EMT STANDING ORDERS:

• Routine Patient Care.
• Keep the patient in Trendelenburg's position.
• Prevent heat loss by covering with warm blankets if available and if the patient is not febrile.
• Check blood glucose level.
• Obtain 3 lead ECG if available.
• Establish IV access to KVO.
• Call for AEMT/Paramedic intercept. & Assists AEMT / Paramedic in patient care.

AEMT / PARAMEDIC STANDING ORDER:

• Acquire and transmit 12-lead ECG.
• If shock is due to Arrhythmias problem refer to appropriate protocol.
• If Suspected Hypovolemic Shock hypotension is due to volume depletion and lungs are clear, administer 500 ml of normal saline bolus.
• Repeat the second bolus of 500 ml of normal saline if systolic BP remains less than 90-100 mmHg. Maximum 2 liters.
• If suspected Cardiogenic Shock rales are present in both lungs, infusion of normal saline 250 ml followed by Dopamine infusion 5-20mcg/kg/min titrate to maintain a systolic pressure of 90mmHg and above.
• If suspected Neurogenic Shock, spinal immobilization procedure, administer 500 ml of the normal saline bolus. Repeat the second bolus of 500 ml of normal saline if systolic BP remains less than 90-100 mmHg. Maximum 2 liters. Consider Dopamine infusion 5-20mcg/kg/min titrate to maintain a systolic pressure of 90mmHg and above.
• If Suspected Septic Shock, administer 500 ml of normal saline bolus. Repeat a second bolus of 500 ml of normal saline if systolic BP remains less than 90-100 mmHg. Maximum 2 liters Consider Dopamine infusion 5-20mcg/kg/min titrate to maintain a systolic pressure of 90mmHg and above.
• Monitor Lung sounds before all fluid boluses.
• Consider expert consultation.