FIELD REFERENCE
Full criteria & treatment guidance
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.
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.
VISUAL FIELD REFERENCE
Adult shock: reassess lungs before more fluid
Adult / adolescent · ALS
Apply the complete shock assessment, monitoring, transport, and destination guidance below.
Clear lungs / no CHF
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 / possible cardiogenic shock
If rales suggest cardiogenic shock, contact base for further orders. Do not continue the clear-lung fluid pathway without reassessment.
- Reassess before every fluid repeat; pulmonary edema changes the pathway.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-M-045 · PR-230
UNDERSTAND THE CARE
Why a blood-pressure response is only part of resuscitation
The assessment combines pressure with skin perfusion, pulse quality, consciousness and the likely cause. An isolated number does not describe whether hemorrhage, dehydration, infection or cardiac dysfunction is driving the presentation. Record the initial findings so a treatment response can be interpreted.
Applying the guidance
The clear-lung fluid pathway depends on the lung examination remaining appropriate. Repeat pressure, breathing, lung sounds and clinical perfusion after each intervention. If rales develop or acute MI is suspected, use the relevant contact and cardiac-destination instructions. The current adult epinephrine procedure does not cancel separate condition-based contact requirements.
Reassess after each fluid bolus
Putting it together
Teaching example: pressure remains low after a bolus and rales appear. Report both the lack of perfusion response and the new lung findings rather than automatically using the rest of the fluid allowance.
Diagram text & teaching checkpoints
- Cause
- Hemorrhage, dehydration, infection or cardiac disease.
- Baseline
- Pressure plus clinical perfusion.
- Response
- Perfusion and lung findings after treatment.
- Escalation
- Nonresponse or cardiogenic concern requires direction.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Give a cause-and-response report
Organize the shock report around three questions: what may be causing poor perfusion, what support has been given, and what changed afterward? Separate an observed finding from a suspected cause. “Low pressure with weak pulses after reported fluid loss” conveys more than a label such as “dehydrated,” which can conceal uncertainty about hemorrhage, infection or cardiac disease.
Keep the lung examination linked to each fluid decision. Report the amount actually delivered and the pressure, clinical perfusion and respiratory findings afterward. If the pressure improves but breathing deteriorates, communicate both rather than summarizing the intervention as successful. If there is no meaningful response, say how much treatment has already been given when requesting further orders.
For suspected acute MI, the rhythm/12-lead findings and destination discussion remain part of the same assessment. The adult push-dose epinephrine procedure answers a medication-specific question; it does not remove the shock order’s separate contact requirements. A clear report lets base understand whether the issue is persistent hypotension, new congestion, suspected cardiac ischemia, or a combination that changes the plan.