TP5 SHOCK by housework


									TP5 SHOCK

      Basic Life Support                                                                                       Comment [SE1]:
                                                                                                               No PSAG in new protocol.
      Primary survey.
           Perform ABC’s.
           Administer oxygen.
           Maintain airway support if needed using BVM if required.
           Initiate cardiac monitoring and obtain a rhythm strip if trained to do so

      Secondary survey.
          Treat for shock
          Obtain and record vital signs every five minutes.

      Shock is indicated by the presence of the following:
          restlessness and anxiety, progressing to lethargy;
          cool, clammy, pale skin;
          nausea;
          cyanosis (peripheral, perioral),
          rapid shallow respiration progressing to slow, laboured respirations;
          pulse thready and greater than 100 per minute in an adult, 120 in a school aged child, 140
              in a preschooler and 160 in an infant;
          decrease in level of consciousness; and/or
          decreasing blood pressure less than 90 mmHg systolic in adults.

        1. When in a service area where EMT-A or Paramedic service is available, if the patients
            condition deteriorates, arrange an ALS intercept.

      Advanced Life Support
            In adults, if shock is present, administer enough normal saline to maintain a blood pressure
                between 90 - 100 mmHg, or peripheral perfusion (defined as the presence of a radial
            In children, maintain a blood pressure adequate for their age. USE OF THEBROSELOW
      If a fluid bolus is required administer at a rate of 20 ml/Kg in both adults and children.
            An infusion cuff should be used to increase the IV flow rate.                                     Comment [SE2]:
            If dysrhythmia develops, proceed to appropriate protocol.                                         New use of infusion cuff for flow rate.
            The IVs should be established enroute unless:
                a) there is delay in extrication of the patient;
                b) airway management during transportation will not allow for IV initiation;
                c) in patients with "controlled hemorrhage" where ongoing blood loss will not be a
                     problem; or
                d) transport time of greater than 30 minutes in length.


      The Paramedic may carry out the following procedure:

             Percutaneous cannulization of the external jugular vein may be carried out if the following
              criteria are met:
              a) This route is only to be used for the administration of drugs or volume replacement in
                   patients with hypovolemic shock where cannulization of a peripheral vein is not
                   possible or has not been successful.
              b) Cannulization of the external jugular vein will occur en route to the health care facility
                   unless an exception is present as described previously for peripheral IV initiation.
              c) Whenever this procedure is carried out it must be documented on the PCR form,
                                                                                                               Comment [SE3]:
                   including unsuccessful attempts.                                                            Specific reference to External Jugular.

Saskatchewan Emergency                                                                         TP5 SHOCK
Treatment Protocols                                                                      Revised August 2008

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