Hemorrhagic Shock

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Section 6 - TRAUMA

6.13 HEMORRHAGIC SHOCK

HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION SECONDARY TO BLOOD LOSS

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

  • 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
    • Strongly consider transport of patient to a Trauma Center if TXA administered even if atraumatic hemorrhage.
  • Establish 2 large bore IV lines if Systolic BP less than 90 mm Hg. 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.


ADMINISTRATION OF DOPAMINE TO HYPOVOLEMIC PATIENTS IS CONTRAINDICATED.