Hemorrhagic shock: stop the bleeding first, then small boluses to a palpable radial pulse or mentation.
Before you read
Test yourself first: 5 questions
Question 1 of 5
When estimating the burned body surface area to guide fluid resuscitation, which burns should be counted?
Answer: A. Superficial (first-degree) burns such as sunburn do not cause the capillary leak that drives fluid loss, so counting them inflates the estimate and leads to over-resuscitation. Partial- and full-thickness areas are both counted, because both leak plasma. Counting only full-thickness burns would badly underestimate the fluid need.
Question 2 of 5
During a long transport, a burn patient has received far more fluid than the formula estimated. Which complication is the main concern of this 'fluid creep'?
Answer: A. Over-resuscitation pushes more fluid through leaky capillaries, worsening airway edema, abdominal and extremity compartment syndromes and pulmonary complications. Formulas are starting points to be titrated to perfusion and urine output. Warm fluid reduces but does not eliminate hypothermia risk, and blisters are not the concern.
Question 3 of 5
A patient with known heart failure has lost a moderate volume of blood from a leg wound. Fluid resuscitation needs particular caution here because:
Answer: A. A ventricle that already cannot manage its normal load backs fluid up into the lungs when it is given generously, so the volume is titrated to perfusion signs and reassessed after every small amount rather than run in. Heart failure does not speed clotting, and the patient's medication is not a reason to withhold the volume they genuinely need.
Question 4 of 5
A cervical spine injury patient has a pressure of 76/42, a heart rate of 50 and warm skin in the legs. After an isotonic fluid bolus the pressure is unchanged. The next treatment to consider is:
Answer: A. Neurogenic shock is a loss of sympathetic tone: vessels dilate and the heart cannot speed up. Fluids are given first to fill the enlarged vascular space and rule out hidden bleeding, but persistent hypotension calls for a vasopressor, with atropine for symptomatic bradycardia. Endless boluses risk pulmonary edema; beta-blockers and nitrates would deepen the shock.
Question 5 of 5
A patient with a gunshot wound to the abdomen, no head injury, has a weak radial pulse and is confused. After a fluid bolus the radial pulse is stronger and the patient answers questions appropriately. The best action now is to:
Answer: A. The endpoints of permissive resuscitation have been reached: a palpable radial pulse and improved mentation. More fluid only raises pressure and dilutes clotting factors in a patient who is still bleeding internally. Keep access in place and repeat small boluses only if perfusion deteriorates again.
Keep the streak going with more questions like these, each with a full rationale.
What is shock resuscitation & fluid strategy?
In hemorrhage the answer is bleeding control and blood, not large volumes of crystalloid; in sepsis early fluid matters; in cardiogenic shock fluid can drown the lungs. The exam rewards matching the fluid plan to the cause.
Key points to remember
- Hemorrhagic shock: stop the bleeding first, then small boluses to a palpable radial pulse or mentation.
- Permissive hypotension does NOT apply to traumatic brain injury — avoid any hypotension there.
- Lethal triad: hypothermia, acidosis and coagulopathy — keep trauma patients warm.
- Septic shock: early fluid bolus with reassessment, then vasopressors if pressure stays low.
- Cardiogenic shock: cautious or no fluid; listen to the lungs before and after every bolus.
Field priorities
- Control external hemorrhage before starting IV access.
- Reassess mental status, pulse and lung sounds after every bolus.
- Rapid transport to definitive care — surgery and blood fix hemorrhage.
Coaching the patient
- Large crystalloid volumes dilute clotting factors and cool the patient.
Red flags: act now
- Crackles after a fluid bolus
- Narrowing pulse pressure with rising heart rate
- Cold, shivering trauma patient
Shock Resuscitation & Fluid Strategy: FAQs
What are the priority actions for Shock Resuscitation & Fluid Strategy in the field?
Control external hemorrhage before starting IV access. Reassess mental status, pulse and lung sounds after every bolus. Rapid transport to definitive care — surgery and blood fix hemorrhage.
What findings in Shock Resuscitation & Fluid Strategy change your plan or your transport decision?
Crackles after a fluid bolus. Narrowing pulse pressure with rising heart rate. Cold, shivering trauma patient.
What do I need to know about Shock Resuscitation & Fluid Strategy for the NREMT?
Hemorrhagic shock: stop the bleeding first, then small boluses to a palpable radial pulse or mentation. Permissive hypotension does NOT apply to traumatic brain injury — avoid any hypotension there. Lethal triad: hypothermia, acidosis and coagulopathy — keep trauma patients warm. Septic shock: early fluid bolus with reassessment, then vasopressors if pressure stays low.
What should the crew communicate or document for Shock Resuscitation & Fluid Strategy?
Large crystalloid volumes dilute clotting factors and cool the patient.
