Page 31 - 2026 SMOG

HYPOTENSION/SHOCK
Signs and Symptoms Differential Diagnosis
• Altered mental status (AMS) • Congenital heart disease
• Weakness/dizziness • Cardia arrhythmia
• Tachycardia • Pulmonary embolism
• Pale, cool, clammy skin • Tension pneumothorax
• Delayed capillary refill • Medication overdose
• Bleeding • Vasovagal episode
• Dehydration • Shock: hypovolemic, cardiogenic, septic,
• Nausea/vomiting neurogenic, anaphylactic
Treatment
• Shock due to hemorrhage/trauma:
˚ Control hemorrhage
˚ Optimize homeostasis (See Notes, Warnings, Cautions)
˚ Optimize hypothermia management
˚ TXA 2G IV/IO
˚ Maintain SBP >100 (>110 TBI), move to appropriate protocol for continued treatment
(i.e., BLOOD AND COMPONENT USE PROTOCOL)
• Shock due to Non-Traumatic/Non-Cardiac:
˚ 1L or 30mL/kg IVF bolus prn, additional crystalloid based on reassessment of clinical
indication.
˚ Maintain SBP >90, MAP >65
˚ If inadequate BP
■ Norepinephrine: 5–15mcg/min infusion IV/IO
• Shock due to Cardiac
˚ Treat per appropriate Cardiac Guideline:
■ Adult BRADYARRHYTHMIA PROTOCOL
■ Adult TACHYARRHYTHMIA PROTOCOL
■ Adult ACUTE CORONARY SYNDROMES PROTOCOL
■ Adult POST-CARDIAC ARREST CARE PROTOCOL
˚ Non-Invasive PPV (BVM) vs. Advanced Airway
˚ 500mL IVF Bolus
˚ If inadequate BP:
■ Norepinephrine 5–20mcg/min infusion IV/IO
Notes, Warnings, Cautions
• Optimize Homeostasis:
˚ Hemorrhagic trauma with NO significant Head Injury: Should target maintaining SBP >100.
˚ Casualties able to maintain SBP >100 do not need immediate fluid resuscitation.
˚ Hemorrhagic trauma WITH significant Head Injury: Should target maintaining SBP >110.
Reference: CPG ID #83 (Sepsis Management in PFC), CPG ID #23 (Hypothermia: Prevention and
Management), CPG ID #18 (Damage Control Resuscitation), CPG ID #73 (Damage Control Resuscitation –
Prolonged Field Care), American Red Cross (ARC) ALS guidelines

2026 Standard Medical Operating Guidelines (SMOG) • 23