Page 93 - 2026 SMOG

MWD SHOCK FLUID THERAPY
Indications Clinical Signs
• Hypotension • Early, compensatory shock:
• Systolic <90mmHg ˚ Tachycardia
˚ MAP <65mmHg ˚ Tachypnea
˚
Hypovolemia
Alert mentation
• Massive hemorrhage (external, cavitary) ˚ ˚ Rapid pulse
˚ Severe dehydration (heat injury, GI loss) ˚ Normal to increased pulse pressure
˚ Cavitary pressure impeding arterial ˚ Normal Capillary Refill Time (CRT) (<2
perfusion or venous return
sec)
˚ Normal to bright red mucous membranes
(MM)
• Late, decompensatory shock:
˚ Bradycardia
˚ Prolonged or poor CRT (>2 sec)
˚ Pulses are poor or absent
˚ Hypothermia
Stupor
Treatment ˚
• Place multiple largebore IV or IO catheters.
˚ If one percutaneous attempt is not successful in a shock patient, immediately choose an
alternate percutaneous site or perform IO catheterization.
˚ Cephalic veins are ideal for peripheral catheterization
˚ IO catheter placement
■ Proximal cranial medial tibia or proximal lateral humerus
■ Most MWDs weigh >40lbs so use adult size IOC 25mm × 15g
■ Use pediatric size IOC 15mm × 15g in MWDs weighing <40lbs
• Give crystalloid fluids as firstline treatment
˚ Normosol-R or Plasmalyte-A is optimal for dogs; saline or LRS is acceptable in
emergent cases.
˚ Administer up to 90mL/kg of crystalloids in the first hour (1 blood volume for the dog)
˚ Quick calculation for a bolus shock dose: Add a zero to the dog’s body weight (in pounds) to
approximate a safe but effective bolus volume. For example, a 45lbs dog would need about a
450mL bolus, and a 75lbs dog would need about 750mL as a bolus.
• Use synthetic colloids or hypertonic saline (HTS) in dogs with refractory shock.
˚ Give a Hydroxyethyl starch (HES) IV/IO bolus 10–20mL/kg over 50min if clinical signs of
shock do not abate after the first 30min (first 2 quarter-shock IV challenges) of crystalloid
fluids, or response to crystalloid challenges is not sustained.
■ Repeat this bolus if there is no response to therapy.
■ Give a Hypertonic saline (HTS) IV/IO bolus 4mL/kg over 5min (if 7–7.5% HTS
is available) for MWDs that fail to respond to two or three quartershock boluses of
crystalloids and/or one to two boluses of HES.
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 85