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Trauma

HYPOTENSION / SHOCK

Signs and Symptoms: Differential Diagnosis:
• Restlessness/Confusion • Shock: Hypovolemic, Cardiogenic, Septic,
• Weakness/Dizziness Neurogenic, Anaphylactic
• Tachycardia • Cardiac Arrhythmia
• Pale, Cool, Clammy Skin • Pulmonary Embolus
• Delayed Capillary Refill • Tension Pneumothorax
• Hypotension • Medication Effect/OD
• Bleeding • Vasovagal Episode
• Nausea/Vomiting

Continued From:
Tactical Evacuation Guideline
AIRWAY GUIDELINE Continuous Monitoring
Reassess q5min
IV/IO GUIDELINE Return to:
NO Tactical Evacuation
Symptomatic? Guideline
Hemorrhage / Trauma YES Cardiac
Non-trauma & Non-cardiac
Maximize Mechanical Hemorrhage Control 2L or 30mL/kg IVF Bolus pprn r n Treat per appropriate
Additional crystalloid based on reassessment Cardiac Guideline:
Optimize Hemostasis: (See Pearls!) of clinical condition
• BRADYCARDIA w/Pulse
Optimize Hypothermia Management • CARDIAC ARREST
Inadequate Response to therapy? • TACHYCARDIA w/Pulse
TXA 2g IV/IO
Consider NOREPINEPHRINE Non-Invasive PPV (BVM) vs.
If unable to maintain SBP >100 (110 2-20mcg/min IV/IO Advanced Airway
TBI), move to
Enroute Damage Control
Resuscitation Guideline Maintain SBP >90, MAP >65 500mL IVF Bolus

At Any Point, Once BP Controlled: Inadequate Response to therapy?
• Continuous Monitoring
• Reassess q5min
Return to: Tactical Evacuation NOREPINEPHRINE
Guideline 2-20mcg/min IV/IO
Pearls:
• Optimize Hemostasis:
o Hemorrhagic trauma with NO significant head injury:: Should target maintaining SBP >100. Casualties able to maintain
SBP >100 do not need immediate fluid resuscitation.
o Hemorrhagic trauma WITH significant head injury: : should target maintaining SBP >110
o If SBP falls <100 (with TBI <110), transition to Enroute Damage Control Resuscitation guideline.

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