STANDARD OPERATING PROCEDURE FOR THE MANAGEMENT OF SHOCK (HEMORRHAGIC SHOCK)

PRIMARY SURVEY

Ensure airway is patent and protect the c-spine with a cervical collar if indicated.

Ensure patient is breathing and ventilating adequately

Check vital signs -- respiratory rate,pulse rate,bloodpressure, spo

Set up a double wide bore IV access

Take sample for grouping and crossmatching

Give IV crystalloid( normal saline, ringers lactate) 2L fast then 500mls -- 4hourly

Transfuse with atleast 2 pint of blood , if Type specific blood is not available, give Type O blood, RH-
negative are preferred for females.

Recheck vital signs if patient is not hemodynamically stable,transfuse and monitor vital signs until
patient is stable

Check for any disability and do brief neurological examination and check the papillary reflexes.

Expose the patient completely and check for any other injuries

CONTROL OF HEMORRHAGE

Direct pressure on the bleeding wounds with dressing

Tourniquets for controlling peripheral limb hemorrhage

Fracture of pelvic –retroperitoneal hemorrhage use pelvic binder(towel or blanket) tightened round the
pelvis.

ADJUNCT TO PRIMARY SURVEY

Obtain ABG analysis and ventilator rate,check temperature

Urethral catheterization to monitor input/ output .Adequate resuscitation should produce urinary
output of 0.5ml/kg/hr in adults and 1ml/kg/hr for children

Laboratory investigation – ECG, E/U/CR ,Lipid profile,urinalysis,rbs,fbc ,Xrays if indicated

SECONDARY SURVEY AND MANAGEMENT

Brief history

Past medical and drug history

Thorough clinical examination and probe cause of shock

ADJUNCTS TO SECONDARY SURVEY

FAST—focused assessment sonography on trauma for patients with abdominal injury .

CT –SCAN for head injured patients.

Definitive Care

Transfer patient to tertiary centre for expert care to treat any underlying injuries