Shock/Hypotension Administrative Guideline

Question 1

History

Answer 1

- Blood loss - vaginal or gastrointestinal
bleeding, AAA, ectopic
- Fluid loss - vomiting, diarrhea, fever
- Infection
- Cardiac ischemia (MI, CHF)
- Medications
- Allergic reaction
- Pregnancy
- History of poor oral intake

Question 2

Signs and Symptoms

Answer 2

• Tachycardia out of proportion to temp
• AMS
• Delayed capilary refill >2 sec
• Tachypnea
• Hypotension for age
• Cool/mottled or flushed/ruddy skin.
• Tarry stool/GI bleed

Question 3

Differential

Answer 3

• Ectopic pregnancy
• Dysrhythmias
• Pulmonary embolus
• Tension pneumothorax
• Medication effect / overdose
• Vasovagal
• Physiologic (pregnancy)
• Sepsis

Question 4

Initial steps for shock/hypotension

Answer 4

If pregnant place in left lateral recumbant position. IV/IO access, cardiac monitor, ECG if indicated

Administer 20 mL/kg NS/LR fluid bolus over < 15
min (push pull method for peds)
May repeat x 1
Reassess after every 500 mL and hold administration for signs of fluid overload

Question 5

Is the patient responsive to fluid administration? Improved VS and perfusion?
NO?

Answer 5

Dopamine 2-10 mcg/kg/min IVPB

Titrate to SBP >90

Question 6

Does the patient have a history of adrenal insufficiency?

Answer 6

Assist with patient’s own hydrocortisone

Administer corticosteroids:
Preferred is patient's own hydrocortisone
(Solucortef)
or
Methylprednisolone 2 mg/kg
(max dose 125 mg) IV/IO/IM

Question 7

Dosages for stress dose steroids

Answer 7

• For adults the typical dose of hydrocortisone is 100 mg IM
• For children:
• 0-3 years 25 mg IM
• 3-12 years: 50 mg IM
• 12+ years: 100 mg IM
• Methylprednisolone is the alternative treatment