Protocol 2-583 - Hypotension / Shock

CMH EMS & MIH Protocols

AEMT:

Ensure completion of applicable items above.

Adult:	Pediatric:
Meets SEPSIS criteria: LR bolus of 30 ml/kg. Up to a max of 2,000 mL. Click "calculate" to get dose. Enter height and click "calculate" to get dose based on IDEAL weight. LR 250-500 ml IV bolus to maintain MAP greater than 65 and/or SBP greater than 90.	Consider LR 20 ml/kg IV bolus (may repeat) to maintain MAP greater than 65. Click "calculate" to get dose.

RN:

Ensure completion of all applicable items above.

Consider IO NS/LR.

Adult:	Pediatric:
Meets SEPSIS criteria and SBP less than 90 or MAP less than 65 after fluid bolus: Consider Phenylephrine 50 mcg-100 mcg every 5 minutes to maintain SBP greater than 90 or MAP greater than 65 after fluid bolus Not septic: Consider Epinephrine 1:100,000 (Push-Dose) 5-20 mcg every 2-5 min. Consider fluid bolus in AEMT section.	Epinephrine 1:100,000 (Push-Dose) OR Click "calculate" to get dose. Consider fluid bolus in AEMT section.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914127 - Medical - Hypotension/Shock (Non-Trauma)

Citations:

Protocol 9-010 - References
Alderfer, 2016
American Heart Association, 2020
Bollaert, Bauer, Audibert, Lambert, & Larcan, 1990
Citizens Memorial Hospital, 2021
Cox, 2017
Day, et al., 1996
De Backer, Aldecoa, Nijmi, & Vincent, 2012
Hammond, et al., 2019
Harkness, 2017
Hunter, Silvestri, Dean, Falk, & Papa, 2012
Intermedix, 2017
Levy, et al., 1997
Levy, Evans, & Rhodes, 2018
Mackenzie, Kapadia, Nimmo, Armstrong, & Grant, 1991
Martin, Papazian, Perrin, Saux, & Gouin, 1993
Martin, Viviand, Leone, & Thirion, 2000
Moran, O'Fahartaign, Peisach, Chapman, & Leppard, 1993
NASEMSO Medical Directors Council, 2017
Rhodes, et al., 2017
Rochwerg, et al., 2014
Semler, et al., 2018
Society of Critical Care Medicine, 2016
Society of Critical Care Medicine, n.d.
University of Pittsburgh, n.d.
Yunos, et al., 2012
Zhou, Qiu, Huang, Yang, & Zheng, 2002

Change Log:

Date	Link to previous version	Description of change
10/15/21		New protocol approved by protocol committee on 5/26/21 and Dr. Nicholes on 6/8/21. This protocol was created from sepsis treatments found in 2-440 for push dose epi and LR and post resuscitation treatments found in 2-704 for dopamine. Additionally, levophed dosing was added per Dr. Nicholes on 6/8/21 as found in the Sepsis physician order set OS01-118.
03/15/23	pdf	Modified LR bolus in AEMT section to utilize ideal body weight if BMI over 30 per Dr. Butvilas and protocol committee on 1/25/23. Changed target MAP from 70 to 65 in RN section per Dr. Butvilas and protocol committee on 1/25/23. Clarified RN and medic roles. Added CP.
03/17/23		Changed links to NS.
03/19/23		Changed link for Norepi.
03/19/23		Changed links for LR.
03/20/23		Changed link to Epi.
03/20/23		Changed link for Dopamine.

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Protocol 2-583 - Hypotension / Shock

EMD:

EMR:

EMT:

AEMT:

RN:

Medic:

CP:

Citations:

Change Log: