# Adult shock / hypotension

Identify poor perfusion, reassess fluid response, and recognize the cardiogenic branch.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/shock/
Official source: [SO-M-045 — Shock (Symptomatic Hypotension)](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12038.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Reassess before every fluid repeat; pulmonary edema changes the pathway.
- Use the pediatric shock guide for children rather than adult 250 mL increments.

## Source documents

- [SO-M-045 — Shock (Symptomatic Hypotension)](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12038.pdf)
- [PR-230 — Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf)

## Assess the patient

- Look for systolic BP at or below 90 with poor skin signs, altered mental status, tachycardia, or weak pulses. Search for hemorrhage, dehydration, infection, or a cardiac cause.
- Monitor and document rhythm. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. Obtain IV; consider IO for an unresponsive patient when peripheral IV cannot be established.

## Clear lungs with poor perfusion

- When lungs are clear and there is no evidence of CHF, give normal saline 250 mL and reassess. Repeat as indicated to a maximum 1 L to support perfusion.
- Contact base if hypotension does not respond. Track the cumulative amount and watch for newly developing rales.

## Rales or suspected acute MI

- If rales suggest cardiogenic shock, contact base for further orders. Do not continue the clear-lung fluid pathway without reassessment.
- Obtain a 12-lead for suspected acute MI/STEMI and contact base for CVRC destination. PR-230 governs current adult push-dose epinephrine preparation/eligibility; its April 2026 change does not cancel other contact requirements.

## Transport and handoff

- Provide rapid ALS transport with treatment en route when possible, to the nearest ERC or base-directed destination.
- Report the suspected cause, BP/perfusion trends, lung findings, oxygenation, glucose when relevant, total fluids, and response. Consider sepsis even when an early set of vital signs is less dramatic.