Prehospital protocol pediatric shock

Perform general assessment

1. 100% O2 NRB and Obtain Vital Signs
2. If hypotensive, elevate lower extremities IV NS TKO
3. Cardiac Monitor / 12 lead ECG / Pulse Oximetry

Is patient symptomatic with?

1. Chest Pain
2. Difficulty Breathing
3. Seizure
4. Altered Mental Status
5. Bradycardia

Follow individual associated protocols

Assess for signs of hypotension and poor perfusion

• Weak Pulses
• Capillary refill 3 seconds
• Mottled or cool skin
• Altered mental status
• Hypoxia

Other signs of shock

Tachycardia, fever AND one of the following

• Cancer
• Sickle Cell
• Transplant
• Indwelling catheter
• Immune deficiency
• Severe developmental delay

Pulmonary edema?

Yes

• Give (weight *10)mL NS bolus.
• Reassess for pulmonary edema after each bolus
• Repeat up to 3 boluses

No

• Give (weight *20)mL NS bolus.
• Reassess for pulmonary edema after each bolus
• Repeat up to 3 boluses

Advanced Notification

If treating for shock then ensure advanced notification to receiving hospital.

Continued hypotension or signs of shock?

Yes

• Begin dopamine drip with titration to age appropriate SBP
• Further orders per on-line physician

No

• Reassess en-route