Hemorrhagic Shock

Question 1

Hemorrhagic Shock Adult Management

Answer 1

▪ Rapid transport, keep on-scene times less than 10 minutes.
▪ Provide Oxygen Therapy

Question 2

Hemorrhagic Shock
Fluid Resuscitation

Answer 2

▪ Establish two large bore IVs while en route. NEVER delay transport to start IVs on scene.
▪ Internal hemorrhage
o Give only enough normal saline to maintain a blood pressure high enough for
adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 90 mmHg, which is the goal of fluid resuscitation for a patient with suspected internal hemorrhage.
o Bolus of Normal Saline 500mL, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.-
o Permissive Hypotension in trauma
o BLOOD TRANSFUSION: See Protocol

Question 3

Hemorrhagic Shock
Pediatric Management

Answer 3

▪ Rapid transport, keep on-scene times less than 10 minutes.
▪ Provide Oxygen
▪ Control external severe extremity hemorrhage (direct pressure, Combat Application Tourniquet (C.A.T.), apply at the most proximal anatomical location of extremity until the bleeding stops). Never apply C.A.T. directly over injury site or
joint.
▪ If clotting agent is available, severe junctional hemorrhage (e.g., neck, axillary, thoracic, abdominal, pelvis and groin) and any other severe external hemorrhage that is not able to be easily controlled using C.A.T. shall be controlled using clotting agent. Pack wound with clotting agent and maintain pressure for a minimum of one minute.
▪ Spinal Motion Restriction if indicated.
▪ Maintain body temperature with blankets.

Question 4

Pediatric Hemorrhagic Shock
Fluid Resuscitation

Answer 4

NORMAL SALINE: 20mL/kg bolus, titrated to maintain a SBP as listed below. May
repeat 1x prn for hypotension.

• Assess lung sounds and blood pressure often.
  Minimum Pediatric Systolic Blood Pressure Values
  o Neonates: 60mmHg
  o Infants: 70mmHg
  o Children 1-10 years old: 70 + (age in years x 2) mmHg
  o Children greater than 10 years old: 90mmHg