Shock

Front 1

Hypovolemia

Back 1

A. Control external bleeding

B. Give up to 2 L isotonic fluid as rapidly as possible or until:

*SBP 90

*JVD or Pulmonary rules develop

* Normal mentation

Front 2

Head injury and shock

Back 2

A. Fluid challenge as indicated for hypovolemic target SBP 100-110

B. Maintain normal ventilation rate target Etco2 35mm/Hg

Front 3

Distributive shock (sepsis, neurogenic)

Back 3

A. Begin 500 to 1000 ml fluid challenge to maintain SBP > 90 repeate once if continued signs of shock and no signs of Pulmonary edema

B. Norepinephrine starting 4mcg/min if no improvement then increase by 4mcg/min every 5 minutes to a max of 12mcg/min goal is SBP > 90

(Alternative epinephrine 2-10mcg/min)

Front 4

Cardiogenic (stemi, cardiomyopathy)

Back 4

A. Follow appropriate dysthymia protocol

B. 250 - 500cc fluid challenge to maintain SBP >90 repeate once if there are still signs of shock and no Pulmonary edema (max 1000cc)

C. Norepinephrine 4mcg/min if no improvement increase by 4mcg/min every 5 minutes to a max of 12mcg/min (alternative epinephrine 2-10mcg/min)

Front 5

Hypoadrenal shock (Addisons Crisis)

Back 5

A. Known hypoarenal state: hx from family, medical bracelets

B. Suspected: pt on high dose chronic steroid

C. 250-500cc fluid challenge if no improvement and no signs of edema repeate to a max of 1000cc

D. Solumedrol 125 -250mg IV (Alternative dexamethasone 10mg IV/IM/PO)

Front 6

Pediatric fluid bolus

Back 6

20cc/kg may repeate x 1 to a BP appropriate for age or signs of Pulmonary edema