Two large-bore IVs should be started and a Ringer's lactate infusion begun. Percutaneous IV sites have the lowest incidents of complications. Cutdowns may be employed in the antecubital fossa or in the lower extremities. Central line placement in the internal jugular or subclavian veins may also be employed and are of value for central venous pressure monitoring. Hypovolemic shock is not treated by vasopressors, steroids, or sodium bicarbonate.
Adequate resuscitation is assessed by following pulse blood pressure and urinary output.
Placement of urinary and nasogastric catheters should now be considered. Urinary catheters are contraindicated in the presence of suspected urethral transection, and nasogastric tubes are contraindicated in the presence of cribriform plate fractures. The secondary survey begins with an evaluation of the head and proceeds downward. The scalp and bony structures of the head should be checked for evidence of blunt penetrating trauma. The eyes should be examined for chemical irritation, foreign bodies, and pupillary integrity.