Management
- Immediate Step: ABCs + 2 large-bore IV access + aggressive fluid resuscitation (usually 30 mL/kg crystalloid bolus). c
- A single peripheral IV is insufficient to handle the high-volume fluid and blood resuscitation.
- Hypovolemic: Isotonic crystalloid. If severe hemorrhage (Hgb < 7 or symptomatic), administer PRBCs/MTP (Massive Transfusion Protocol).
- Cardiogenic:
- Caution with fluids (can worsen pulmonary edema).
- Inotropes: Dobutamine (if normotensive), Norepinephrine (if hypotensive).
- Revascularization (PCI/CABG) if MI.
- Distributive (Sepsis):
- Aggressive IVF.
- Vasopressor of choice: Norepinephrine (first-line).
- Add Vasopressin if refractory.
- Distributive (Anaphylaxis):
- First-line: IM Epinephrine (do not delay for IV).
- Fluids, antihistamines, steroids (adjuncts).
- Obstructive:
- PE: Anticoagulation/Thrombolytics/Embolectomy.
- Tamponade: Pericardiocentesis.
- Tension Pneumothorax: Needle decompression -> Chest tube.