Patient presentation with signs, symptoms, and history suggesting inadequate tissue perfusion. Every attempt should be made to determine the cause of the shock and whenever possible, attempt to treat the underlying cause. Causes are commonly grouped into hypovolemic, distributive, cardiogenic and obstructive. Regardless shock patients should be transported without delay for definitive treatment to the nearest appropriate facility.

1. Perform patient assessment and ABC's.
2. Attempt to determine cause of shock. Treat the cause per appropriate protocol.
3. Administer high-flow oxygen via a device, which will insure adequate oxygenation.
4. Monitor vital signs in accordance with S.O.P. protocol
5. Place the patient in trendelenburg position if no respiratory compromise.
6. Apply PASG and inflate if appropriate.
7. Initiate Rapid Transport and request ALS Intercept.

INTERMEDIATE LIFE SUPPORT

1. Initiate 2 large-bore IV's of an isotonic solution. Run wide open and titrate to response of vital signs, reassess frequently. Do not delay transport to start IV's.

ADVANCED LIFE SUPPORT

1. If cause of shock is cardiogenic, place the patient in position of comfort.
2. Administer 250-500cc fluid challenge of isotonic fluid if lung sounds do not reveal rales or otherwise 'wet' lung sounds. Do not delay transport to initiate IV's.
3. If lung sounds are 'wet' and shock is not secondary to fluid or blood loss, contact Medical Control and request orders to initiate an infusion of Dopamine at a rate of 5-20 mcg/kg/min. Advance drip to improve vital signs and improve perfusion. There is no advantage to exceeding 20 mcg/kg/min.