Medical Shock

1. Follow General Medical Protocol.

2. Mandatory interventions:

a. Cardiac monitoring

b. Oxygen

c. IV access

d. Rapid glucose testing

3. Observe for signs of sepsis:

a. Fever

b. Hypotension

c. Tachycardia

d. Tachypnea

e. Obvious source of infection

4. Calculate or measure the Mean Arterial Pressure (MAP)

MAP = SBP + 2(DBP) / 3

a. If MAP < 65 mmHg, begin infusion of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE  1000 mL IV bolus and recheck MAP

b. If MAP does not show improvement after bolus of 250 - 500 mL, begin EPINEPHRINE “push-dose” vasopressor administration

i. Mix EPINEPHRINE 1:1000 1 mL (1 mg) in 100 mL of normal saline (concentration of 10 mcg/mL), mix well, and withdraw 2 mL into a 3 mL syringe

ii. Administer 20 mcg (2 mL) every 5 minutes to maintain MAP of > 65 mmHg

iii. If MAP > 65 and stabilizes, continue 0.9% NORMAL SALINE infusion at an appropriate rate to maintain SBP