Immediate actions

0 min in the ED:

• Recognize decreased mental status and perfusion.
• Begin high flow O₂.
• Establish IV/IO access.

5 min in the ED:

• Initial resuscitation:
  • Push boluses of 20 cc/kg isotonic saline or colloid up to and over 60 cc/kg until perfusion impoved or rales/hepatomegaly develop.
  • Correct hypoglycemia and hypocalcaemia.
  • Begin antibiotics.
  • If 2nd PIV start inotrope.

15 min in the ED:

Is shock reversed?