Shock (Hypoperfusion)

Common Errors

Critical errors in prehospital application of shock (hypoperfusion):

• Failing to reassess after intervention. Vital signs must be rechecked every 5 minutes for unstable patients
• Incorrect medication dosing. Always use length-based estimation (Broselow tape) for pediatric patients
• Tunnel vision on one finding while missing the complete clinical picture
• Not communicating changes to receiving facility during transport

Overview

Inadequate tissue perfusion: hypovolemic, cardiogenic, distributive, or obstructive. Core EMT and Paramedic exam topic. Must distinguish compensated vs. decompensated shock.

In prehospital assessment, blood glucose reference range: adult 70-140 mg/dL, pediatric 60-100 mg/dL (neonates lower). Deviations from these norms guide treatment decisions in the field.

Documentation

Documentation of shock (hypoperfusion) in the patient care report (PCR) must include: time of assessment, findings, interventions performed, patient response, and reassessment findings. Use objective, measurable terms like "patient reports 8/10 chest pain" rather than "patient in pain." Document pertinent negatives. All medications administered must include drug name, dose, route, time, and patient response.

Professional Standards

Professional standards for shock (hypoperfusion) are established by the relevant certification body and regulatory agencies. Certified professionals must demonstrate competency through examination and maintain credentials through continuing education. Scope of practice is defined by state law and facility policy. Never perform tasks outside your authorized scope.

Troubleshooting

Troubleshooting shock (hypoperfusion) in the field:

• King airway: If supraglottic blind-insertion airway device fails, verify connections, check battery, try alternate equipment. Available sizes: Size 3 (4-5 ft), Size 4 (5-6 ft), Size 5 (over 6 ft)
• IO drill: If intraosseous access device for emergent vascular access fails, verify connections, check battery, try alternate equipment. Available sizes: EZ-IO: 15mm (peds), 25mm (adult), 45mm (obese)
• AED: If automated external defibrillator for vf/pvt fails, verify connections, check battery, try alternate equipment. Available sizes: Adult pads (over 8yo or 25kg), Pediatric pads (under 8yo or 25kg)

Patient Communication

Communication about shock (hypoperfusion) in the prehospital setting includes: explaining procedures to the patient in simple terms, obtaining informed consent when possible (implied consent for unresponsive patients), providing a calm and reassuring presence, and delivering a structured handoff report (SBAR: Situation, Background, Assessment, Recommendation) to the receiving facility.