Fluid refractory shock:

  • Begin inotrope IV/IO.
  • Use atropine/ketamine IV/IO/IM to obtain central access and airway if needed.

Reverse cold shock by titrating central dopamine or, if resistant, titrate central epinephrine.

Reverse warm shock by titrating central norepinephrine.

Dose range:

  • dopamine up to 10 mcg/kg/min
  • epinephrine 0.05 to 0.3 mcg/kg/min.

After 60 minutes, is shock reversed?

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