2-7 MEDICAL HYPOTENSION - SHOCK

Hypotension is defined as systolic BP less than 90mmHg in adults.

Shock is a state of decreased tissue oxygenation.  Significant vital organ hypoperfusion may be present without hypotension. Clinical signs and symptoms of hypoperfusion include pale, cool, and clammy skin, tachycardia, altered mental status; ischemic chest pain, etc. Home medications and/or comorbidities may limit development of tachycardia.

Goal of therapy is to maximize oxygen delivery to tissues with supplemental oxygen and assisted ventilations (if needed), as well as to maximize tissue perfusion with IV fluids.

Any patient requiring ACLS care should have an ALS intercept if logistically possible.

EMR - Emergency Medical Responder

1. Begin initial medical care
2. Administer oxygen
3. Assist ventilations if RR < 8/min or > 35/min
4. Assess for hypotension/ shock (HR >130, cap refill > 2 seconds) & follow shock protocol
5. Call for ALS intercept

EMT- Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assure ALS intercept is en route
2. Transport as early as possible
3. Measure blood sugar if indicated, follow hypoglycemia protocol
4. Reassess VS & lung sounds often during transport
5. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed)
6. Perform 12-lead ECG (if trained) as indicated

CONTACT MEDICAL CONTROL

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Start IV access en route, NS TKO (do not delay transport) CONTACT MEDICAL CONTROL
2. Report lung sounds
3. Administer NS fluid bolus, as directed

Intermediate   Perform/Confirm All Above Interventions

1. Attach cardiac monitor if not already done, confirm rhythm in more than 1 lead
2. Treat dysrhythmia primarily; Heart rates > 150 or < 50  are often unstable and/ or symptomatic
3. Administer NS fluid bolus up to a total of 500 mL -IF-
   1. Symptomatic, no dysrhythmia & lungs are clear
4. Reassess VS, lung sounds & rhythm frequently
5. Consider other possible causes to focus treatment
   1. H’s & T’s: Hypovolemia, Hypoxia, H+ acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Toxins, Tamponade, Tension pneumothorax, Thrombosis (coronary, pulmonary), Trauma
6. Consider Septic Shock when the following criteria are met:
   1. Presence of Systemic Inflammatory Response Syndrome (SIRS):
      1. Heart rate > 110
      2. Respiratory rate > 24
      3. Temp > 100.4 F or < 96.8 F
   2. Suspected infection
   3. Signs of hypoperfusion
7. If the criteria for Septic Shock are met, consider alerting receiving facility of the concern for a septic patient. CONTACT MEDICAL CONTROL
8. May administer additional NS fluid bolus, as directed, after a total of 500 mL -IF-
   1. Symptomatic, no dysrhythmia & lungs are clear

Paramedic   Perform/Confirm All Above Interventions

CONTACT MEDICAL CONTROL

1. May administer Push Dose Epinephrine to maintain blood pressure / tissue perfusion.  Please reference the Push Dose Epinephrine Guideline for specific details of this process.