a. The goal of managing hypovolemic shock is to increase tissue perfusion and oxygenation status. Treatment is directed at providing adequate oxygenation and ventilation.

STOPPING THE BLEEDING must be the priority before any fluid resuscitation is attempted.

 

(1) Circulation and hemorrhage control priorities include controlling severe hemorrhage immediately, obtaining intravenous access, and assessing tissue perfusion.

(2) If the casualty has a significant injury, initiate a single 18-gauge catheter in a peripheral vein and place a saline lock on it. If no significant injury exists, parenteral fluids are not required; however, the casualty should be encouraged to drink oral fluids as he will likely be somewhat dehydrated.

NOTE: Sometimes, a casualty who has had been wounded may not need intravenous fluids at the time of initial treatment, but may need them at a later time. It is usually a good idea to prepare for administering IV fluids while the vein is still strong and easy to find. This is done by inserting the needle/catheter into the vein, removing the needle, and inserting a saline lock adapter into the catheter hub. The adapter seals off the catheter until you are ready to administer fluids intravenously.

b. If you are unable to initiate peripheral IV access, consider initiating a sternal intraosseous (IO) line. Although there are many other IO methods available, the sternal kit known as F.A.S.T.1TM has been chosen.

NOTE: Intraosseous means “within the bone.”

(1) The sternum is protected by body armor and the cortex of the bone is much thinner than the tibia. Many injuries are to the lower extremities.

(2) If the patient no longer has a sternum, he will not likely benefit from an IO infusion.

(3) Indications for the need of an IO infusion include:

(a) Inadequate peripheral access.

(b) Need for rapid access for medications, fluid, or blood.

(c) Failed attempts at peripheral or central venous access.