What is the first aid and treatment for hypotension (low blood pressure) due to shock?

From the Guidelines

For shock treatment, immediately call emergency services while laying the person flat with legs elevated about 12 inches (unless head, neck, or spine injury is suspected), and medical professionals will typically administer oxygen, intravenous fluids, and possibly medications like vasopressors (norepinephrine, epinephrine, or dopamine) to raise blood pressure, with norepinephrine being the first-choice vasopressor 1. The initial management of shock involves a series of steps to ensure the patient's airway, breathing, and circulation are maintained.

• Call emergency services immediately
• Lay the person flat with legs elevated about 12 inches (unless head, neck, or spine injury is suspected)
• Keep them warm with blankets and loosen tight clothing
• Don't give food or drink
• If the person is unconscious but breathing, place them in recovery position (on their side)
• For someone who stops breathing, begin CPR if trained
• Monitor vital signs until help arrives Shock occurs when insufficient blood reaches vital organs, causing potentially life-threatening oxygen deprivation. The specific treatment depends on the cause - whether hypovolemic (blood loss), cardiogenic (heart failure), distributive (widespread vasodilation), or obstructive (blockage preventing blood flow).
• Norepinephrine is recommended as the first-line vasopressor agent to correct hypotension in septic shock 1
• The goal is to restore a mean arterial pressure of 65 to 70 mmHg 1
• Fluid therapy is needed to improve microvascular blood flow through an increased cardiac output as an essential part of the treatment of sepsis 1 Prompt treatment is critical as shock can rapidly progress to organ failure and death if not addressed quickly. In patients with sepsis, the 2016 SCC guidelines suggest that initial hemodynamic resuscitation should be achieved within 3 h 1. Vasopressors may be useful if used transiently to sustain arterial pressure and maintain tissue perfusion in face of a life-threatening hypotension, with norepinephrine being the agent of choice 1. It is essential to respect the recommended objectives for arterial pressure (systolic arterial pressure 80 to 90 mmHg) and to assess cardiac function during the initial ultrasound examination 1.

From the FDA Drug Label

1. INDICATIONS & USAGE 1.1 Hypotension associated with Septic Shock Epinephrine Injection USP, 1 mg/10 mL (0.1 mg/mL) is indicated to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock.
2. DOSAGE & ADMINISTRATION 2.1 General Considerations ... 2.2 Hypotension associated with Septic Shock ... To provide hemodynamic support in septic shock associated hypotension in adult patients, the suggested dosing infusion rate of intravenously administered epinephrine is 0.05 mcg/kg/min to 2 mcg/kg/min, and is titrated to achieve a desired mean arterial pressure (MAP).

The treatment for shock, specifically hypotension associated with septic shock, involves administering epinephrine (IV) at a suggested dosing infusion rate of 0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve a desired mean arterial pressure (MAP) 2 2.

• The dosage may be adjusted periodically, such as every 10 – 15 minutes, in increments of 0.05 mcg/kg/min to 0.2 mcg/kg/min, to achieve the desired blood pressure goal.
• After hemodynamic stabilization, wean incrementally over time, such as by decreasing doses of epinephrine every 30 minutes over a 12- to 24-hour period.

From the Research

Types of Shock and Resuscitation Fluids

• Hemorrhagic shock: hypotensive resuscitation with blood is the most appropriate approach 3
• Septic shock: crystalloids are the preferred solution for resuscitation, with balanced crystalloids being a better alternative to normal saline 4
• Cardiogenic shock: no specific studies addressed this type of shock in the provided evidence

Resuscitation Fluids and Their Effects

• Lactated Ringer's solution: improves hemodynamic status and tissue oxygenation, with more favorable effects on extravascular lung water and pH compared to normal saline 5, 6
• Normal saline: may lead to increased extravascular lung water and acidemia compared to lactated Ringer's solution 6
• Hypertonic saline: can improve hemodynamic status, but its effects on tissue oxygenation are unclear 5
• Balanced crystalloids: may improve patient-centered outcomes and are a better alternative to normal saline 4

General Principles of Shock Management

• Early identification and timely institution of therapeutic measures are crucial to avoid death 3, 7
• The goal of resuscitation is to restore adequate circulation and oxygenation to tissues and organs 7
• The type and dose of fluids to be delivered remain undetermined, and the best approach may vary depending on the type of shock 3