Chief Complaint: Hypotension
Managing hypotension in a trauma patient is critical, as it can indicate significant blood loss or other life-threatening injuries.
The goal is to quickly identify the cause and restore adequate blood pressure and tissue perfusion.
- **Airway**: Ensure the airway is open and protected. Consider intubation if necessary.
- **Breathing**: Assess breathing and oxygenation. Provide high-flow oxygen or ventilation support.
- **Circulation**: Check for signs of shock (e.g., rapid, weak pulse; cool, clammy skin). Establish large-bore IV access (14-16 gauge) and start fluid resuscitation.
- **Disability**: Assess neurological status using the Glasgow Coma Scale.
- **Exposure**: Fully expose the patient to identify injuries, keeping them warm to prevent hypothermia.
### 2. **Fluid Resuscitation**
- **Crystalloids**: Begin with rapid infusion of isotonic crystalloids (e.g., normal saline or lactated Ringer’s solution). Typically, 1-2 liters are administered quickly.
- **Blood Products**: If hypotension persists or if there’s evidence of significant blood loss, initiate transfusion with packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets, in a ratio (e.g., 1:1:1) appropriate for massive transfusion protocols.
- **Permissive Hypotension**: In some cases, particularly with penetrating trauma, aggressive fluid resuscitation may be avoided to prevent dislodging clots (permissive hypotension). Maintain a lower systolic blood pressure (around 90 mmHg) until bleeding is controlled.
### 3. **Identify and Control Hemorrhage**
- **External Hemorrhage**: Apply direct pressure, tourniquets, or hemostatic dressings.
- **Internal Hemorrhage**: Use imaging (FAST ultrasound, CT scan) to identify sources. Surgical intervention (e.g., laparotomy, thoracotomy) may be required for definitive control.
### 4. **Vasopressors**
- **Vasopressors**: These are generally avoided initially in trauma patients because hypotension is usually due to hypovolemia, not vasodilation. However, they may be used if the patient remains hypotensive after adequate fluid and blood resuscitation, particularly if neurogenic shock is suspected.
### 5. **Monitoring and Reassessment**
- Continuously monitor vital signs, urine output, and mental status.
- Reassess after each intervention to determine effectiveness and adjust treatment as necessary.
### 6. **Address Underlying Causes**
- **Tension Pneumothorax**: Immediate needle decompression followed by chest tube placement.
- **Cardiac Tamponade**: Perform pericardiocentesis if tamponade is suspected.
- **Spinal Cord Injury**: Consider neurogenic shock, treat with fluids, and vasopressors if necessary.
### 7. **Definitive Care**
- Once stabilized, transfer to the appropriate setting (e.g., operating room, ICU) for ongoing management.
### 8. **Hypothermia Prevention**
- Use warm fluids, external warming devices, and minimize exposure to cold environments to prevent hypothermia, which can worsen coagulopathy and shock.
This approach is part of the Advanced Trauma Life Support (ATLS) guidelines and should be adapted to the specific situation and available resources.