EMS Protocol of the Week - Undifferentiated Shock (Adult)

The new protocol for the adult patient in undifferentiated shock puts a lot of tools in the hands of paramedics. To be clear, the approach changes if there is a clear etiology for the shock, but for the patient who is in shock without a clear reason why, there’s now a protocol to assist! Providers at the BLS level will initiate transport procedures while checking a blood glucose level. ALS providers will obtain vascular access and check an EKG to look for a cardiac cause of the shock, after which they will initiate a 20mL/kg crystalloid bolus. If this doesn’t resolve the shock, paramedics can either administer a repeat bolus or start a vasopressor agent – options include infusions of norepinephrine or dopamine, or push-doses of epinephrine. After choosing an agent, if crews want to switch to a different agent (or give an additional one), OLMC can be used for additional orders. OLMC also has the option of authorizing vasopressin administration as another option.

Check the attached pdf for specifics in dosing, but overall this is a great summary of what’s now available in the paramedic’s toolbox for shock. Protocol binder or www.nycremsco.org for more.

Dave