fluid therapy, administer DOPAMINE 5 - 20 mcg/kg/minute titrated to systolic BP greater than 90 mm Hg.

ADMINISTRATION OF DOPAMINE TO HYPOVOLEMIC PATIENTS IS CONTRAINDICATED.