Basic Life Support Comment [SE1]:
No PSAG in new protocol.
Maintain airway support if needed using BVM if required.
Initiate cardiac monitoring and obtain a rhythm strip if trained to do so
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;
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
TAPE IS REQUIRED IN CHILDREN.
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
d) transport time of greater than 30 minutes in length.
REQUIRES DIRECT MEDICAL CONTROL
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,
including unsuccessful attempts. Specific reference to External Jugular.
Saskatchewan Emergency TP5 SHOCK
Treatment Protocols Revised August 2008