Assessment

Look, Listen and Feel for :

• Capillary refill longer than 3 seconds

• Pale extremities

• Look for both external and internal bleeding:

• Burns 

• Cold extremities

Management

• Establish 2 large bore IV cannulae appropriate for age 

• Start 1 litre bolus of Normal Saline or Ringer’s Lactate and give its as fast as possible with in 30 minutes (or 20mL/kg in children if no evidence of fluid overload or malnutrition) 

• Re-evaluate after and plan for second bolus if condition not improved, plan for blood or other colloids

• For burns, use fluid replacement by Parkland formula

• Femur fractures should be splinted

• A pelvic fracture should be bound with a pelvic binder

• Apply direct pressure to control active bleeding and do deep wound packing if wound is large or gaping

• If amputated limbs or other uncontrolled bleeding, Apply tourniquet, start IV fluids and plan for urgent surgical intervention

• Always leave any penetrating objects in place and stabilize the object before definitive surgical intervention

Examples of Conditions: 

1. Hypovolaemic Shock

Signs and symptoms

• Tachycardia, tachypnoea, pale skin, cold extremities, slow capillary refill
• Dizziness, confusion, altered mental status
• May be hypotensive
• External bleeding or internal bleeding

Management: as indicated above

2. Pericardial Tamponade

Signs

• Tachycardia, tachypnea, hypotension, pale skin, cold extremities and delayed capillary refill
• Distended neck veins
• Muffled heart sounds
• Dizziness, confusion, altered mental status

Management: IV fluids, pericardiocentesis